Abstract:
A dual chambered syringe includes: an inner barrel defining a first inner chamber, the inner barrel having an apertured stopper at its distal end, the inner barrel being open at its proximal end; a shaft adapted to fit within the inner barrel, the shaft having a distal end which is engageable with the aperture of the stopper; a device for controlling engaging and disengaging of the distal end of the shaft with the aperture of the stopper; an outer barrel concentric with the inner barrel defining a second inner chamber, the outer barrel having a distal end for receiving and dispensing fluids and a proximal end into which the distal end of the inner barrel is insertable into the second inner chamber; the apertured stopper engages the second inner chamber of the outer barrel and selectively prevents or permits the passage of fluids between the outer barrel second chamber and the inner barrel first chamber; the inner barrel having an engageable surface on its outside surface; and, the outer barrel having operatively associated therewith an engaging device for selective engagement and disengagement with the engageable surface on the inner barrel.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation application of PCT Application Serial No. PCT/US2015/26270, filed Apr. 17, 2015, which claims the benefit of priority to U.S. Provisional Patent Application No. 61/980,612, filed Apr. 17, 2014. The complete disclosures of these applications are hereby incorporated by reference herein. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to an apparatus and method for preparing platelets rich plasma (PRP) and delivering systems for one or more components to the human skin. 
       BACKGROUND OF THE INVENTION 
       [0003]    Skin rejuvenation is occupying a significant part in the aesthetic field as it is deals with wrinkles, scars, pores, pigmentation and skin textures. Various materials, chemical and biological, are used for this purpose and a lot of delivery systems have been developed to assure an effective delivery to the different layers of the skin. 
         [0004]    Recently, platelet rich plasma or PRP is proving to be efficient for skin rejuvenation procedures. Platelets contain several growth factors that are necessary to the healing and tissue renewal process. Many researches have presented results of PRP used for rejuvenation that was applied topically to the face or injected to the deeper skin layers. In addition, the PRP treatment was combined in several more researches with energy source treatments as ultrasound and fractional laser for improving outcomes and decreasing healing time. 
         [0005]    The current methods for applying PRP are still not optimized to be the most efficient for each treatment. The efficiency of the treatment relies on the several aspects such as the amount of PRP used, the location of applying the PRP whether it is topical or in any of the skin layers, and it also depends on the diffusion of the PRP through the skin layers. 
         [0006]    Fractional CO2 laser therapy is based on the theory of fractional photothermolysis. It has been used to treat skin problems, such as scar removal, skin tightening and skin rejuvenation. Two types of fractional laser treatments are available presently, nonablative and ablative. Nonablative fractional laser is less invasive, provides good clinical outcomes but is not sufficient to treat the above mentioned skin problems at a single treatment compared to an ablative laser treatment. The ablative fractional laser treatment creates ablative microscopic channels of thermal injury that causes skin tightening and smoothening. This effect is achieved by collagen remodeling that causes the skin to re-epithelialize. Despite its advantageous over nonablative laser, ablative laser has a longer down time and more adverse reactions for patients, such as erythema, acne, milia and infection. Hence, the aesthetic field has been concerned about improving the results of skin rejuvenation but shortening the recovery or downtime from the treatment. A few studies have suggested the use of PRP after fractional laser treatment. (Lee et al. The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split—face trial, Dermatol Surg, 2011) suggested faster healing occurs for the skin areas that have been treated with PRP after ablative fractional laser treatment for acne scars. Less Erythema was observed 4 days after the treatment and an improved overall clinical appearance of acne scaring occurred for PRP treated areas. (Gawdat et al., Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars, Dermatol Surg, 2014) compared improvement of acne scars after ablative fractional treatment when PRP was applied topically or injected intradermally. The same improvement in acne scaring reduction was showed for both application methods but significantly lower pain levels were shown for the topical application of PRP after fractional treatment. The above mentioned methods disclose applying PRP after fractional treatment is completed but yet no method has suggested to apply PRP into newly ablated channels have been formed by fractional treatment. 
       SUMMARY OF THE INVENTION 
       [0007]    In an aspect, a dual chambered syringe includes an inner barrel defining a first inner chamber, in which the inner barrel has an apertured stopper at its distal end, the inner barrel being open at its proximal end; a shaft adapted to fit within the inner barrel, the shaft having a distal end which is engageable with the aperture of the stopper; it also includes a device for controlling engaging and disengaging of the distal end of the shaft with the aperture of the stopper; an outer barrel concentric with the inner barrel defines a second inner chamber, the outer barrel having a distal end for receiving and dispensing fluids and a proximal end into which the distal end of the inner barrel is insertable into the second inner chamber. The apertured stopper engages the second inner chamber of the outer barrel and selectively prevents or permits the passage of fluids between the outer barrel second chamber and the inner barrel first chamber; the inner barrel has an engageable surface on its outside surface; and, the outer barrel has operatively associated therewith an engaging device for selective engagement and disengagement with the engageable surface on the inner barrel. 
         [0008]    In another aspect, in the dual chambered syringe, the engageable surface of the inner barrel is in the form of one of an internal screw thread or an external screw thread, and the engaging device engages the internal or external screw thread. 
         [0009]    In yet another aspect, in the dual chambered syringe, the engaging device is a protrusion which is selectively engaged with or not engaged with the internal or external screw thread. 
         [0010]    In another aspect, in the dual chambered syringe, the device for controlling engaging and disengaging of the shaft with the aperture of the stopper comprises corresponding internal and external screw threads on one of the outside of the shaft and the interior of the first inner chamber. 
         [0011]    In yet a further aspect, in the dual chambered syringe, the inner barrel is movable in distal and proximal directions by pushing or pulling the inner barrel along the longitudinal axis of the outer barrel or by turning the inner barrel in either direction when the engaging device engages the inner barrel engageable surface. 
         [0012]    In a further aspect, in the dual chambered syringe, the outer barrel distal end receives a dispensing apparatus, the dispensing apparatus dispensing fluids from the syringe on skin and tissue surface. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0013]      FIGS. 1 a  and 1 b    illustrate schematic drawings of the dual chamber syringe in closed and open position respectively. 
           [0014]      FIG. 2  illustrates a schematic drawing of a brush delivery system to be connected to the dual chamber syringe. 
           [0015]      FIG. 3  illustrates a schematic drawing of a sponge delivery system to be connected to the dual chamber syringe. 
           [0016]      FIG. 4  illustrates a schematic drawing of a flexible brush delivery system to be connected to the dual chamber syringe. 
           [0017]      FIGS. 5 a  and 5 b    illustrate schematic drawings of a spiral delivery system to be connected to the dual chamber syringe. 
           [0018]      FIG. 6  illustrates a schematic drawing of a ballpoint head delivery system to be connected to the dual chamber syringe. 
           [0019]      FIG. 7  illustrates a schematic drawing of a micro-needles delivery system to be connected to the dual chamber syringe. 
           [0020]      FIGS. 8 a  and 8 b    illustrate a schematic drawing of a micro-needles pen delivery system to be connected to the dual chamber syringe. 
           [0021]      FIGS. 9 a  and 9 b    illustrate schematic drawings of a micro-needles roller delivery system to be connected to the dual chamber syringe. 
           [0022]      FIGS. 10A and 10B  illustrate an embodiment for combining PRP delivery in connection with a fractional laser treatment. 
           [0023]      FIG. 11  illustrates an alternative embodiment of a sealing element for the syringe of  FIGS. 1 a    and  b.    
           [0024]      FIGS. 12A, 12B and 12C  illustrate a further embodiment of a dual chamber syringe. 
           [0025]      FIG. 13  illustrates a section of the skin after fractional laser treatment. 
           [0026]      FIGS. 14A and 14B  illustrate a laser treatment system and handle combined with PRP and PPP treatment. 
           [0027]      FIGS. 15A, 15B, 15C, 15D  illustrate a method of treating cellulite combined with PRP and PPP treatment. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0028]      FIG. 1 a    illustrates a dual chamber syringe  100  according to the present invention. A first main chamber  104  is defined by the interior portion of syringe barrel  102 . As can be appreciated by reviewing  FIG. 1 a   , the syringe barrel  102  has a fixed maximum volume. However, the effective volume, that is, the volume which is available to contain material, is defined by the position of the syringe piston  106  positioned within the barrel  102 . The syringe piston  106 , in a conventional manner, can slidably and sealably move within the syringe barrel  102 . The syringe piston  106  position within the barrel may change the effective volume of the main chamber  104  to anywhere from its maximum volume to zero should the piston be pushed towards the distal end  125  of the barrel. According to the present invention, the syringe piston  106  is of a hallow construction. The hollow piston  106  defines therein a sealed and slidable moving secondary chamber  108 . The slidable secondary chamber  108  changes the effective volume of the main chamber  104  due to the movement of the piston from the proximal end  123  of the barrel to its distal end  125 . The main chamber  104  of the syringe and the secondary chamber  108  of the syringe are separated by a barrier  110 . The barrier has an aperture  112  which may establish a fluid communication between the main chamber  104  and secondary  108  chambers. The aperture  112  may be sealed by a movable sealing element  114 . 
         [0029]    The movable sealing element  114  is configured to seal the aperture  112 , through the operation of a mechanism which may be contained within the secondary chamber  108 . The sealing element  114  may be connected to a shaft  116  extending along the axis of the secondary chamber and out of the proximal end  123  of the secondary chamber  108 . The shaft  116  is configured to move the sealing element  114  from a sealed-closed position as shown in  FIG. 1 a    to an open position by pulling a shaft grip  118  to compress a spring  120  as shown in  FIG. 1 b    In the illustrated embodiment of  FIGS. 1 a  and 1 b   , the spring  120  may be seen to be of a type that pushes the shaft  116  in a distal direction  125  to keep the sealing element  114  in contact with the barrier  110 . In the closed position as shown in  FIG. 1 a    there is no fluid communication between the main chamber  104  and secondary chamber  108  of the syringe  100 . In the open position as shown in  FIG. 1 b   , in which the shaft  116  has been pulled by the grip  118  in a proximal direction  123  against the bias of the spring  120 , fluid communication is established between the main chamber  104  and the secondary chamber  108 . With this configuration, unlike those of prior art syringes, multiple, controllable movements of material between the main chamber  104  and the secondary chamber  108 . 
         [0030]    The mechanism of action of the syringe  100  and a method for PRP preparation in accordance to one aspect of the present invention will now be described. A barrel discharge opening  122 , which is configured to connect to a standard needle, is positioned on the distal end  125  of the barrel and may be sealed by a cap  124 . By uncapping the discharge opening  122  can be connected to any needle for the purpose of withdrawing the blood. While the shaft  116  is sealing the aperture  112  the blood will be contained in the main chamber  104 . The blood can be separated to layers of red blood cells, white blood cells and platelets, and plasma by centrifuging the capped syringe  100  with the blood content through any conventional centrifuge. After the centrifugation the layers will be separated according to the specific gravity of each component. For separating the red blood cells from the white blood cells, platelets and plasma the following procedure may be performed with the syringe: while keeping the discharge opening  122  sealed with the cap  124 , the shaft  116  is manually manipulated in a proximal direction  123  to move the sealing element  114  out of the aperture  112 . While maintaining aperture  112  open, the piston  106  is pushed in a distal direction  125  against the layers in the main chamber  104  in order to decrease the free volume of the main chamber  104 . The layers located in the proximal end  123  of the main chamber  104  will be moved to the secondary chamber  108 . When reaching the limit line between the red blood layer and the white cells-plasma layer the shaft grip  118  is released to allow the sealing of the aperture  112  by the sealing element  114 . The cap  124  is removed from the syringe  100  and the piston  106  is pushed towards the distal direction  125  to extrude the red blood cells layer. The syringe  100  is capped again with the cap  124  and the shaft  116  is manipulated again towards the proximal end  123  to unseal the aperture  112  and establish the fluid communication again between the main  104  and the secondary  108  chambers. By keeping the aperture  112  open and by retracting the hollowed piston  106  back, since the barrel head  122  is sealed, vacuum is established in the newly-formed free space in the main chamber  104  which in turn sucks the white cells, platelets and plasma layer to into the main chamber  104 . The centrifugation process can be done again to the content of the main chamber  104 , this will allow a further concentration of the platelets as its specific gravity is higher than the plasma. The same process of separation between layers into two chambers can be done again to separate the platelets layer in the main chamber  104  from the plasma layer in the secondary chamber  108 . The PRP layer is now ready to be applied to any area by connecting the barrel head  122  to any of the delivery systems further described in  FIG. 2  to  FIG. 9 . 
         [0031]    Topical Application Delivery Systems 
         [0032]      FIG. 2  illustrates a brush delivery system  200  that can be connected through a luer lock opening  202  to any matching connection. The material can be pushed through the luer lock opening  202  towards the bristles  204 . By moving the bristles  204  on any surface, the material will be spread to form a layer topically covering the surface. 
         [0033]      FIG. 3  illustrates an embodiment of sponge delivery system  300 . The sponge delivery system  300  can be connected through a luer lock opening  302  to any matching connection. The material passes through the luer lock opening  302  towards a sponge head  304 , the sponge head consists of pores  306  having either the same size or different sizes. The pores  306  will deliver the material contained in them when pushed against any surface as the sponge head  304  will compress and squeeze the material inside the pores  306 . 
         [0034]      FIG. 4  illustrates a flexible brush delivery system  400 . The flexible brush delivery system  400  can be connected through a luer lock opening  402  to any matching connection. The material passes through the luer lock opening  402  to a container  404 . The material will be delivered through flexible filaments  408  by passing through flexible filaments openings  406 . Each of the flexible filaments  408  will apply the same amount of material on any surface by moving the flexible filaments  408  in the desired direction in parallel to the surface. 
         [0035]      FIG. 5 a    illustrates a spiral delivery system  500 . The spiral delivery system  500  can be connected through a luer lock opening  502  to any matching connection. The material passes through the luer lock opening  502  towards a head  504 .  FIG. 5 b    shows a bottom view of the head  504 , the material extrudes through the apertures  506  while a spiral protrusion  508  spread the material on the surface. The head  504  can be moved in any direction in parallel to the surface and can also be rotated for applying circular massage on the surface. 
         [0036]      FIG. 6  illustrates an embodiment for a ballpoint head delivery system  600 . The ballpoint head delivery system can be connected through a luer lock opening  602  to any matching connection. The material passes through a container  604  and divides to balls openings  606  for being extruded and applied to the surface. The balls openings  606  may be made of rigid material for applying a massage to the surface being pushed against. A vibrational movement can be combined with the parallel movement of the ballpoint head delivery system  600  for applying a massage and assist in improving the diffusion of the material through the surface. 
         [0037]    Injection Delivery Systems 
         [0038]    The following embodiments describe delivery systems for injection to different skin layers as the needle&#39;s length in any of the embodiments can be changed to allow the penetration to desired skin layer and the application of any material especially PRP. Needles described herein may also be configured to deliver radio frequency (RF) treatment to the skin into any of the skin layers as known to the skilled person in the art. A combined PRP and RF treatment may be done by injecting PRP to the site of RF treatment before, during or after the injection of the PRP. RF needles may have one or more conductive surfaces (electrodes) configured to deliver RF energy to the skin. One such conductive electrode may be located at the tip of the needle proximal to its injecting end. In this case the PRP and RF targets adjacent tissue on approximately the same skin layer. According to another aspect of the invention, conductive electrodes may be located proximally to the tip of the needle configured to deliver RF energy to tissue area located above the tissue which is targeted by the PRP. In a combined RF and PRP treatment, PRP should be protected thermally to avoid thermal damage to the PRP. According to one aspect of the invention, needle array may be divided into at least two groups. At least one group of needles may be configured to deliver RF treatment only while at least one group of needles may be configured to deliver PRP only. As mentioned above, another way to protect the PRP from the elevated temperature of the RF treatment may be achieved by keeping a certain distance along the needle between the PRP needle delivery end and the location of the RF electrode of such micro-needle. During operation, PRP injection and RF treatment may be delivered into the tissue in a sequence which is designed to avoid overheating of the PRP, whether located in a delivery system or already injected into the tissue, either by cooling the delivery system and/or the tissue or by allowing the heat to diffuse from the needle or tissue before PRP is delivered through or into it. According to another aspect of the invention a combined fractional RF treatment may be delivered before during or after the delivery of the PRP. 
         [0039]      FIG. 7  illustrates an embodiment for micro-needles delivery system  700 . The micro-needles delivery system  700  can be connected through a luer lock opening  702  to matching connection. The material can be pushed through the luer lock opening  702  towards the container  704 . The material will be divided and extruded micro-needles  706  as the same portion will be delivered by each needle to the skin layer where the micro-needles  706  tip is positioned. 
         [0040]      FIG. 8 a    described a micro-needles pen delivery system  800 . the micro-needles pen delivery system  800  extrudes the material through micro-needles  802 . Any syringe can be inserted to a container  804  where the material can be pushed manually or automatically from the syringe towards the micro-needles  802 . In a closed position, the micro-needles  802  are covered with a safety ring  806  to secure the micro-needles  802  and prevent the penetration to an undesired surface. In an open position, as shown in  FIG. 8 b   , the micro-needles  802  will be pushed towards the distal end of the micro-needles pen delivery system  800  and can be penetrated to the skin. The micro-needles pen delivery system  800  can either be manually operated to allow the penetration of the micro-needles  802  through the skin, or automatically operated by controlling the speed of the penetration and un-penetration of the micro-needles  802  through the skin layers. The automatic operation of the needles pen delivery system  800  is thought to maximize the efficiency of the treatment and reduce the pain of the micro-needles  802  penetration. 
         [0041]      FIG. 9 a    illustrates a micro-needle roller delivery system  900 . The micro-needle roller delivery system  900  can be connected to any syringe by a luer lock opening  902 . The material is pushed and extruded through a hollowed channel  904  to reach a roller head  906 . The roller head  906  consists of micro-needles  908  that covers the outer surface area. the micro-needles  908  deliver the material only through the needles row that penetrates the surface, the mechanism of action for this device will be further described below: the user grabs a handle  910  that is connected to the hollowed channel  904  and the roller head  906  by a fixed angle γ that allows convenient grip for moving the roller head  906  against a parallel surface. By manually or automatically controlling the material passage from a container  912 , the material will pass through the luer lock opening  902  and the hollowed channel  904 , reaching the roller head  906  and will be injected through the micro-needles  908  only to the penetrated surface area. by moving the handle  910  in parallel to the surface, the roller head  906  will rotate and allows the penetration of new row of micro-needles  908  to the surface when the last row will now deliver the material while all the others row are sealed.  FIG. 9 b    shows a detailed illustration for the mechanism of passing the material only through the penetrating micro-needles row  914 . The roller head  906  consists of openings  916  directed and fixed perpendicular to the surface  920 . When the micro-needles  908  rotates, micro-needle row openings  918  become conjugated with the openings  916  and allow the passage of the material through this micro-needles row  914 . in the phase of rotating the roller head  906  to move between different micro-needles rows  908 , the openings  916  is sealed by the roller head  906  inner wall and do not allow the passage of the material. 
         [0042]      FIGS. 10A and 10B  illustrate the application of PRP or other material in combination with a laser fractional treatment. As can be seen in the figures, a housing  1001  may be placed in contact with the skin surface  1000 . The housing  1001  may include a laser fractional treatment head  1002  which may be of any known type, including the fractional treatment apparatus described in US 2012/0065551, the entirety of which is herein incorporated by reference. The housing  1001  along may include a syringe  1006  of the type described in the present application connected by tubing  1004  to an outlet within housing  1001 . In addition, a source of pressure and/or vacuum  1008  with its conduit  1010  may also be connected to the housing  1001 , as seen by the openings  1004 ,  1010  in  FIG. 10B . 
         [0043]    In operation, the fractional laser  1002  may be activated and either before, simultaneously with or after the fractional laser has been activated, the syringe, which may contain a supply of PRP, also activated by pushing on a plunger manually or using suitable mechanical devices. Thus, as “channels” are formed in the skin surface  1000  by the fractional laser, amounts of, for example, PRP may be forced into those formed “channels” before the channels close following laser activation. The source of pressure/vacuum may also be activated to enhance delivery of the PRP into the “channels” formed. 
         [0044]      FIG. 11  illustrates an alternative arrangement of the movable sealing element  114  of  FIGS. 1 a  and 1 b   . In  FIG. 11 , in place of the conically-shaped sealing element  114  which mates with a similarly shaped aperture in barrier  110 , an externally-threaded sealing element  114   a  mates with an internally-threaded opening  112   a  in barrier  110   a . A further sealing flange  118   a  is placed proximally of the sealing element  114   a  to assure good sealing quality. In operation, in order to allow contents of the main syringe body to enter or be mixed with contents in the syringe piston (as those elements are shown in  FIGS. 1 a  and 1 b   ), the threaded element  114   a  is turned, by way of example, in the direction  116   a . This causes the threaded element to disengage from the barrier  100 , and then be able to be moved in the directions  119   a . This arrangement may be particularly useful for applications in which separation of the two chambers must be assured, such as in the delivery of drugs whose powder and liquid components must be kept separated until mixed and administered. 
       Further Syringe Embodiments 
       [0045]    Turning now to  FIGS. 12A and 12B , these figures illustrate a second syringe embodiment  1200 . Like the syringe  100  of  FIGS. 1 a  and 1 b   , the syringe  1200  includes a syringe barrel  1202  and a needle  1204 . The syringe also includes a syringe piston  1210  which is fitted within barrel  1202 . Like the syringe barrel  106  of  FIG. 1 a   , the syringe barrel  1202  is not solid but hollow and capable of containing materials. At the distal end  1205  of the barrel is fixed by any suitable means (like gluing, heat shrinking, etc.) a stopper  1214  with one or more apertures or a holes therethrough formed along an axis parallel to the barrel longitudinal axis. The stopper  1214 , like its counterpart  112  of  FIG. 1 a   , is made to fit at the distal end of the barrel and prevent the escape of fluids either to outside of the syringe or into the piston  1210  internal volume. 
         [0046]    The piston  1210  shown in  FIG. 12A  includes an external screw thread  1209  formed on the outside of the barrel and covering the majority of the barrel. In an alternative arrangement, instead of an external screw thread an internal screw thread  1211  may be formed into the barrel  1212  of  FIG. 12A . In addition, an engageable switch  1208  seen in  FIGS. 12A and 12B  includes a holder  1206  which mounts the engageable switch on the syringe barrel  1202 . The holder and engageable switch may be mounted on syringe barrel by any suitable joining device, such glue or heatshrinking or welding. When mounted in the holder  1206 , the switch  1208  is movable in directions  1219 . The switch  1208  may also include an engaging tooth  1218 . While one tooth is shown in  FIG. 12B , it is to be understood that a greater number may be employed. 
         [0047]    The purpose of the engaging tooth  1218  is to selectively engage either the internal screw threads  1211  or the external screw threads  1209 . The interaction of the tooth  1218  and the internal or external threads  1209  or  1211  will be explained below.  FIG. 12A  also illustrates a shaft  1216  that fits within the internal space of the barrel  1210  or  1212  and is insertable though the proximal end  1207  of barrel  1210 . As mentioned, the stopper  1214  includes a hole  1215  therethrough (see  FIG. 12C ) along the central axis of the barrel  1210  that allows or restricts the passage of fluids from the syringe barrel interior to the interior of the barrel  1210  and vice versa. Whether fluids may flow or not flow between the barrels is determined by the position of shaft  1216 . Shaft  1216  at its distal end includes a protruding member  1220 . The shaft  1216  is movable in directions  1222  within the barrel  1210 . Movement may be by way of a screw thread  1224  which interacts with a complementary screw thread (not shown) within the barrel  1210  and may be located towards the proximal end  1207  of the barrel. Other devices, such as a pressure fitted shaft may be implemented. In any case, turning the shaft in a clockwise direction  1225  may cause the shaft to move in direction  1226  within the barrel  1210 . At some point the protruding member  1220  will enter the hole or aperture in the stopper or the hole in the distal end  1205  of the barrel and prevent fluid interaction between the two chambers. Turning the shaft in the opposite direction will permit fluid communication between the two chambers. A left hand or a right hand screw may be implemented as desired. 
         [0048]    Unlike the embodiment of  FIGS. 1 a  and 1 b   , the embodiment of  FIGS. 12A and 12B  has the advantage of less parts and less moving parts. In the embodiment of  FIGS. 1 a  and 1 b   , as described above, after each centrifugation, the process of separation of components is done by pushing the inner barrel in a distal direction towards the distal end (see  FIG. 1 a   ). It may be difficult to precisely gauge where one type of blood component ends and a second type begins. This is true for the first centrifugation to discern the red blood cells/white cells-plasma line and in the second centrifugation to discern the line between platelet rich and platelet poor plasma. With the simple “push-pull” of the inner barrel in the  FIG. 1 a    embodiment, it may be easy to “overshoot” the line and that may cause undesirable mixing of blood components. 
         [0049]    In the embodiments of  FIGS. 12A and 12B , the syringe may be used in either a “push-pull” mode or a more precise “screw” mode. For example, after centrifuging the second time, the inner barrel may be advanced in a distal direction  1228  by pushing. However, as the distal portion of the inner barrel approaches the rich/poor PRP line, the user may move engageable switch  1208  to cause tooth  1218  to enter into or between internal or external threads  1209  or  1211 . Once this is done, the barrel can no longer be pushed in a distal direction or the opposite direction in fact. However, by turning the inner barrel by grasping knurled knob  1230  and turning it in a clockwise direction (if a right—hand groove or screw thread), will cause the inner barrel to advance in a distal direction in a more controlled manner so as to prevent the type of intermixing discussed above. When the “screw” function is not needed, such as, for example, when blood is being taken from the patient, the tooth is disengaged from the threads  1209  or  1211 . The embodiment of  FIGS. 12A and 12B  also does away with the spring  120  shown in  FIG. 1 a    and the need to compress and hold the spring  120  in a compressed state in certain operations, thus allowing the blood separation process to be smoother with the simple “on/off” screw arrangement in the shaft  1216  described above. 
         [0050]    Once the needle  1204  has been removed from the distal end of barrel  1202 , any of the application accessories shown in  FIGS. 2 through 9   b  may be fitted onto the distal end which can then dispense PRP onto a skin or other tissue site. A luer-type lock may be fitted or otherwise incorporated onto the distal end to accommodate these accessories. Also, once needle  1204  has been removed the syringe may be fitted onto connector  1004  of the fractional energy deliver device shown in  FIGS. 10A and 10B . 
         [0051]    The mechanism of action of the syringe  1200  and a method for PRP preparation in accordance to one aspect of the present invention will now be described. A barrel discharge opening is configured to connect to a standard needle  1204 , and is positioned on the distal end of the barrel  1202  and may be sealed by a cap, not shown but similar to cap  124  in  FIG. 1 a   . By removing the cap, the discharge opening of the distal end of barrel  1202  can be connected to any needle for the purpose of withdrawing blood while the shaft  1216  and its protuberance  1220  is sealing the aperture in the stopper  1214  so that blood will be contained in the main chamber of barrel  1202 . The blood can be separated into layers of red blood cells, white blood cells, platelets and plasma by centrifuging the capped syringe  1200  with the blood content through any conventional centrifuge. 
         [0052]    After a first centrifugation, the layers will be separated according to the specific gravity of each component. For separating the red blood cells from the white blood cells, platelets and plasma the following procedure may be performed with the syringe: while keeping the barrel head sealed with the cap, the shaft  1216  is manually manipulated in a proximal direction by turning it in a direction opposite to arrow  1225  (for a right hand thread) to move the sealing element  1220  out of the aperture in the stopper  1214  or the aperture in distal end  1205 . While maintaining the aperture open, the piston  1210 / 1211  is pushed in a distal direction  1226  against the layers in the main chamber in order to decrease the free volume of the main chamber of outer barrel  1202 . This may be done by either pushing the barrel  1210 / 1211  in a distal direction and/or engaging the threads  1209 / 1211  on the barrels  1210 / 1211  respectively with the tooth  1218  of assembly  1208  by moving it in a direction so that the tooth enters the threads  1209 / 1211 . Using the threads allows for very precise movements so that only those blood components (like PRP) enter into the barrel  1210 / 1212 . The layers located in the proximal portion of the outer barrel will thus be moved to the secondary chamber  1210 / 1212 . 
         [0053]    When reaching the limit line between the red blood layer and the white cells-plasma layer, the shaft  1216  is turned in direction  1225  to seal the aperture in the stopper  1214  by the sealing protuberance  1220 . The cap is then removed from the syringe  1200  and the piston  1210 / 1211  is pushed towards the distal direction  1226  to extrude the red blood cells layer from the barrel  1202 . The syringe is then capped again with the cap and the shaft  1216  is moved again in a proximal opposite direction  1226  to unseal the aperture in the stopper  1214  and establish fluid communication again between the main barrel  1202  and the secondary barrel  1210 / 1211 . 
         [0054]    By keeping the aperture in the stopper  1214  open and by retracting the secondary piston  1210 / 1212  back, since the distal end of the barrel  1202  is sealed, vacuum is established in the newly-formed free space in the main chamber of barrel  1202  which in turn sucks the white cells, platelets and plasma layer to into the main chamber of the barrel  1202 . The centrifugation process can be repeated again to the contents of the main chamber of the barrel  1202 . This will allow a further concentration of the platelets because its specific gravity is higher than that of the plasma. The same process of separation between layers into two chambers can be done again to separate the platelets layer in the main chamber of the barrel  1202  from the plasma layer in the secondary chamber of barrel  1210 / 1212 . The PRP layer is now ready to be applied to an of skin or tissue area by connecting the distal end of barrel  1202  to any of the delivery systems described in  FIG. 2  to  FIGS. 10   a/b.    
         [0055]    After the second centrifugation, the blood components left behind include a volume of Platelet Rich Plasma (PRP) as well as Platelet Poor Plasma (PPP). Rather than dispose of the PPP, the PPP may be extracted from the syringe and used in known processes to produce fibrin that may be used to seal wounds or the like into which, for example, PRP has been applied, or, in an alternate manner, the PPP is first applied followed by the PRP onto or into the designed skin or other tissue. 
         [0056]    In addition, in the event that a dual barrel structure is not required, but only a single (outer) barrel, the mechanism shown in  FIG. 12A  with the internal or external threads illustrated on a syringe piston may be retained as well as the locking mechanism described above. In this manner, in those instances of injection/application of fluids is desired to be better controlled or metered than with a simple push movement, which has potential problems of injecting a patient with greater a quantity of medicine or other fluid than desired, the screw threads may be engaged and the medicine or fluid dispensed in a controlled manner by rotating the threaded syringe piston. Thus, in the above embodiment, the inner mechanisms within the syringe piston are dispensed with. 
         [0057]    Administration of PPP and PRP During Fractional Treatment of the Skin 
         [0058]      FIGS. 10A and 10B  illustrate and the accompanying text describes combining PRP with fractional treatment.  FIG. 14 , discussed below, further describes this type of treatment but also adds treatment using PPP.  FIG. 13  illustrates a section of skin after laser fractional treatment  1300 . Fraction laser treatment may be manipulated to create different channel shapes in the skin. One channel shape  1302  as shown here contains two distinct hole shapes; a shallow big hole  1304  and a deep narrow hole  1306 . While the deep hole  1306  is shown as being V-shaped, it is to be understood that any suitable shape may be created and formed in the skin. PRP and PPP may be applied to the channel  1302  using various methods to induce skin rejuvenation and wound healing. A first method includes applying PPP after its activation, with Thrombin or similar compounds that converts fibrinogen to fibrin, in the shallow broader hole  1304 . Activated PPP creates a sealant layer on the skin and enters the channel  1302 . The sealant prevents the channels from collapsing after treatment. Other methods may combine the application of PPP with PRP. Following the application of PPP, the PRP is applied above the sealant layer and diffuses through the channel  1302  to reach the deep narrow hole  1306 . 
         [0059]    In the same manner, the PRP may be applied to the skin  1300  prior to the PPP application. The PRP diffuses through to the deep narrow hole  1306  and initiates the rejuvenation process. Then, the PPP is activated and applied to the skin  1300 . The PPP enters the channel  1302  and seals the shallow broader hole  1304 . 
         [0060]    Finally, the PRP and PPP may be mixed before the application and applied simultaneously to the skin  1300 . 
         [0061]      FIG. 14A  illustrates laser treatment system combined with PRP and PPP application. The laser system  1402  is connected to a handle  1404  through a delivery mean  1406 . The delivery mean  1406  delivers the laser energy to the handle  1404 . The handle  1404  is connected to a disposable housing  1408  that contacts the patient skin during the treatment. The disposable housing covers two nozzles  1410  and  1412  that apply PPP and PRP to the skin during the treatment. 
         [0062]      FIG. 14B  illustrates one embodiment of the handle  1404  for applying PPP and PRP using air pressure. The handle  1404  includes the disposable housing  1408  that is connected to a laser scanner or beam splitter  1414 . The laser scanner  1414  receives the laser energy and apply it fractionally to a section of skin  1416 . The disposable housing covers at least one PRP nozzle  1418 , at least one PPP nozzle  1420  and at least one activator nozzle  1426 . PPP nozzle  1420  and PRP nozzle  1418  apply the PPP and PRP respectively during or after the treatment to the skin section  1416 . The PRP and PPP are inserted into the nozzles  1418  and  1420  through sealed rubber barriers  1422  and  1424  respectively to prevent contamination of the materials. To activate the PPP, an activator such as thrombin is inserted through nozzle  1426  and is separated from the PPP nozzle  1420 . The activation of PPP will be initiated after the application of the PPP and the activator. For delivering PPP, PRP and activator, air pressure is applied inside the disposable housing  1408  through an air pressure aperture  1428 . The air pressure allows spraying of PRP, PPP and activator from at least one aperture for each material  1430 ,  1432  and  1434 . When spraying, the materials are mixed and the PPP is activated. 
         [0063]    Treatment of Cellulite 
         [0064]    Cellulite is the accumulation of fat within a connective tissue. The fat grows and causes alterations of the topography of the skin that are characterized by a padded “bumps” appearance. Many treatments aim to disconnect the connective tissue to allow a smoother appearance of the skin. These treatments are mostly invasive and require a long recovery time.  FIG. 15A  illustrates a method of treating cellulite combined with PRP and PPP application. The treatment device  1500  is placed on a section of skin  1502 . Part of the skin  1504  is sucked into chamber  1506  in the treatment device  1500 . The chamber  1506  includes a port  1505  which is attached to a source of vacuum to draw the skin  1504  into the chamber  1506  of treatment. The chamber includes a sealable aperture  1508  to allow the insertion of a needle  1510  and for it to move it back and forth and/or horizontally to the sides within the chamber  1506 . The needle  1510  is inserted into the aperture  1508  and invasively enters the part of skin  1504 . The needle moves in x-y direction  1507 . The movement of the needle  1510  disconnects connective tissue  1512  to allow “relaxation” of the skin and create a smoother appearance of the skin  1504 . PRP and PPP can be applied to the treated area by any means. One method is to apply PPP, PRP and an activator, with no limitation to the order of application, on top of treated section of skin  1504  during the treatment. Another method is to apply PPP, PRP and an activator, with no limitation to the order of application, to the section of skin  1504  through the needle  1510  after treatment with the needle. The PRP can be also applied inside the treated area  1504  while the needle  1508  disconnects the connective tissue  1512 ; afterwards, the PPP can be applied with the activator on the surface of the skin  1504  to seal the wound caused by the needle  1510  insertion. Other variations may be applied. 
         [0065]    The needle  1510  is further illustrated in different embodiments in  FIG. 15C  and  FIG. 15D .  FIG. 15C  shows a hollowed shaft  1520  that has an opening  1522  next to a blade  1524 . While or after the blade  1524  disconnects connective tissue  1512 , the PRP, PPP and activator can be applied through opening  1522 . 
         [0066]      FIG. 15D  shows another embodiment of the needle  1510 . One shaft  1526  and one hollowed lumen  1528  are connected to each other in parallel. The shaft  1526  ends with a blade  1524  that is used to disconnect the connective tissue  1512 . The hollowed lumen  1528  may be used to apply PRP, PPP and activator through aperture  1530  to the skin  1504  during the disconnection of the connective tissue  1512  or after the treatment for enhancing wound healing. 
         [0067]      FIG. 15B  shows a front view of the aperture  1522  or  1530  in the tip of the needle  1510 . The aperture  1522  or  1530  may be also configure to include a number of lumens, for example, at least one nozzle for dispensing PRP  1514 , at least one nozzle for dispensing PPP  1516  and at least one nozzle for dispensing activator  1518 . The respective aperture  1522  or  1530  may apply the above materials while the needle  1510  is moving in x-y directions  1507  within skin section  1504 . 
       Example 1 
       [0068]    Three ml of blood were withdrawn using a syringe as described in the present application and shown in  FIGS. 1A and 1B  from the patient and were mixed with Heparin to prevent coagulation. The platelets count in the whole blood was found to be 326×10 3  in mm 3 . The syringe was then capped and centrifuged for 12 minutes at 1000 RPM (Rotofix 32a with 15 ml tubes adaptor, Hettich, Germany). After centrifugation the blood and plasma were found to have separated in the syringe with the red blood cells layer having been moved to under the plasma layer. The plasma was then transferred to the inner chamber  106  of the syringe as described herein. Once the inner chamber&#39;s content were separated from the barrel&#39;s content, the red blood cells layer were discarded by uncapping the barrel and pushing the red blood cells out of the syringe using the piston. The syringe was then capped and the plasma layer contents moved to the main chamber as described herein. After centrifugation, the platelets count was found to be 523×10 3  in mm 3  in the plasma layer. A second centrifugation was performed at 2500 RPM for 2 minutes. After centrifugation, the content were found to have separated into a viscous layer at the bottom of the barrel and a liquid layer above that layer. The liquid layer was moved to the secondary chamber in the same manner as described above. The platelet count for the contents in the main chamber was measured to be 1364×10 3  in mm 3 . Thus, the platelet count using the syringe apparatus of the present invention and the centrifugation process described above increased from 326×10 3  in mm 3  1364×10 3  in mm 3 , a more than four folds increase.