Platelet Rich Plasma (PRP) use in clinical medicine dates back to 1998 where a group of maxillofacial surgeons at the University of Miami School of Medicine elegantly showed bone regeneration doubled in PRP- treated bone grafts compared with placebo.4 Over the past two decades PRP’s popularity soared and now widely utilized anywhere from joint injections to repair damaged cartilage and arthritic pain, to cosmetic surgeries such as face lifts and facial rejuvenation, to hair restoration.3 A double blind placebo-controlled study published this month in Dermatologic Surgery, assessed the use of PRP in women with androgenetic alopecia (female pattern hair loss), and found a statistically significant difference in hair loss, and the way hair felt coarser and more manageable in treated vs non-treated patients. Although no difference was detected in this 26 week trial in hair count, this study highlights an important benefit of PRP in hair restoration.6
PRP is a volume of autologous (tissue obtained from the same person) plasma that has a very high concentration of platelets. In normal blood platelet count is 150,000 to 350,000, whereas PRP levels reach close to 1 million platelets.1,2 Why are platelets special? Because they contain several growth factors, cytokines, and chemokines which stimulate cells and blood vessels to increase in number to repair tissue. Platelets determine the healing potential of damaged tissue by proliferation of stem cells, fibroblasts, and type I collagen. We also need our platelets to form a clot so we don’t bleed to death from the smallest paper cut or hang nail all the way to open heart surgery. The amount of platelets to reach an area of injury follows the degree of injury, in that the greater the insult, the more platelets come to the rescue. Therefore, delivery of plasma with very high concentrations of platelets is like using a shotgun to kill an ant.
PRP’s are not all created equal. Elaborate studies have shown that not only platelets but even their secretory proteins have variable concentrations in prepared specimens. Different centers using different machines and tubes have not afforded us a standard approach. Furthermore, patient related factors such as age, yield different concentrations of platelets and growth factors extracted from whole blood. Regardless of its inter individual and center variability, platelet-rich plasma has many potential applications for tissue wound healing as has been positively demonstrated in many animal and human studies. To date, the FDA only gives clearance on sterility of tubes and validity of centrifuge, but not a particular method of extraction nor its specific uses in the clinical setting.
Collagen induction therapy with PRP has been reported in the literature, as a simple and effective technique for facial rejuvenation, treatment of acne scars and pigmentation, as well as skin tightening.5 A recent human study found even a histological difference of increased collagen synthesis on skin biopsies after PRP microneedling.7 To date, no randomized controlled trials comparing effectiveness of this approach to other conventional therapies such as lasers, fillers or botox have been performed for nonsurgical facial rejuvenation. In our center, we have begun to utilize PRP microneedling combined with direct subcutaneous injections for management of various face, hair and skin issues. We hope to experience first hand the powerful work of stem cells and growth factors on transforming the photo-aged skin in our patient population. The future is bright for PRP’s clinical uses and we are very excited to be a part of this new biotechnology.
“Microneedling + PRP is better than microneedling alone.”
Dr. H K
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