Platelet Rich
Plasma (PRP)

The Elixir of Youth: Platelet Rich Plasma

Humans keep on discovering, or achieving whatever someone has imagined. Did someone mention “The Elixir of Youth?” The regenerative factors that are stored within our platelets appear to function as the elixir of regeneration and youth.

Platelets are cell fragments that are split off of megakaryocyte cells which reside in our bone marrows. The stored repair and regenerative mediators within the platelets are employed in Platelet Rich Plasma (PRP) treatment.

When a capillary is severed, a number of protein molecules that are produced by the liver and the bone marrow, which normally float within the plasma (the liquid acellular portion of the blood), are transformed, and cross-linked to form a sticky lattice that is called the fibrin. In between the strands of fibrin, the pebble-like platelets, which normally float in the blood, become embedded to form a plug, i.e., a blood clot. Invariably, at the site of the laceration of a capillary, repair and regeneration is needed. Platelets contain the molecules that facilitate repair and regeneration.

Orthopedic surgeons first thought of, and tried to tap the regenerative potential of platelets to facilitate repair of partially torn tendons and ligaments. Many other medical fields have since employed the benefits of PRP. Currently, we have a number of methods to isolate, activate, and place the platelets where repair and regeneration is needed. Dr. Y. Zhou and colleagues at University of Pittsburgh published the results of a laboratory study that they had done on tendon stem cells that were exposed to white blood cell-poor PRP and PRP that contained some white blood cells, i.e., the immune cells, in the Journal of Stem Cell Research Therapy 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572462/ The amount of white blood cells,, within the PRP preparation made a noticeable difference in the effect of the platelets on tendon stem cells. The authors found that less immune (inflammatory) cell resulted in more favorable results. They noted that as of 2015 a number of commercially available orthopedic PRP preparations, such as Arthrex and Zimmer Biomet (ACP and GPS that are mentioned in the Discussion segment of the article) contained too high level of white blood cells, possibly resulting in sub-optimum or erratic benefit from the procedure.

What Is PRP Used for in Dermatology

Scalp hair. Men and women who notice thinning of their scalp hair, or altered quality of hair, and have decreased density often times notice remarkable thickening of their hair after the third or fourth monthly session, as if the clock was turned back.

Lichen sclerosus et atrophicus is an inflammatory condition that affects the genital area of a small percentage of women, and less often men. The affected areas appear pink and thinned out. Often patients report marked sensitivity and irritability of the affected area. Dr. Andrew Goldstein and colleagues presented skin biopsies of the affected area before and after PRP treatment in a case report that was published in the Journal of American Academy of Dermatology in January of 2017. https://www.ncbi.nlm.nih.gov/pubmed/27986140. A number of other studies have been published on this application of PRP.

Alopecia areata. Dysregulation of certain immune cells results in a completely bald patch that appears suddenly. The area could remain bare for weeks or months. Waiting for a while, or injection of a dilute cortisone suspension were the most common treatment options. Three sessions of PRP has shown success in treating alopecia areata. Here is a link to an article that can be viewed on www.pubmed.gov : http://onlinelibrary.wiley.com/doi/10.1111/dth.12437/full .

Scars and acne scars. Two scars or acne scars on a patient can be quite different from each other, and, as expected would respond differently to a particular treatment. PRP alone, and more so in combination with microneedling can result in noticeable improvement in scars and acne scars.

Burns and non-healing wounds. PRP injection under the burn or wound expedites healing significantly, results in a better appearance of the final healed area.

Facial rejuvenation. PRP alone, and more so in combination with microneedling and sugar-based fillers (hyaluronic acid fillers, such as Restylane, or Juvederm) result in marked restoration of skin suppleness and elasticity that can last a very long time, and age with the person. To appreciate the enhancement, often it has to be repeated monthly for three times. This is a link to a study on prp microneedling and hyaluronic acid filler, http://www.jaad.org/article/S0190-9622(17)31769-3/fulltext.

Eyelashes. Application of platelet rich plasma with a brush on the upper eyelid margin can result in longer and thicker eyelashes.

Sexual organ, and function enhancement (PRP Rhino Boost). The penis is a very porous organ. When PRP is injected at one spot of the tissue the platelets distribute throughout the organ. The erectile enhancement is noted incrementally day by day over the next months. No human being could tolerate a needle piercing through his genitalia. The area is numbed by a numbing gel, and numbing injections at distant sites in the groin to deaden the nerve fibers that reach the penis, without injecting the penis with anesthetics.
Many women suffer from slight or mild incontinence as a result of prior childbirth. Female genital treatments with PRP can result in increased muscle tone of the vaginal wall and pelvic floor muscles, thus reversing the issue. In addition, as a result, women notice well-appreciated sensitivity of the genital area.

Neck and V of the chest. Three monthly treatments with PRP, along with microneedling and sugar-based fillers (hyaluronic acid fillers, such as Restylane, or Juvederm) can result in marked natural restoration of the neck and chest. Obviously, results vary in different people, but the great majority notice a difference after the third session.

Breast restoration and enhancement. Most women notice alteration in the their breasts after the nursing period is over. PRP treatments result in restoration of the suppleness of the breasts in great majority of women.

Stretch marks. PRP has been shown to to help improve the appearance of stretch marks in the majority, but not, all the patients that were treated. Here is a link to a study, http://onlinelibrary.wiley.com/wol1/doi/10.1111/jocd.12160/abstract.

How Much Blood is Drawn for This Procedure?

A single tube of 22 ml is drawn for a scalp treatment. 11 or 22 ml for face treatment, and 22 ml plus another 11 ml for the face, neck, and décolleté areas. Just to give you an idea of the significance of the blood loss, a healthy woman in her twenties loses 50 ml of blood over her monthly period. 500 ml of blood is drawn when a healthy person donates blood.

Is There Any Chance of Contamination?

AN Patel and colleagues studied the effect of pouring PRP on chest wounds after cardiothoracic surgery in 2000 patients over seven year period. Their article was published in the Journal of Cardiothoracic surgery in April of 2016, the the pubmed link is https://www.ncbi.nlm.nih.gov/pubmed/?term=prp+cardiothoracic+infection. The PRP treated group developed much less infections than the control group.A company by the name of Eclipse has made a sterile kit, and accessories that make it possible to perform the procedure sterilely. Dr. Silvers became well familiar with the sterile technique as a fourth year Yeshiva College student when he used to prepare cell cultures in a research laboratory at Columbia Medical school. He applies the sterile technique principles that he learned in the research lab to perform the PRP procedures at his office. Dr. Silvers treats one PRP patient at a time to leave no room for cross injecting patients’ blood product specimens.

Is there any chance of scarring, or worsening a scar? None that has been reported as of 2017. We do not see why it would promote scarring or exacerbate a scar.

How long will it take for a patient to perceive an effect? I depends on the site of injection, the condition of the patient, and what is being treated. The penile PRP treatment induces noticeable improvement days after one treatment, but for most other sites that the body is expected to lay down new collagen fibers and other soft tissue components, it might take three to four sessions, and about three to four months to see a difference.

What percentage of people it doesn’t work on? The current notion among doctors is that it works on almost all patients, but to various degrees. The nuances of of which patient would be the ideal candidate, and the approximate percentage of patients who would respond to a specific PRP preparation device or method is being worked on. Since the 1990’s we have witnessed the development of various PRP methods and evolution of each method or device. Therefore, the data that was obtained on previous methods of PRP preparation may not apply to, for instance, the current Eclipse PRP device kit.

Besides contamination, are there any other adverse effects reported for PRP? As of October of 2017, contamination and infection has not yet been reported for PRP that is prepared through the Eclipse system, or any other. I think that is the case because platelets contain molecules that are anti-microbials, and those molecules increase blood flow to the area. The regrowth and regenerative factors that are within platelets interact with the control mechanisms that are in place already within tissues, and I think that is why there has not been a case of overhealed scar, or overgrowth in any shape or form. I will update this paragraph if I come across any reports of unwanted effect from platelet rich plasma treatment.

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