What is Plasma and PRP?
Blood plasma, which appears as light-yellowish or straw-colored, is the liquid portion of whole blood minus the red-blood cells, white-blood cells, and platelets. Containing roughly 90 percent water and making up more than half of the body’s total blood volume, plasma also comprises of other components such as dissolved plasma proteins, coagulants, glucose, electrolytes, immunoglobulins, hormones, enzymes, and vitamins. Plasma helps with maintaining serum osmotic pressure and blood pH, coagulation, fighting infections, transporting biochemicals, nutrition, excretion of waste products, and more. Platelet rich plasma is the plasma combined with platelets.
Extraction of PRP
Platelet-Rich Plasma can be separated from whole blood by using a special device called a centrifuge. Centrifugation, is the process in which blood is mixed into a special solution that prevents the blood from clotting while it is spun down at very high speeds. Once the blood is spun down you usually notice three layers, a red layer that contain the red blood cells, a thin white film that contains platelets and a yellow layer with plasma. The plasma and the platelets are extracted to comprise what is referred to as PRP.
Platelet-Rich Plasma Is Utilized Across a Variety of Medical Specialties
- Orthopedic Surgery – Enhance repair of torn tendons
- Dentistry/Oral Surgery – Enhance healing after dental procedures and extractions
- Cardiac Surgery – Improve recovery of sternal wound closures
- Sports Medicine – PRP injections to help with muscle tears
- Dermatology – Enhance recovery after deep laser resurfacing and microneedling
- Hair Loss – Injections stimulate hair growth
- Pain Management –PRP injections are utilized for degenerative disc disease
Dermatology and PRP
PRP has garnered a significant interest in skin rejuvenation, hair stimulation, improved wound healing, scar revision, and more. PRP has the ability to provide growth factors and activate other beneficial biomolecules such as fibrin, assist in the modulation of inflammation and coagulation, and promote interaction of molecules to promote cell differentiation and regeneration. Furthermore, when combined with other treatment modalities such as microneedling and laser therapy, patients can experience improved aesthetic results.
PRP and Cosmetic Skin Rejuvenation
Skin aging, either caused by intrinsic and extrinsic factors, involves skin changes at the cellular and molecular level. During aging, the body experiences a decrease in hyaluronic acid polymers and collagen in the skin, degeneration of connective tissue, reduction of other beneficial biomolecules, alterations of the extracellular matrix and more. PRP can help with these unwanted changes and provide improvements in facial skin appearance, elasticity, texture, and lines.
PRP and Improved Wound Healing
Platelets play an important role in wound healing. It makes sense that PRP must help with hemostasis and accelerated skin healing. The three stages of wound healing include the inflammatory stage, the proliferative stage and the remodeling stage. During the inflammatory stage the wound-healing process is jump started. Tissue injuries lead to platelet activation, which results in the activation of active proteins, growth factors, and other molecules that aid in wound healing and repair. In turn, this activation process creates a cascade for stimulating neoangiogenesis (formation of new blood vessels), collagen production, connective tissue healing, and epithelial development. PRP is thought to help to supplement the would healing process and accelerate repair.
PRP and Scar Revision Treatments
PRP, when used in combination with other scar treatment modalities, such as laser therapy and microneedling, can help improve the quality of scars due to PRP’s ability to rebuild damaged skin structures by stimulating connective tissue cells called fibroblasts and keratinocytes, or epidermal cells. In turn, PRP improves the texture of the skin by promoting the production of healthy new skin tissue.
PRP and Hair Growth
There are many causes for hair loss such as genetics, age, alopecia, cancer treatments, childbirth, illness, poor hair care, hormonal imbalance and stress. PRP injection treatments can help combat hair loss. Given that platelets release granules containing a myriad of growth factors and other biomolecules, PRP has shown substantial effects on hair cell regeneration. When used on the scalp, PRP helps increase blood supply to the hair follicle, thus promoting natural hair growth and thickening the hair shaft.
Dermatologic Treatment Modalities using PRP
PRP and Microneedling
Microneedling, also known as percutaneous collagen induction therapy, involves the use of oscillating fine needles that are allowed to penetrate the skin for up to depths of 3 mm. The mechanical injury induced to the skin actually helps to stimulate collagen production and triggers a plethora of growth factors and immune system factors that work to improve the skin. Special cells known as fibroblasts saturate the treated site to stimulate endothelial cells and begin the process of neoangiogenesis, and elastin and collagen production. The wound healing process, in turn, improves the appearance of facial scars, skin discoloration, fine lines, wrinkles and slight skin discoloration. When microneedling is combined with PRP, it allows for a speedier recovery to the induced micro-trauma as well as enhances the overall results. Studies demonstrate that when microneedling is combined with PRP, the results show a thicker epidermal layer, greater concentration of elastic fibers and collagen formation.
After application of a topical numbing cream a microneedling pen is used to allow for fine, oscillating needles to create small micro-punctures within the skin. The provider will make multiple passes on the skin, in various directions to ensure even distribution. Additional pressure is applied to areas where the skin is thicker or where there is more problematic skin. The patient’s skin texture and thickness and sebaceous quality are considered when determining the depth of the procedure. PRP solution is then immediately applied to the skin and once again the microneedling device is used to facilitate the PRP penetration into the skin
Immediately after the treatment, there will be areas of redness and minimal bleeding after the first 1 to 2 days. Patients with more sensitive skin may experience prolonged redness. Localized bruising may also occur in areas of thinner skin such as the periorbital regions, forehead, and upper nasal dorsum.
The extremely fine and oscillating needles used in microneedling devices preserves the stratum corneum and the epidermal barrier function, which results in the lack of scarring in the aftermath of the procedure. It is also safe for patients of all skin types and within the Fitzpatrick classification since there is no thermal injury nor necrosis induced.
PRP and Facial Injections
Injecting PRP to the face and neck can improve facial volume, skin color and texture and fine lines and wrinkles. Topical numbing crème can be used to assist with discomfort during the procedure, however some needle sensation may still be felt. Post-procedure patients may experience increased downtime due to bruising and some swelling.
There may be some downtime due to bruising and some swelling. In general, these procedures are done at 4- to 6- week intervals and repeated at least 3 to 5 times, or until the desired result is achieved.
PRP as an Adjuvant for Post Deep Laser Resurfacing
Laser resurfacing is an effective treatment for improving skin tone and texture and re-establishing a more youthful skin appearance. Using fractional ablative technology laser treatments can reach specific skin depths in order to treat scars and photodamaged skin. PRP can help mitigate post-laser adverse effects and symptoms. Using PRP for post deep laser resurfacing treatments can help improve wound healing and recovery for better treatment outcomes. Taking advantage of PRP as an adjuvant for laser therapy has demonstrated an increased number of fibroblasts formation, increased dermal-epidermal junction length, higher collagen density, and an improved epidermis and stratum corneum layer at the treated sites.
PRP Injections for Hair Promotion
PRP injections are great for treating hair loss either by itself or as a multi-modality approach. Traditional approaches to hair loss typically consisted of FDA-approved medications such as minoxidil and hair transplantation. PRP injections can be performed by individuals experiencing hair loss or those that want to improve baseline hair volume.
PRP hair injections are performed by administrating small amounts of PRP in multiple locations throughout the target area of the scalp. PRP injection stimulate stem cells found at the hair root as well as awaken previously dormant hair follicles. The result is thicker and more fuller hair. The growth factors contained within PRP promote natural hair growth by prolonging the proliferative anagen (active growth) phase of hair follicles, promoting angiogenesis to create new blood vessels and activating anti-apoptotic pathways to increase hair cell survival.
During treatment, blood is taken from the patient’s arm and spun in a centrifuge for five to ten minutes. The platelet-rich plasma extracted after centrifugation is collected using tiny syringes and used for injecting growth factor-rich plasma into the scalp. The takes about ten to fifteen minutes to perform. Depending on the desired results, it is recommended to perform a series of three-to six treatment sessions at four-to six- week intervals.