What is PRP and How Can It Help Me?
PRP, or platelet rich plasma, is a term heard more and more commonly in modern medicine.
It’s used to treat NFL players’ knee injuries. It’s used to heal chronic wounds in diabetics. It's the essential ingredient in Vampire Facelifts®. And at Ascentist Aesthetics and Facial Plastics, PRP allows us to rejuvenate the skin, add youthful facial volume, and restore a natural hairline for our patients. But what is PRP? How does it have such a wide variety of effective uses? Are there risks? Explaining the answers to these questions is mandatory before offering these treatments to our patients.
First things first: Who makes PRP?
Easy – you make PRP. Platelet Rich Plasma is in your blood. It is your blood, or at least a supercharged, distilled version of it. We borrow it from you and give the important stuff back to you.
Blood is a mix of ingredients. There’s plasma (the liquid portion of the blood – 92% water), red blood cells, white blood cells, and platelets. Red blood cells are filled with hemoglobin, which have iron, which is the part that reflects light to make your blood appear red. Hemoglobin in the red blood cells bind oxygen and then share it with the rest of your tissues (be glad they do). White blood cells, “leukocytes”, fight infection. They float within the bloodstream picking fights with intruders (and other jobs).
But it’s the platelets that are the essential ingredient in platelet rich plasma. PRP is your serum without the red or white blood cells and with 2 to 5 times the regular concentration of platelets. We draw your blood, we spin it in a centrifuge to separate the ingredients, then we gather up only the PRP portion in a syringe for its myriad uses.
Platelets are a lot smaller than the red or white blood cells. They’re shaped like little discs, they’re colorless and you have a lot of them. Picture the volume of the thimble from the Monopoly™ game, then divide that volume by 1,000. You probably have about 150,000 to 450,000 platelets in just that amount of plasma.
We have a lot of platelets in our blood because we need a lot of platelets.
Platelets are essential for sticking to holes in our blood vessels when we have a cut or bruise as well as clotting our blood. They’re also a bundle of growth factors to promote wound healing and tissue growth! It’s this function that drew the attention of facial plastic surgeons more than 20 years ago.
But well before that, in the 1970s, doctors began experimenting with PRP in novel ways. Doctors at the time understood the possible wound healing benefits of platelets, but it had never been used therapeutically before. The first to try it were maxillofacial surgeons. It was touted as PRF – platelet rich fibrin – named for its anti-bleeding properties. Despite some mixed results noted in Cochrane review studies, the surgeons, and patients, enjoyed the results. PRP was gaining traction and scientists and physicians set out to find new applications.
It next became a fixture in sports medicine – used as an injection into injured tendons and ligaments. PRP continued to grow in popularity - soon urologists, cardiac surgeons, gynecologists, pediatric surgeons, ophthalmologists, dermatologists, and others continued to find PRP an important treatment option.
And very quickly we aesthetic surgeons began to investigate its benefits. Within facial plastic surgery, searching for the newest and most effective tools and techniques to rejuvenate the face and neck is a perpetual endeavor.
We all want to be able to offer safe and transformative treatments to our patients.
While this searching has produced many diamonds in the rough, there have also been plenty of weeds. At any established cosmetic office you’ll find a closet filled with devices that, while safe, never caught on. My colleagues and I had to do our own research to find out if PRP is a diamond in the rough or a temporary trend.
There are two important questions we ask when evaluating a new treatment: 1): can it cause any harm to my patient? 2): does it actually work? Luckily with PRP we had plenty of prior study from other fields to ensure that it’s safe. But we have to fully answer number 2: will patients be glad they received a PRP treatment?
Within Facial Plastics and Aesthetics, PRP is often used for three main purposes: 1) for facial rejuvenation and scar treatment following microneedling or laser resurfacing, 2) for combining with fat or filler to add volume to the face, and 3) to correct hair loss. We’ll go over each one.
Microneedling and laser resurfacing are tried-and-true ways to rejuvenate the skin. The mechanisms are different but the goal is the same: we selectively wound the skin in precise ways to inflame it. This inflammation results in the production and remodeling of collagen and elastin in the dermis – the main proteins that contribute to the strength and youthful appearance of the skin. The greater amount and organization of these proteins – the better looking the skin.
Enter the PRP. After we treat with a laser or microneedle and then topically administer PRP we allow an abundance of growth factors within the PRP to seep in. This use has been tested many times by researchers – does it help?
In one study, doctors perform laser resurfacing of the face on multiple patients. Then, on one half of the face they injected or topically applied PRP, and on the other half just saline. They found that the PRP halves healed quicker and looked better in the end. In another similar study the half that received the PRP treatment recovered from the treatment more quickly while the saline half was red and inflamed for significantly longer. Not all studies on the topic have provided such consistent and tidy results - but PRP is now a staple of skin rejuvenation.
Now to the next question - is PRP helpful in adding volume to the face?
As we age, our faces gradually transform from a heart shape – with the volume resting around the cheeks and temples – to a box shape – with the volume settling in our jowls and jawlines. So the question we often hear in clinic is – how do I get this heart shape back?
The two most common methods to recontouring the face are by adding either hyaluronic acid filler (Juvederm®, Voluma®, Restylane®) or performing fat transfers. PRP has been used in conjunction with both methods, but has more commonly been studied in conjunction with facial fat transfer. Transferring fat cells from the abdomen, thighs, and love handles to the cheeks, temples and brows is popularly performed across the country with great results. Also, many patients seek to improve the appearance of their facial scars from prior surgeries or accidents. Fat injections into these scars can help to make them blend more easily, and restore an unblemished contour.
These are effective treatment options, except that anywhere from 30 to 70% of that transferred fat may not be around in a year. This is because, after the fat volume is carefully transferred to the face, it takes around 48 hours before the proper blood flow can work its way to the newly transplanted cells. So until then these healthy cells just rely on the oxygen and nutrients that were already in the area. If there’s not enough to go around, some of the healthy, transplanted fat cells don’t survive long-term and the initial result may not be lasting.
But if we mix PRP in with the fat, its sensible to think the growth factors and vascularity that PRP brings would help ensure better fat survival. Indeed some tidy studies have shown this to be the case. Researchers have compared traditional fat grafting with and without PRP added. We’ve learned that adding PRP does seem to lead to a better result, although we surgeons need to develop a consistent technique to really nail down how much it helps. As with facial rejuvenation, adding the growth factors found within PRP for facial volumization helps to get better results for our patients.
It’s similar for our third application, too – using PRP to correct hair loss. We commonly inject PRP into the scalp for patients with receding hairlines or bald spots. After a series of injections, with some regular maintenance, we’re able to create thicker and more abundant results.
PRP treatment for hair loss is one approach among many.
There are hormonal treatments like Propecia™. There are topical treatments to encourage blood flow like Rogaine™. There are a variety of herbal and anecdotal treatments like sandalwood, rosemary and thyme. On the other hand, we also perform a tried-and-true surgical technique with excellent results – hair transplantation. Here, we use microscopic magnification to carefully relocate hair from the very back of the head to the areas in need. This produces precise results with a high satisfaction rate. But, it requires a half to full day of procedure time with 6 to 18 months before we see the final result.
So there is a role for PRP injections for hair loss. With no downtime for recovery, after a short series of injections and a bit of patience the growth factors within PRP are able to work their magic and get results. Here, too, the studies have guided us. Researchers have performed split studies in which they inject PRP on one side and a placebo like saline on the other. The results tell us that PRP helps to strengthen the blood supply to the hair follicles to prevent them from falling out as well as acting on follicular stem cells to generate new hair follicles. By just placing PRP within the scalp we can prevent further hair loss and regrow some of what was lost.
For restoring youth, treating scars, recontouring the face, regrowing hair – platelet rich plasma has earned its place as an essential tool of any plastic surgeon.
But it requires dozens of studies, years of results, and countless happy patients to truly understand the safety profile and usefulness of a new treatment. As any plastic surgeon knows, there are multiple new machines, new techniques, new implants and injectables that become available each year. And each year many of those machines, techniques, implants and injectables from the years past are proven to be ineffective, unpopular, or – very rarely – unsafe. It is our job, as physicians, to “Do No Harm” to our patients and diligently evaluate the right emerging trends and technology that safely provide the best results.
PRP, like other tried-and-true techniques, will continue to help our patients for decades to come.