Saturday, January 16, 2010

PRP (Platelet Rich Plasma)

What is PRP? Platelet rich plasma is concentrated blood plasma which contains approximately five times the number of platelets found in normal circulating blood. Human blood is comprised primarily of red blood cells (RBC), as well as white blood cells (WBC), platelets, and plasma. By initiating the first step of coagulation, platelets are the key to the body’s ability to heal wounds.

It is thought that by increasing the platelet count in a wounded area, the body’s healing to that area would be accelerated – explaining the use of PRP (platelet rich plasma) in wound healing.

Platelet rich plasma is concentrated blood plasma which contains approximately five times the number of platelets found in normal circulating blood. In addition, blood plasma contains the growth factors PDGF and VEGF and other bioactive proteins that aid in wound healing. To obtain PRP, a patient’s blood is spun in a centrifuge that separates the solid from liquid components. This separated “solid” portion of the blood is PRP (platelet rich plasma)

PRP is used in many areas of medicine, including the acceleration of healing of tendon injuries, the treatment of osteoarthritis, in some aspects of dental work (i.e. jaw reconstruction), and in cardiovascular medicine. The concentrated form of plasma has been shown to accelerate wound healing and tissue repair and, thus, could potentially benefit hair restoration procedures.

In hair transplantation, PRP can be injected into the recipient site area to theoretically stimulate the healing of the transplanted grafts and into the donor area to facilitate healing of the donor incision.

Mechanism of Action in Hair Transplants

Basically, a small amount (50cc) of your blood is taken before surgery. The platelets, which are part of your blood and help with healing of wounds, are separated to form a solution called platelet rich plasma. The follicular unit grafts are bathed in this PRP before being implanted. The PRP is also injected in the scar and recipient sites.

Hair follicles survive through the absorption of oxygen from surrounding tissue. It is conjectured that the introduction of platelets and white blood cells through platelet rich plasma (PRP) would amplify the body’s naturally occurring wound healing mechanism. Others propose that PRP can actually stimulate the stem cells (dermal papilla) of the newly transplanted hair follicles. Some practitioners also claim that PRP can be used to stimulate the growth of follicles, thereby reversing hair miniaturization seen in androgenetic alopecia and even preventing hair loss.

While there is much conjecture as to the benefits of using PRP during hair transplantation and its use in the medical treatment of hair loss, there is little scientific evidence to support these theories at the present time. This is an exciting new area in the field of hair restoration that awaits further scientific data.

[Graft survival and the use of platelet rich plasma in hair transplantation

Our interest was stimulated by two previous hair restoration physicians, Carlos Uebel from Brazil and Joseph Greco from Florida, who reported improved healing and graft survival with use of PRP.

Vascular factors include the immediate post-operative oxygenation and successful revascularization of each graft. Unlike organ transplants where the transplanted organ is hooked up to a new blood supply, hair transplants are “free” grafts which are surgically implanted without re-attaching a new blood supply (because that would be impossible to do with hair follicles). Until this process is complete, the graft must survive by passively absorbing oxygen from the surrounding tissue. We have been using and testing a variety of techniques to ‘prime the pump’ so to speak: topical hyperbaric oxygen, vasodilators, and angiogenesis stimulators. This is where platelet - rich plasma (PRP) comes in.

How does applying PRP help transplanted hair? Remember that platelets are key players in the body’s wound healing mechanism. Whenever there is a wound (e.g. an incision to place a hair graft during hair replacement), the platelets are trapped in the clot and are activated to release various hair growth factors that stimulate the healing process. These naturally occurring growth factors include:

  • PDGF (Platelet derived growth factor)
  • TGF-a & b (Transforming growth factor alpha & beta)
  • EGF (Epidermal growth factor)
  • FGF (Fibroblast growth factor)
  • Insulin-like growth factor (IGF)
  • PDEGF (platelet derived epidermal growth factor)
  • PDAF (platelet derived angiogenesis factor)

These factors stimulate new blood vessels to form (angiogenesis) and collagen to be produced. Cells are stimulated to divide and go into action surrounding the wound. In addition, white blood cells present in the area help eliminate bacteria in the area. PRP merely amplifies this naturally occurring wound healing process by providing increased numbers of platelets and white blood cells to the wound. It is important that the PRP be concentrated enough to have a therapeutic value and some techniques and devices in use by some physicians today may not accomplish this. produce at least 1.5 million platelets/1ml, well above the therapeutic threshold. This represents about a five-fold increase compared to the platelet count in circulating blood (for 10 cc of PRP).

Follicular unit transplantation outcomes may be increased by the correct application of PRP.

  • Donor site pre-treatment with PRP ( purpose is to provide platelet cell therapy and platelet-derived growth factors, both of which are key elements in wound healing).
  • Recipient site pre-treatment with PRP ( this seems to be an important factor affecting graft growth and survival rates).
  • Optimal use of intra-operative PRP and platelet-derived growth factors, in and around the graft
  • Graft emersion in PRP ( “ soaking the graft in the PRP gel”)

Following advantages are claimed by use of PRP

  1. to enhance donor site wound healing
  2. to decrease the incidence of infection
  3. to reduce donor scarring
  4. to increase donor scar tensile strength
  5. to enhance recipient site healing (which should increase growth)
  6. to be utilized as an effective treatment protocol in severe cases of wound dehiscence or infection.

Today, physicians and scientists demonstrate that platelet rich plasma may actually wake up dormant follicular stem cells and could quite potentially become the next major breakthrough in treating hair loss and growing hair. While some people feel this is yet another marketing attempt to rob balding men and women of their hard earned money, others are very excited by its potential.

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