“A little blood may not give us immortality but can certainly enhance our aesthetic reality.”

History:

Studies have confirmed that blood contains growth factors and stem cells which have the ability to regenerate tissue. Use of PRP has been dated back since the 1970s. Fortunately, for those of you  who have been waiting  for an “organic rejuvenation method”,  the medical world has decided to apply these investigated benefits to clinical practice in aesthetics. PRP is now accepted worldwide as a clinically valid method of improving the health of various tissues and skin, contributing to restoration of its youthful function. Although popularised in the 1990s as a therapeutic treatment in orthopedic medicine (musculoskeletal injuries), it is today considered mainstream for its’ anti-aging skin benefits. Japan and Europe have been applying it to aesthetic practice since 2004 while doctors in the US embraced PRP therapy about 6 years ago, in 2009. As more and more doctors are becoming aware of the benefits and becoming skilled  in applying its technique, we can now seek out this cutting edge yet natural rejuvenation method from our favorite aesthetic professionals.

Introduction:

Platelet-rich plasma (PRP) (syn. autologous platelet gel, plasma-rich growth factors and platelet-concentrated plasma) means “abundant platelets that are concentrated into a small volume of plasma.” ^[1].

Takakura et al., ^[2] revealed that platelet derived growth factor (PDGF) signals in cell interactions are required for hair canal formation and growth of dermal mesenchyme, thereby opening newer perspectives for PRP in hair restoration.

What is PRP?

PRP is defined as a volume of the plasma fraction of autologous blood with an above baseline platelet concentration. ^[3]

The regenerative potential of PRP depends on the levels of growth factors released upon activation.^{[4, 5]}

Main growth factors (GFs) involved in androgenetic alopecia are platelet-derived growth factor (PDGF), transforming growth factor (TGF),vascular endothelial growth factor (VEGF) and insulin-like growth factor (IGF) with their isoforms.^{[6,7, 8, 9]}

Degranulation of the pre-packaged GFs in platelets occurs upon “activation” i.e., on coming in contact with coagulation triggers. The secreted GFs in turn bind to their respective transmembrane receptors expressed over adult mesenchymal stem cells, osteoblasts, fibroblasts, endothelial cells, and epidermal cells. ^[10] This further induces an internal signal-transduction pathway, unlocking the expression of a normal gene sequence of a cell like cellular proliferation, matrix formation, osteoid production, collagen synthesis, etc., thereby augmenting the natural wound-healing process. ^[3]

Mechanism of action:

•       In AGA / Hair loss:

-GFs appear to act in the bulge area of the follicle, where they bind to their respective receptors located in stem cells.

-In the bulge area, primitive stem cells of ectodermal origin are found, giving origin to epidermal cells and sebaceous glands.

-In matrix, germinative cells of mesenchymal origin are found at the dermal papilla (DP). Interactions between these two kind of cells as well as with binding growth factors (PDGF, TGF-b and VΕGF) activate the proliferative phase of the hair, giving rise to the future follicular unit. Therefore, PRP could serve as a potential treatment of AGA.

•       In skin rejuvenation and scars: ^{[13, 14]}

–    Increased proliferation of human dermal fibroblasts

–    increased expression of MMP-1 and MMP-3 (Matrix metalloproteinase) leads to removal of photo damaged ECM

–    Increased production of pro collagen type 1 peptide leads to formation of new collagen

–    Expression of G1 cell cycle regulators accelerates wound healing

Preparation of PRP:

Double Spin Method:

•    The American Association of Blood Banks technical manual, ^[11] states that “platelet-rich plasma is separated from whole blood by ‘light-spin’ centrifugation and subsequently the platelets are concentrated by ‘heavy-spin’ centrifugation with removal of the supernatant plasma.”

•     The first centrifugation is slow (generally 1000 to 1200rpm) to avoid spinning down platelets and to isolate plasma. Platelets are mostly concentrated right on top of the buffy coat layer. Subsequent centrifugation is faster (2000 to 2500 rpm), so that platelets are spun down and separate as a pellet at the bottom of the tube from platelet-poor plasma (PPP) above. The final platelet concentration depends on the volume reduction of PPP. Approximately 3/4 of the supernatant is discarded and the platelet-rich pellet is resuspended in remaining amount of plasma. The resulting suspension is used as PRP.

•    Calcium chloride (CaCl 2 ) or thrombin can be used as an “activator” to trigger coagulation and hence degranulation of GFs to yield “activated PRP”.

•    The platelet yield depends mainly on conditional parameters like size and shape of the container used, rate and time of spin and anticoagulant used. There has been a gross lack of comparative studies to standardise the PRP procedural parameters.

^•      The active secretion of prepackaged GFs begins within 10 minutes of clot initiation and 95% of the secretion is completed within 1 hour. ^[12]

Indications:

•    AGA (Androgenetic Alopecia)

•    Telogen Effulvium

•    Skin Rejuvenation

•    Acne Scars

•    Strie densae

•    Chronic ulcers

Procedure:

A proper informed consent, aseptic conditions and local anesthesia are important pre-requisites for the procedure. Patient must be free of anti-platelet drugs like aspirin or other non-steroidal anti-inflammatory drugs, for at least two weeks prior to the procedure.

(Centrifuge rotations will vary from machine to machine)

•    8.5 ml of blood is drawn in 10 ml test tube and mix with 1.5 ml of anticoagulant (ACD)

•    1st light spin should be done : 1000 rpm for 10 mins

•    Aspirate Plasma, buffy coat and superficial RBC layer and transfer it to other test tube

•    2nd heavy spin should be done : 2200 rpm for 10 mins

•    Platelet pellet will accumulate in bottom, reduce plasma volume to 1/3rd to get platelet concentrate.

•    The activation process includes the addition of calcium gluconate in a 1:9 ratio (0.1 ml calcium gluconate per 0.9 ml of PRP).

•    The concentration of platelets in PRP is approximately 4-5 times as great as that in whole blood.

•    Scalp :

•    Inter- follicular injections 0.05ml -0.1ml /cm2

•    PRP Mesotherapy : micro needling with meso pen is done and PRP solutions is sprayed on top of it and left on over night.

•    In hair transplant : The follicular grafts are dipped into PRP for about 15 minutes, before implantation so as to increase their survival rate after implantation.

•    Face : Intra dermal injections 0.05 ml-0.1ml /cm2 or micro needling is done.

Treatment Sessions:

•    Treatments are usually repeated 6-8 weeks interval, until desired results will be achieved.

•    The number of treatments required will depend on how each individual responds to the treatments.

•    For scar reduction, usually 4 session are required.

•    In case of hair loss problems, 6-8 session are required.

•    Maintenance sessions are done once in few months.

Advantages of PRP in comparison to other treatments:

•    Use of platelets native to one’s own blood means the treatment is non-toxic, hypoallergenic and with extremely low incidence of side effects.

•    Even when used alone adds natural fullness to face without necessity of more aggressive fillers or aesthetic treatments.

•    Reduce need for surgical intervention.

•    Can be used to rejuvenate harder to treat and delicate areas such as skin around eyes, neck, chest and hands.

•    Can be used to rejuvenate several problematic areas in one session.

•    Simple and quick treatment, usually an hour-long office visit is sufficient for entire preparation and procedure.

•    It is also frequently being used to improve out comes of other aesthetic procedures such as chemical peels, lasers and radio frequency treatments and even pre-surgery to assure optimal healing.

Vampire Facelift:

•    PRP is a derivative of our own blood, for this reason PRP therapy is popularly referred to as “The Blood Facial” or “Vampire Facial”.

•    It is trademarked procedure which combines Hyaluronic Acid(HA) and PRP, additional enhancement provided by Hyaluronic Acid (Juvederm, Restylane, Perlane)

•    HA serves as a scaffold structure for PRP.

•    HA is extremely hydrating, adds suppleness and additional structure to the skin. It also allows contouring power to the aesthetic practitioner, allowing additional fullness to be placed where needed and enhancing the rejuvenating power of the PRP.

•    Hollywood is going wild about the Vampire FaceLift results and everyone, including celebrities, are signing up without hesitation.

Reference:

1.      Marx RE, Garg AK. Dental and Craniofacial Applications of Platelet-Rich Plasma. Chicago: Quintessence Publishing; 2005.  Back to cited text no. 1

2.     Takakura N, Yoshida H, Kunisada T, Nishikawa S, Nishikawa SI. Involvement of platelet-derived growth factor receptor-alpha in hair canal formation. J Invest Dermatol 1996;107:770-7.  Back to cited text no. 3

3.     Sclafani AP. Application of platelet-rich fibrin matrix in facial plastic surgery. Facial Plast Surg. 2009;25:270–6. [PubMed]

4.     Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: Implications for wound healing. Plast Reconstr Surg. 2004;114:1502–8. [PubMed]

5.     Weibrich G, Kleis WK, Hafner G, Hitzler WE. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count. J Craniomaxillofac Surg. 2002;30:97–102. [PubMed]

6.     Sánchez-González DJ, Méndez-Bolaina E, Trejo-Bahena NI. Platelet-rich plasma peptides: Key for regeneration. Int J Pept. 2012;2012:532519.

7.     Su HY, Hickford JG, The PH, Hill AM, Frampton CM, Bickerstaffe R. Increased vibrissa growth in transgenic mice expressing insulin-like growth factor 1. J Invest Dermatol. 1999;112:245–8

8.     Tavakkol A, Elder JT, Griffiths CE, Cooper KD, Talwar H, Fisher GJ, et al. Expression of growth hormone receptor, insulin-like growth factor 1 (IGF-1) and IGF-1 receptor mRNA and proteins in human skin. J Invest Dermatol. 1992;99:343–9

9.     Arshdeep, Kumaran MS. Platelet-rich plasma in dermatology: Boon or a bane? Indian J Dermatol Venereol Leprol. 2014;80:5–14.

10.            Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:638-46.

11.            American Association of Blood Banks technical manual committee. Method 6.11: Preparation of platelets from whole blood. In: Vengelen-Tyler V, editor. AABB Technical Manual, 13 th ed. Bethesda (MD): American Association of Blood Banks; 1999. p. 725

12.            Kevy S, Jacobson M. Preparation of growth factors enriched autologous platelet gel. Proceedings of the 27 th Annual Meeting of Service Biomaterials, April 2001.

13.            Cho JW, Kim SA, Lee KS. Platelet-rich plasma induces increased expression of G1 cell cycle regulators, type I collagen, and matrix metalloproteinase-1 in human skin fibroblasts. Int J Mol Med 2012;29:32-6.

14.            Kim DH, Je YJ, Kim CD, Lee YH, Seo YJ, Lee JH, et al. Can platelet-rich plasma be used for skin rejuvenation? Evaluation of effects of platelet-rich plasma on human dermal fibroblast. Ann Dermatol 2011;23:424-31.  Back to cited text no. 26 [PUBMED]