PLATELET RICH PLASMA

September 11, 2017

WHAT IS PRP?

PRP, also known as Platelet Rich Plasma or Platelet Concentrate is an autologousconcentrated preparation of platelets in plasma. Autologous implies that the PRP is prepared from the patient’s own blood and hence is nontoxic, non-immunogenic and safe. The normal concentration of platelet in blood is usually found to be 1,50,000/mm3 -4,50,000/mm3. In case of PRP solution, the concentration of platelet in blood is usually 10,00,000/mm3 i.e. 4-6 times more platelets as compared to normal plasma. Owing to the higher concentration, this solution contains high concentrations of growth factors. Simple centrifuge is not apt to achieve such high concentration and hence a more sophisticated technology and a higher cost is needed to achieve the objective.

THE SCIENCE BEHIND PRP

PRP solution contains a very high concentration of platelets. Many alpha granules are present within the platelets, and upon activation, these alpha granules release proteins called as growth factors.

Platelet-derived growth factor (PDGF)
Transforming growth factor (TGF)
Vascular endothelial growth factor (VEGF)
Insulin-like growth factor (IGF)
Epidermal growth factor (EGF)
Interleukin (IL)-1
The growth factors act upon various hair cells like dermal papilla, fibroblast, and other stem cells. These growth factors promote hair growth and enhance hair thickness.

HOW IS PRP OBTAINED?

60 ml of blood was taken out from the patient and collected in a tube containing acid citrate dextrose (ACD-A) anticoagulant (8.5 ml blood and 1.5 ml ACD-A ratio is the gold standard). It is best prepared by double -spin method. The spinning was done by a standard centrifuge for a certain time, usually 7-13 minutes, and at a certain speed, usually 1000-3000 RPM. It should be noted that the speed and time varies depending on the brand of tube and centrifuge.

The first spin was for 10 minutes at 1,300 RPM. This resulted in separation of blood to a low red blood cell (RBC) region and upper straw-coloured plasma region. This plasma contained a relatively low concentration of platelets (platelet-poor plasma PPP) in the uppermost region and a higher platelet concentration in the boundary layer, often called as the puffy coat.

The second spin was carried out onto this solution (i.e. lower RBC region was not used. Only PPP & Buffy coat layer till RBC layer was used for second spin) at 2000 RPM for 10 min. Post the spine, each of the tubes consisted of an upper portion of clear yellow supernatant serum, containing fibrinogen, and a very low concentration of platelets; the bottom layer, often red tinged, consisted of highly concentrated PRP, or cPRP.

After the upper yellow serum was removed, this bottom layer used for treatment (leaving only cPRP at bottom). This completed the procedure for preparation of the crop. Volume of crops depends on the volume of blood processed. For example: 60 ml whole processed blood lead to 2 cc of cPRP according to study done by Uebel et al in 2006. (Plast. Reconstr. Surg. 118: 1458, 2006).

USE OF PRP

PRP is applicable in two ways with regards to hair care:

PRP to reverse miniaturisation (thinning of hair) in androgenic alopecia (Male Pattern baldness) and to stimulate hair growth in other conditions such as alopecia areata(patchy hair loss).
PRP during and after hair transplant surgery.
A. HOW IS PRP PROCEDURE PERFORMED FOR HAIR LOSS

While PRP is being prepared, the scalp area where PRP injection is supposed to be applied is selected and cleaned with proper aseptic precautions.
Local anaesthesia in the form of ring block is carried out. Micro needling is done either with an automatic instrument or Derma roller. PRP solution is then activated with 10% calcium chloride and bovine thrombin (activation fastens release of growth factors from alpha granules of PRP). This activated solution is then injected into the treatment area. It is also sprayed on the scalp and left overnight. Four such sessions are required for clinical results.
IS PRP PROCEDURE PAINFUL?

There is just an initial anaesthetic injection pain.

POST PRP CARE

It is normal to carry out routine daily work just after the PRP procedure.
The patient can go for shampooing, shower or conditioning after 6-7 hours or post overnight.
No colouring or perming advised for 72 hours after PRP treatment.
WHAT ARE RISKS ASSOCIATED WITH PRP TREATMENT?

PRP is a safe & simple procedure but a bit inflammation owing to procedure and a fair amount of numbness due to local anaesthesia is common.
Swelling on forehead is observed in up to 5% patients and it usually subsides in a couple of days.
DOES PRP WORK & WHEN CAN YOU EXPECT RESULT FROM PRP AND HOW LONG
DO THEY LAST??

Yes! As per various published papers, research and exhaustive studies, pure PRP enhance the hair shaft diameter (reverse miniaturisation) and hair growth. The results are usually visible 3-4 months post the treatment and the overall hair appearance gets enhanced gradually. The first positive sign is reduction in hair loss and reversal of miniaturisation. Also, there is a decrease in scalp visibility. PRP results are not permanent (i.e. remain for one hair cycle), thus PRP needs to repeat on a regular basis.

WHO IS SUITABLE FOR PRP TREATMENT?

PRP is ideal solution for:

Younger men experiencing early stages of androgenic alopecia.
People with weak hair quality (to reverse miniaturisation).
Female Pattern Hair Loss (FPHL).
Post childbirth in women.
Perimenopausal or Menopausal hair loss.
Alopecia Areata (hair loss in small patches).
WHO IS NOT SUITABLE FOR PRP TREATMENT?

Patients with certain conditions like blood and platelet disorders.
Chronic liver disease.
Presence of an active severe infection.
Cardiovascular or hemodynamic instability.
Presence of anti-coagulation therapy (e.g. Warfarin) would make PRP contraindicated.
Recent steroid treatments.
Smoking has relative contraindications and should be discussed with your Hair Restoration Physician first.
PRP WITH EXTRA CELLULAR MATRIX-LIKE A-CELL AND BIO-D

With extracellular matrix like A-CELL and BIO D, PRP results are enhanced in terms of quality as well as longevity.
PRP in combination with A-CELL provides a continuous supply of growth factors to the weak hair follicles for several months.
As A-Cell is a protein matrix that recruits body’s own growth factors and healing proteins, it can sustain the result for several months.
PRP WITH DERMA ROLLER (MICRO NEEDLING)

Micro Needling with Derma Roller (or automatic instruments) helps in the activation of alpha granules of PRP. It aids in the release of growth factor therefore micro needling also potentiates PRP (Tissue injury due to micro needling results in the release of Thrombin. It is the same chemical that is required for PRP activation. Hence, it fastens the activation process).

PRP WITH MINOXIDIL AND FINASTERIDE

Generally, Minoxidil and DHT blocker (i.e. Finasteride) are prescribed with PRP. They form a strong combination to provide a very good result.

PRP WITH LOW-LEVEL LASER.

Generally, low-level laser is given after or before PRP. These two procedures have different mechanism but potentiate each other.

HOW TO CHOOSE PRP CLINIC

We Indians love to create a cheap copy of everything. Some examples of this mentality are Fashion Street, Food adulteration, Remake of movies and songs, etc. Same tendency is also seen in context to hair transplant clinics.

Be careful while choosing clinic:

If the clinic is drawing only 10 ml (or less) blood, consider that it is not following the proper PRP (Platelet Rich Plasma) method. It is rather PPP (Platelet Poor Plasma).
If they call you weekly or fortnightly for PRP, then it is jugad and not PRP.
If they are using ordinary blood collection tube it is again PPP (Platelet Poor Plasma) and not PRP (Platelet Rich Plasma).
If clinic is using ordinary centrifuge machine, then they are going to inject PPP.
Free or complimentary PRP is actually PPP and not PRP.
Tricoscopy must be done by doctor who will diagnose patient’s who are going to be benefited by PRP treatment.
B. ROLE OF PRP IN HAIR TRANSPLANT

Some intentional injuries are made during the transplant process. Example: Long strip shape in FUT and pin point shape in FUE. Surgeons extract the grafts, keep these grafts out of the body and then insert it at the recipient area. In this process, the tissue often gets injured. While extraction injury like transaction, dehydration and crushing can happen. The ‘out of body’ grafts may lack in nutrition and oxygen. Change in temperature and pH is also a potential source of follicular unit damage. While inserting it back, ischemia-reperfusion injury can take place. There are certain methods to reduce these injuries (so as to enhance the result). PRP is that magic solution that protects grafts in all situations if it is done properly. If the grafts are preserved in PRP, it provides oxygen and nutrition to the grafts. Also, it provides the body like environment while the graft is out of the body, and it neutralises the effect of change in temperature and change in PH.

The growth factors contained in platelets of blood plasma are basically:

Platelet-derived growth factor (PDGF)
Transforming growth factor (TGF) – beta
Vascular endothelial growth factor (VEGF)
They are protein molecules, which in contact with their respective receptors, act in tissue angiogenesis, stimulating the healing and growth of new organic structures. PRP heals wounds faster and better. Crusting and redness is reduced.

In a study at Chungnam National University, Daejeon, Korea they found that there is a significant improvement in hair density and stimulation of growth when follicular units were pretreated with Platelet Plasma growth factors before their implantation. As reported in a study, 15.1% increase in follicular density was observed. So the overall growth of hair post hair transplant is faster and much consistent by growth factors released from PRP. PRP may act on stem cells in the bulge area of the follicles stimulating the development of new follicles and promoting neovascularization. PRP is very useful during hair transplant surgery and overall enhances clinical results.

HOW TO CHOOSE CLINIC BEFORE TRANSPLANT

If a clinic offers free PRP, do verify it from reliable sources about the trustworthiness of the clinic. Most of the times, it is just an eyewash as clinics in India use PRP as an offer to attract your attention. In reality what they do is something else.

Keep an eye on how much blood they are drawing. If it is 10 ml, it is complete eyewash. They cannot reach the required therapeutic level platelet concentration and sufficient amount of PRP to achieve and complete the whole process .
If they are using simple blood collecting tube, its of no use.
If they are using simple centrifuge machine, it will produce PPP, and not PRP.

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