PRP has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. A recent study published in the journal of Plastic and Reconstructive Surgery evaluated the results and benefits of the use of platelet-rich plasma and showed there is a therapeutic advantage to the use of platelet-rich plasma as a treatment modality for hair restoration and skin rejuvenation and in combination with laser skin treatments.
Introduction
The use of platelet-rich plasma in the medical arena has grown exponentially in the past few years, due to its regenerative and restorative properties. Originally used in the dental field going back 20 years for oromaxillofacial conditions, PRP has since grown within other clinical specialties such as the orthopedic field, to help heal torn ligaments and chronic joint arthritis, and in the plastic surgery field. Dermatologic and plastic surgical uses include facial rejuvenation, hair restoration, and acne scarring treatments. Studies have shown improvements in wrinkles, skin texture, facial volume, and hair regrowth. Other clinical trials have shown good results with regard to tissue healing.
Platelet-rich Plasma Science
Platelets play a vital role in the initiation of blood clotting and wound healing and increasing the speed of wound repair. In response to tissue and vascular damage, such as what occurs during a microneedling treatment, platelets are activated, with subsequent release of biologically active proteins. These proteins, released from within the platelet, initiate a cascade of events leading to tissue healing and regeneration. Over 30 biologically active proteins are released, including transforming growth factor-β, platelet-derived growth factor, vascular endothelial growth factor, fibroblast growth factor, and epithelial cell growth factor. These growth factors promote new blood vessel and tissue formation and promote wound repair with new collagen and elastin production.
Applications in Plastic Surgery
The regenerative ability of platelet-rich plasma has been used in multiple areas within plastic surgery such as skin rejuvenation, treatment of acne scars, scalp hair restoration, and improved healing from laser treatment. This is related to growth factor stimulation and activation of dermal fibroblasts, which in turn induce collagen synthesis.
Injection of PRP
Historically, platelet-rich plasma was injected into the skin, with improvement in skin texture, color, and reduced wrinkle depth. Some of the first medical studies showed a statistically significant increase in dermal collagen levels with platelet-rich plasma injection compared with saline. Additional new collagen formation results from the microneedling effect, which is found to maximize the results. Excellent results have been achieved with PRP used in combination with microneedling. Following are some of the uses in the plastic surgery field.
Topical PRP with Microneedling
One popular technique for skin rejuvenation involves the application of topical platelet-rich plasma after microneedling. This stems from the concept of mesotherapy, which uses multiple small punctures into the skin to facilitate absorption of topical medications. Microneedling creates superficial skin injury at varying depths, which has been shown to increase collagen production, skin tightening, and rejuvenation and it is used to facilitate platelet-rich plasma delivery. There are multiple microneedling devices currently used; however, the SkinPen (Bellus Medical, Addison, Texas) is the only microneedling device cleared by the U.S. Food and Drug Administration, which is the device we use at Renove Med Spa https://www.renovemedspa.org/microneedling. The microneedling treatment is applied numerous times over the face, in various directions, at various depths, until the endpoint of redness with or without pinpoint bleeding is reached. When platelet-rich plasma is combined with microneedling, the effects were found to be magnified. Studies have shown increased collagen with improved elastin fibers with combination microneedling and platelet-rich plasma compared to microneedling alone, which we at Renove Medical Spa have noticed as well, improved results witht he combination of PRP and microneedling. Microneedling with PRP can be performed once, or every 4 to 6 weeks and repeated several times, depending on the results desired. The average treatment recommendation is three sessions to maximize therapeutic results and varies based on the treatment goal. For more information on microneedling visit our page at https://www.renovemedspa.org/microneedling ,
PRP with Laser and Radiofrequency Treatments
Laser and radiofrequency therapy has been combined with platelet-rich plasma to enhance results, with studies showing a therapeutic role in the treatment of acne scarring and facial aging. Platelet-rich plasma can be injected intradermally after laser therapy to provide a synergistic result, although it is also used topically. Not only does it provide local growth factors for healing, it has been demonstrated to decrease redness after laser treatment and accelerate healing. Positive results for facial aging treated with platelet-rich plasma and laser therapy are demonstrated as early as one treatment with three sessions showed maximum results. Studies show statistically significant improvement in skin elasticity for patients receiving combination therapy. Also demonstrated was a more obvious improvement in skin color, texture, and pore size. https://www.renovemedspa.org/rf-microneedling
Hair Restoration
The use of platelet-rich plasma for the treatment of hair loss, holds some of the strongest and most convincing evidence for successful hair restoration. Platelet-rich plasma increases proliferation rates of human cells that regulate hair follicle growth. Through the release of growth factors and stem cells, activation of the growth phase of the hair cycle begins, leading to hair follicle formation and maintenance. The anagen (growth) phase of the hair cycle is thus maintained with a delay in progression to the catagen (fall out) phase, which over time leads to an overall increase in hair density. Studies have shown significant improvements in alopecia with a significant increase in number of hairs per square centimeter.
A common method of performing platelet-rich plasma injections to the scalp is with multiple small injections, in a linear pattern, 1 cm apart, known as the "nappage" technique, which is the technique we use at Renove Medical Spa https://www.renovemedspa.org/prp-scalp-injections . Treatment is usually performed several times, with intervals ranging from 1 week to 1 month. Some protocols also recommend continued maintenance therapy after the initial treatment sessions to maintain the anagen phase of the hair growth cycle. The peak of hair density is at 3 months after initial treatment, and began declining at 6 months; therefore, a booster treatment was administered at 6 months to maintain the results achieved. In that study, hair density at 1-year follow-up remained significantly higher than that of baseline. It is recommended to have periodic treatments of two to three times per year after the initial treatment sessions for the most effective treatment as per the recent studies.
PRP And Acne Scarring Treatment
Treatment with microneedling in conjunction with platelet-rich plasma has also emerged for treatment of acne scars. Microneedling has been used for treatment of facial scars, including ice pick, boxcar, and rolling scars; however, the addition of platelet-rich plasma has shown profound improvement in appearance. Treatment for acne scarring consists of a series of treatments, ranging from two to three monthly sessions. Studies showed a significant improvement in the treatment response for acne scars at 6-month follow-up when platelet-rich plasma was used in combination with laser treatments. Confirmed by other split-face randomized controlled trials, acne scarring showed a higher level of improvement of scar depth and pigmentation, confirming its synergetic effects with PRP.
Safety of PRP
As platelet-rich plasma is an autologous product, as it is self donated, and is considered safe and free from communicable diseases. Sterility should be practiced and platelet-rich plasma harvesting should only be done by a licensed and regulated medical professional and overseen by a physician. If you do not see a physician for your PRP treatment, you should question why not. Minor complications include transient swelling, bruising, redness and crusting, all of which are injection-related. Subjective feeling of skin tightness is transient.
Conclusions
The use of platelet-rich plasma has grown in plastic surgery because of better understanding of its regenerative and restorative effects. A diverse collection of literature exists in support of its use, displaying favorable results for skin rejuvenation, hair regrowth, wound healing, and scar improvement. We offer all of the above treatments at Renove Medical Spa. If you think you may benefit from one of the above treatment modalities, please call or email us to make an appointment for a complimentary consultation. March 2021 we will have a get ready for summer (it's coming!) skin special with our Radiofrequency Microneedling with PRP treatments, book a treatment with PRP and receive a free ZO Growth Factors serum a $148 value https://zoskinhealth.com/pages/search-results?q=growth%20factor .
Platelet-Rich Plasma: Evolving Role in Plastic Surgery
Edward S. Chamata, M.D.; Erica L. Bartlett, M.D.; David Weir, N.P.-C.; Rod J. Rohrich, M.D. DISCLOSURES Plast Reconstr Surg. 2021;147(1):219-230.
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