Q: Dr. Eppley, I would like to get some information about the PRP hair injections for hair loss. I have been diagnosed with Telogen Effluvium. I believe it may be CTE now as its going on a year. Will this treatment help stop the shedding as well as help with growth?
A: PRP (platelet rich plasma) has had good success with a variety of medically induced hair loss problems, not just for androgenic male hair loss only. (PRP Hair) Since telogen effluvium is a reactive process and not genetically induced it should theoretically respond to a variety of stimulatory agents. PRP contains platelets which are concentrated sources of high levels of growth factors. Such growth factors are known to stimulate a variety of cells including the follicle cells in the hair bulb. For hair loss PRP is mixed with other hair growth agents such as niacin to maximize its effects. It is administered through a number of small droplet injections throughout the scalp using a very small 30 gauge needle. While there is no guarantee for response in any patient, the autologous nature of PRP has no downside to its use. PRP hair treatments can also be combined with other hair regrowth methods such as minoxidil for a synergistic effect.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in fat augmentation around my facial implants. My biggest concern is how much fat will survive as the plastic surgeon I saw mentioned that the presence of the implants will make it less likely the injected fat cells will be able to develop their own blood supply and grow. This gives me pause as I’m not too keen on another procedure that might just be an expensive temporary natural filler. I would appreciate your thoughts on this and how to maximize the survival of any grafted fat. Are there any other options to reduce the noticeability of the implants and fill/round out the cheeks more?
A: Your plastic surgeon did reach out to me and I have discussed your case with him. Fat injections are the only treatment that can be used as the ‘missing’ piece of your face is now not what is on the bone but is where the bone/implants aren’t. It is true that the final take of injected fat is both variable and not completely predictable. But I know of no scientific evidence that supports the supposition that fat grafts take less well over or around facial implants. And where you need the fat is to fill in the areas around and between the implants which is only soft tissue anyway.
One technique that can be done to improve fat graft survival is the use of platelet-rich plasma. (PRP) By mixing PRP with the fat grafts, it optimally enhances fat cell survival through its growth factor effects. It may also have an inducing effect on the stem cells that naturally reside in fat. Given that it is an extract from your own blood, there is no reason not to use this natural fat ‘booster’.
Dr. Barry Eppley
Q: Dr. Eppley, Do you use stem cell therapy to fix atrophic rhinitis…to regenerate nasal bone, tissue and mucosa, particularly, nasal mucosa? I have a bad dry nose which is primarily atrophic rhinitis three years after the partial removal of nasal turbinate. All the medication from doctors does not help much. So I can’t wait to find out how stem cell therapy and tissue engineering are going on for help with atrophic rhinitis. I read on other webpages that one plastic surgeon says you are the only doctor in the states doing this. Is that true? Thank you very much for your time. I’d really appreciate if when you kindly answer my question.
A: The treatment of atrophic rhinitis is a difficult problem for which there are no known therapies that are universally effective. The use of injectable autologous therapies offer promise for a lot of difficult clinical conditions in which some regeneration of function or regeneration of actual tissues would be therapeutic. Current autologous injection therapies include PRP (platelet-rich plasma) fat and stem cells. PRP is an extract of one’s own blood that contains platelet concentrates which have numerous potent growth factors in them. Fat concentrates are centrifuged or filtered aliquots of fat and stem cells. Stem cells can be isolated from fat but must be done concurrently as a direct isolate from the patient’s fat and immediately re-injected. The FDA currently bans the growth of stem cells from the patient as an isolated step in cell culture as a delayed reimplantation procedure.
The best approach currently for treating non-healing wounds and dysfunctional tissue elements, in my opinion, is the combination of PRP with a fat/stem cell concentrate. The entire nasal lining, septum and middle turbinates could be injected with up to 5ccs of this combined autologous therapy with the goal of reducing the degree of atrophic rhinitis. Understand that this is not exclusively stem cells but is a mixture of autologous elements that does partially include some stem cells. Whether this would be effective for atrophic rhinitis is not known as the primary problem is that the main producer of the moisturization of air (inferior turbinate) is missing. But whether the middle turbinate and other areas of nasal lining can compensate for it but being stimulated is the theoretical basis of the injections. Because it is an autologous therapy, there is no harm…it is just a question of how much benefit, if any, can be achieved.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 42 year-old male whose hair is thinning. I am on Propecia and Rogaine and it seems to have slowed it down but is not causing any regrowth. I have read about PRP blood treatments for hair loss and wondered what your thoughts were on how effective it might be. I know you have a lot of experience with PRP so your insight would be very valuable.
A: PRP, an acronym for platelet-rich plasma, is a concentrate of platelets derived from a patient’s own blood. Because platelets are packed with growth factors, small peptides that help modulate wound healing when injured, they have been used and shown to be effective in many medical applications. Their success in wound healing and many reconstructive surgery applications and their lack of any known adverse effects has naturally led for PRP to be extended into numerous cosmetic applications. It has been used as an adjunct in facelifts, injectable filler and fat grafting. It is presumed that the platelet concentrate has a tissue stimulating effect for regenerating lost or aging tissues such as fat and skin elasticity. The medical evidence for such effects is weak at best but the idea is so logical that its current use can best be described as a ‘what can it hurt’ approach. PRP use in hair loss treatments or in combination with Neograft follicular unit hair transplantation is another PRP application that has not been scientifically evaluated but numerous practitioners report favorable results with its use. The question of exactly how effective PRP is on stimulating the follicles of hair whether they are in their natural location or after transplantation is not yet known. I am optimistic about the effects of PRP on hair regeneration but no one yet knows how many injection sessions or how often or how many treatments need to be done for maximal benefit. Its use with other hair loss/regeneration treatments therefore is up the patient and their hair restoration physician.
Dr. Barry Eppley
Q: Dr. Eppley, I have read a lot about the Vampre Facelift and wanted to know what you think about it. While the name sounds a little creepy, using your own blood to help make you look younger seems like it might work.
A:Platelets are ubiquitous cellular fragments in the blood stream that is most known for helping blood clot. But platelets also make a major contribution to wound healing as they contain a multitude of growth factors which are well known to help repair and regenerate connective tissues. Application of these growth factors in high concentrations through platelet-rich plasma (PRP) has been used as an adjunct to wound healing for almost 20 years.
Platelet-rich plasma (PRP) is blood plasma that has a high concentration of platelets due to processing techniques. A small amount of blood can be drawn from the patient and the platelets removed from it by centrifugation. This creates a platelet concentrate gel that can be added to a variety of plastic surgery procedures such as facelifts and fat grafts to theoretically improve their results through the delivery of its growth factors.
While PRP can be used alone, a variety of aesthetic facial procedures have been developed that combine it with different types of injectable fillers. Marketed brand names such as Selphyl and the Vampire Facelift create either a platelet-rich fibrin matrix or are used in conjunction with other well known fillers such as Juvederm and Restylane. The benefits of PRP in these facial rejuvenation techniques, while theoretically appealing, has not been fully substantiated in widespread clinical use and ongoing patient studies continue to evaluate this autologous therapy in aesthetic surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to have PRP treatment on my face. My best friend who is a dermatologist in another country told me that the treatment is wonderful.
A: When patients use the terms “PRP Facial’ or “PRP Treatment of the Face’ that can imply multiple types of facial treatments using PRP. (platelet-rich plasma) They fundamentally breakdown into either topical or injectable approaches. PRP injections can be done either alone or mixed with fat or filler to create a volumizing effect and are often dubbed as PRP facelifts or even the marketed Vampire Facelift. When applied as a topical treatment, it is done in conjunction with either fractional laser resurfacing or the dermaroller, both methods which create channels into the skin by which the PRP can be absorbed and exert its effects. You would have to clarify for me whether you are interested in either a topical or an injectable facial treatment.
While the science of whether PRP really provides an immediate or a sustained long-term effect in facial rejuvenation is unknown, having it injected with other agents (fat, injectable fillers) seems the most plausible for having its high levels of growth factor exert a tissue stimulating effect.
Dr. Barry Eppley
Q: I have been reading about PRP and have a few questions. Do you use PRP by itself (not with fat injections) to the under eye area? Which company do you use for the PRP? (Or do you always extract from patient?) I have had a lower blepharoplasty and revision on it due to a scar line that retracted and I still sees crepyness. I do not want surgery again, but would consider just PRP injections to try to smooth skin out. I have done some research on the internet and I thinks this might be right for me.
A: PRP, known as platelet-rich plasma, is an extract from a patient’’s own blood. It ends up being a concentration of platelets, which helps the blood clot, but are prepared for this use because they are a rich source of growth factors. Their value in healing, and specifically plastic surgery, is undergoing a lot of current investigation. Although very promising and appealing, it is not yet clear how and whether it makes certain plastic surgery procedures better as a result of using it.
Using it to help improve wrinkling on the lower eyelids, whether one has had a previous blepharoplasty or not, is certainly not a proven treatment. It is difficult to see how injecting PRP under the skin can help reduce wrinkles. This strikes me as hopeful but far from proven science. Because of its potential wound healing benefits due to its growth factor component, it is tempting to view PRP injections as a ‘magic elixir’ that can be put anywhere for any reason and better outcomes are assured. This is not the case. Remaining lower eyelid wrinkles after blepharoplasty are better treated by an old and less glamorous treatment, a chemical peel. Not seemingly high tech but it is proven as an effective wrinkle reducer.
Dr. Barry Eppley
Q: I’m interested in a facial fat graft. You’ve mentioned in one your Explore Plastic Surgery blogs about the use of growth factors with fat grafting. My understanding is that these can be derived from the patient’s blood . How is that done and how does it work?
A: Fat grafting to the face through injection techniques become popular because it is both natural (organic you might say) can be placed fairly precisely. Its one drawback is that the survival of the fat is not predictable. There are numerous steps with fat grafting that will influence survival from the way it is harvested to how and where it is injected. One historic variable in this pathway has been the addition of agents to the fat graft that may help it survive. Insulin is the best example of this approach. A contemporary agent to add to fat grafts is growth factors. This is done by adding the patient’s own concentrated platelets. Known as platelit-rixh plasma (PRP), this is an extract from the patient’s own blood that is drawn during surgery. The blood is processed in such a way so that several ccs. of platelet concentrate is obtained. This is then mixed in with the fat graft.
While the use of platelets with fat graft injection is a natural agent, it has yet to be proven to be conclusively beneficial to an improved survival volume. Its concomitant use is currently based on more of an alchemy approach with the hope that the potent growth factors which the platelets contain will help the stem cells in the fat graft survive, differentiate into fat cells, and help main graft volume.