Your Questions
Your Questions
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
Indianapolis, Indiana
Q: Dr. Eppley, I saw a post from last year in which you responded to a question regarding whether PRP/stem cells would be beneficial for Atrophic Rhinitis. I am wondering if you are interested in performing PRP on the turbinates. I have travelled to get PRP injections and have recieved some benefit but need further injections and would perfer to find a way closer to home. In my case, I have sufficient turbinate tissue but it has been damaged from cauterization so I am hoping to get further healing of the tissue.
A: Since you have received benefit from PRP injections to the turbinates previously, there would be no reason that you would not get further benefit by additional injection treatments of your atrophic rhinitis. The one caveat that I would add is that you consider the addition of a small amount fat with the PRP placed into the turbinates or go with fat injections alone. Fat has stem cells, (which PRP does not, and this should produce a more profound long-term rejuvenation of the turbinates than the short-stimulus that PRP provides. PRP can only stimulate the cells that are there while fat can create cellular rejuvenation and mucosal tissue regeneration, which ultimately is responsible for their function.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
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
Indianapolis, Indiana
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
Indianapolis Indiana