IntrotoPRP,RichardWeissMD 1
IntroductiontoPRP(PlateletRichPlasma)RichardWeiss,MDMarch14,2017
PRPisbeingwidelyusedbyitselfandincombinationwithlaserskinrejuvenationto
reducefacialwrinklesandimprovethetoneandtextureoftheskin.Withinthelastsix
months,Ihaveincorporatedthistechniqueintomypractice.Havingseenmany‘fads’
comeandgointhisfield,Iamcautiousabouttheevaluationofnewmethods.Inthe
caseofPRP,becausetheresultsarefrequentlylessthan100%(inotherwords,we
reallycan’tmake60year-oldskinlooklikea20year-old–atleast,notineveryone!)it
isespeciallyimportanttohaveahealthyskepticismaboutexcessiveclaims.
InthecaseofthePRPtechnique,Ithoughtitmightbeinterestingformetoexplain
exactlywhatPRPdoes,andtoquotesomeofthescientificevidenceinpeer-reviewed
publicationsthathasconvincedmethatPRPisanimportantnewadditionto
rejuvenationprocedures.IoftenmentiontomypatientsthatIamalsoascientistwith2
patentedinventionsandmanypublishedpapers.Withthatinmind,I’dliketo
summarizesomeofthedatathatsupportsmyclinicalimpression(basedonmy
patient’simprovements)thatPRPworks–myevidence-basedconclusion–byquoting
somepeer-reviewedscientificstudies.
Whatareplatelets?
Plateletsareabloodcomponentwhosemainfunctionistostopbleeding.Weallhave
platelets.Itturnsoutthatplateletsalsohavegranulesthat,whenactivated,release
morethan10growthfactors(GFs)thatnotonlyattractmoreplateletstotheareabut
alsostimulatesnewcollagenproductionandmanyotherprocessesthatarebeneficial
tohealingandhealthyyouthfulskinappearance.“Plateletderivedgrowthfactors’main
functionsaretostimulatecellreplication(mutagenesis)ofhealingcapablestemcells.”
(1)Plateletscontainαgranules,whichcomprisecytokines,growthfactorsandbioactive
proteinsessentialfortissuerepairandhealing.
WhatisPRPtherapy?
“Inrecentyears,autologousplatelet-richplasma(PRP)hasbeenproventopromote
woundandsofttissuehealingandcollagenregeneration.”(2)Thisprogressivenon-
surgicalhealingtreatment“hasbeenusedsuccessfullyinorthopedic,vascular,oraland
maxillofacialprocedures,aswellascosmeticskinimprovement.(4)Ithasalsobeen
usedinOphthalmologyforyearstospeedepithelialwoundhealingofthecornea.
“BecausePRPalsoenhancessofttissuemucosalandskinhealing,itisusedin
connectivetissuegrafts,palatalgrafts,gingivalgrafts,mucosalflapstogetherwith
Alloderm(BioHorizons,Birmingham,AL)forrootcoverage,skingraftdonorand
recipientsites,dermalfatgrafts,facelifts,blepharoplasty,andlaserresurfacing
surgery.”(8)
IntrotoPRP,RichardWeissMD 2
PRPcontainsgrowthfactorsthathaveauniqueroleinstimulatingbiochemical
pathwaysthatpromoteskinrepairandregeneration.PRPiswidelyusedinaesthetics,
wherethenaturalcomponentsofthebodyareharnessedtopromoteskinrejuvenation.
Bystimulatingcollagen,elastinandcellulargrowth,aswellasbyimprovinglocalblood
supplyandhydration,theskintextureandtoneshouldgraduallyimproveandleadtoa
youngerlookingskin.
Thistreatmentcanimproveskintextureandtone,refinewrinklesandreducescarssuchasacneorstretchmarkswhilepreservinganaturalappearance.
“Skinagingisacommonandcomplexbiologicalprocess,characterizedbywrinkles,
epidermalanddermalatrophy,roughtexture,pigmentation,telangiectasia,andskin
laxity.PRPplaysavitalroleintheprocessofwoundhealingthroughsecretionofalarge
numberofgrowthfactors(GFs).Thesecanstimulatecellularmigration,proliferation,
andangiogenesis.PRPasanaturalreservoirofGFs,isabletofacilitatecollagenof
fibroblasts,keratinocyteproliferation,andhyaluronicacidgenerationtoincrease
dermalelasticity,andmayhaveapositiveeffectinfacialrejuvenation.Weinferredthat
usingPRPinultra-pulsedfractionalCO2lasertherapymayacceleratetissuerepairand
relievepain.”(2)
Bystimulatingcollagen,elastinandcellulargrowth,aswellasbyimprovinglocalbloodsupplyandhydration,theskintextureandtoneshouldgraduallyimproveandleadtoayoungerlookingskin.
HowdoesCO2LaserSkinResurfacingwork?
Thelaserisabeamoflightthatisabsorbedbywatermoleculesinourskincells.When
thewaterabsorbsthelightfromthelaser,itheatsupandthewaterisvaporized.The
heatalsocausescollagentighteningandstartstheprocessofnewcollagenformation.
“Ultra-pulsedfractionalCO2lasercanpromotefibroblastsmetastasis,andcollagen
regenerationthroughcreationofMTZ[micro-thermalzones].ThethermaleffectofMTZ
maynotonlyinducehyperplasiaandreorganizationofcollagenfibers,butalso
acceleratetissuerecoverybydirectlyvaporizingpigmentgrouporpigmentcells,
acceleratingskinmetabolism,andpromotingtheregenerationofdermisandepidermis,
therebyreducingoreliminatingmildtomoderatewrinkles,improvingskintextureand
color,shrinkingpores,andrelievingskinflabbiness,achievingtheimmediateandlong-
termeffectoffirmingskin.”(2)
“CO2devicesheattissuemuchmoreintenselythannon-ablativefractionateddevices,
ablatingepidermalanddermaltissuewithsignificantheatingoftheimmediately
adjacentdermalcollagen.Thiscollateralheatingcausesthermalalterationsinthe
helicalstructureofthecollagenfibrilsandresultsintissueshrinkagefollowedby
collagenremodelingandskintightening.”(5)
IntrotoPRP,RichardWeissMD 3
WhatarethebenefitsofPRPtomypatients?
“Whileittakessixweeksfornewcollagensynthesisandaboutsixmonthsforthefull
effectofthetreatments,thecommonresponsebypatientsaftertheinitialtreatmentis
thattheirskinhasa“glow”andfemaleswearlessmake-upandfeelmorecomfortable
whentheyarenotwearingmake-up.”(1)
What’stheevidencethatPRPworks?
1- “FibroblastsareamongthecellsthatareactivatedbyTGF-beta.Whenafibroblastisactivateditwillundergocelldivisionandproducecollagen.
Collagendepositionisresponsibleforplumpingtheskinandreversingthe
visiblesignsofaging.”(1)
2- “OnthePRP-treatedside,theepidermisisthicker,andthestratumcorneumisbetter-organizedthaninthecontrolspecimen,andthecollagendensityishigher,
withbetterorganizationofthethickercollagenfiberbundles.”(5)
3- “Insummary,theresultsofthepresentstudystronglysuggestthattheapplicationofautologousPRPcouldbeaneffectivemethodforenhancing
woundhealing,reducingtransientunwantedadverseeffects,andimprovingskin
tighteningafter…skinrejuvenation.”(5)
IntrotoPRP,RichardWeissMD 4
Summaryofselectedscientificstudies
Study1-In14patientstreatedwithlaserskinresurfacingandPRPonjustoneside,therewasroughlya10%improvementinpatientsatisfactioninfacialwrinkles,skin
textureandskinelasticity.“Patientintheexperimental(PRP)grouphadafaster
recovery,lessdurationofadverseevents,andbettereffectsthanthatinthecontrol
group.Intheprocessoftreatment,patientsfeltthatanydiscomfortcausedbylaser
therapywasrelievedbycoatingwithPRP.”(2)Subjectivescoresoffacialwrinkles,skin
texture,andskinelasticitywerehigherthanthatincontrolgroup.Additionally,thetotal
durationoferythema,edema,andcrustingwasdecreased.Synergisticeffectonfacial
rejuvenation,shorteningdurationofsideeffects,andpromotingbettertherapeutic
effect.”(2)
Study2–23consecutivepatients(agerange28-70,average47)weretreatedwith3monthlyPRPinjectionsalone.(3)Whenevaluatedonemonthafterthelastsessionwith
stateoftheartcomputerassistedphotography,therewasanoverall29%improvement
intheappearanceoftheskin.Facialscarsincludingacnescarsrespondedwell.Patient
satisfactionquestionnaireresults:
Doyouthinkyourgenerallookhasimproved? 87%YES
Doyouthinkyourwrinkleshaveimproved? 52%YES
Doyouthinkyourskintonicityhasimproved? 82%YES
Pleaserateyoudegreeofsatisfactionwiththetreatment?
Excellentimprovement 0%
Verygoodimprovement 4%
Goodimprovement 61%
Mildimprovement 30%
Noimprovement 4%
Caption:Dermacopecheekphotobeforeandafter3monthlyPRPtreatments
IntrotoPRP,RichardWeissMD 5
Caption:Scartreatmentbeforeandafter3monthlyPRPtreatments
Study3–FourpatientsweretreatedwithPRPonceintheupperarm,andthenhadskinbiopsiesovera10-weekperiod.“Histologically,at1week,activatedfibroblasts,new
collagendeposition,andangiogenesisinthemid-todeepdermiswasevidentandwere
accompaniedbyfocalareasofmildlymphocyticinfiltrates”(4)
“Asearlyas7daysaftertreatment,activatedfibro-blastsandnewcollagen
depositionwerenotedandcontinuedtobeevidentthroughoutthecourseofthestudy.
Developmentofnewbloodvesselswasnotedby19days;alsoatthistime,intradermal
collectionsofadipocytesandstimulationofsubdermaladipocytes.”(4)
Study4-FractionalskinresurfacingwasperformedontheinnerarmsandsingletreatmentPRPwasinjectedononesideonly.Biopsiesweretakenfrom5patients.The
skinhealedfasterandtherednesswentawaymorequicklyonthePRPside.Also,
thickercollagenbundleswereseenonthePRPtreatedsideatonemonth.“Theresults
inthepresentstudydemonstratedthatfasterwoundhealingafterlasertreatment
couldalsobeachievedwiththeapplicationofPRP.”(5)
Caption:Noticethethickerepidermiswithabetter-organizedstratumcorneumonthe
PRPside
IntrotoPRP,RichardWeissMD 6
Study5–Sclafani-15patientshadasinglePRPinjectiontothenasolabialfoldswitheasilyseenphotographicresultscontinuingfor3monthsaftertreatment.(6)Hereisa
patientwhounderwentsingletreatmentofnaso-labialfoldswithPRP,(a)
Pretreatment;(b)2weeksaftertreatment.
A–Pretreatment(beforeanytreatment)
B–2weeksaftersinglePRPtreatment
Study6–Shin-22Koreanwomenunderwent3sessionsoffractionallaser.HalfwerealsotreatedwithPRP.“PRPcombinedwithfractionallaserincreasedsubject
satisfactionandskinelasticityanddecreasedtheerythemaindex.PRPalsoincreased
theamountofcollagenandthenumberoffibroblasts.”(7)
Study7–Zenker–Thispapersummarizedtheresultsofenlisted172patientsinJapan(38-72years),194patientsintheU.K.(42-79years),and42patientsinIsrael(46-74
yearsofage).“PRPisaformofbiostimulationthatissafeandcreatesanimmediate
longlastingvolumetriceffectwithnaturallookingresults…andprovidedahighlevelof
patientsatisfaction.”(9)
IntrotoPRP,RichardWeissMD 7
Conclusions:
“Platelet-richfibrinmatrixinjectionleadstodevelopmentofnewbloodvessels,
activationoffibroblastswithneocollagenesisandadipogenesiswithinthedermis”(4)
“ApplicationofautologousPRPisaneffectivemethodforenhancingwoundhealingand
reducingtransientadverseeffectsafterFxCRtreatment.”(5)
PRP“canprovidesignificantlong-termdiminutionofdeepNLFswithouttheuseof
foreignmaterials.PRFMholdssignificantpotentialforstimulateddermalaugmentation.”
(6)
“PRPwithfractionallasertreatmentisagoodcombinationtherapyforskin
rejuvenation.Keratinocyteandfibroblastproliferationandcollagenproductioncan
explainthecapacityofPRPtoincreasedermalelasticity.”(7)
Summary
TheaboveevidencestronglysuggeststhatPRPworks.However,morestudiesare
neededtodeterminetheoptimalamountoftreatmentsneededandhowlongthe
resultslast.Fornow,though,PRPisawelcomeadditiontoourrejuvenationtreatments.
RichardWeiss,MDMarch14,2017
REFERENCES
1. Greco,J."Microneedlingandinjectingplateletrichplasmatoenhancecollagensynthesisandskintightening."(2008).
2. Hui,Qiang,etal."TheClinicalEfficacyofAutologousPlatelet-RichPlasmaCombinedwithUltra-PulsedFractionalCO2LaserTherapyforFacial
Rejuvenation."Rejuvenationresearch(2016).
3. Redaelli,Alessio."FaceandneckrevitalizationwithPlatelet-richplasma(PRP):clinicaloutcomeinaseriesof23consecutivelytreatedpatients.(ORIGINAL
ARTICLES)(Clinicalreport)."JournalofDrugsinDermatology(2010).
4. Sclafani,AnthonyP.,andStevenA.McCormick."Inductionofdermalcollagenesis,angiogenesis,andadipogenesisinhumanskinbyinjectionofplatelet-richfibrin
matrix."Archivesoffacialplasticsurgery14.2(2012):132-136.
5. NA,JUNG-IM,etal."Rapidhealingandreducederythemaafterablativefractionalcarbondioxidelaserresurfacingcombinedwiththeapplicationofautologous
platelet-richplasma."DermatologicSurgery37.4(2011):463-468.
6. Sclafani,AnthonyP.,andYushanLisaWilson."Plateletrichfibrinmatrixforimprovementofdeepnasolabialfolds."TheLaryngoscope119.S3(2009).
7. Shin,Min-Kyung,etal."Platelet-RichPlasmaCombinedwithFractionalLaserTherapyforSkinRejuvenation."DermatologicSurgery38.4(2012):623-630.
8. Marx,RobertE."Platelet-richplasma:evidencetosupportitsuse."Journaloforalandmaxillofacialsurgery62.4(2004):489-496.
9. S.Zenker.“Plateletrichplasma(PRP)forfacialrejuvenation.”JMedEsthetChirDerm.37:148,December2010,179-183.Munich,Germany
