The Amazing Platelet Rich Plasma (PRP)
by Joshua Crose D.O.
The human body is amazing at repairing itself. It loves to keep things running smoothly and hates injury or disruption to its daily routine. This is why our own immune system and injury-repair mechanisms kick into high gear when something damages us. Now imagine being able to take some of the main repair mediators, concentrating them, and injecting them in the area that you want fixed? It’s like bringing in 10 workers to build something that only has 2 people working on it. The job gets done faster and with better reinforcement of quality. This is how Platelet Rich Plasma helps rejuvenate our skin and connective tissue as well as help hair and collagen grow.
Platelet Rich Plasma is our own blood spun down in a centrifuge where the red blood cells and white blood cells are separated and discarded. The left over fluid is yellow to pink and contains platelets, proteins, and hormones. Studies have demonstrated that keeping a small percentage of the red blood cells can actually help the activity and potency of this product. That is why many of the PRP products on the market now look more red as about 5-10% of red blood cells (the lightest ones) at the top of their respective layer in the centrifuged product are included in the solution. Multipotent and mesenchymal stem cells have been found in this border zone between the clear yellow fluid and the dark red blood layer. It is sometimes referred to as the Buffy Coat layer due to its whitish coat appearance. It has dead cell parts and stem cells and many different cellular signaling chemicals (cytokines) in it too. Regardless of which PRP someone uses, they all concentrate the platelets and chemicals that are needed to help the body clot and heal.
PRP works when it is activated and doesn’t really work if it is simply injected back into the body. Think about this…it makes sense. Your body will not react badly to itself, right? Nor will it do anything extraordinary other than be annoyed by extra “friends” suddenly hanging out in a different area. The key is to activate or anger these “friends” (aka platelets) so that they release their stored help signals that promote rapid recruitment of other cells and initiate the healing cascade.
When the platelets in the PRP contact damaged tissue or are activated by calcium gluconate they degranulate and release their cell signals. These signals include Platelet Derived Growth Factor (PDGF), Tumor Growth Factor Beta (TGF -B), Fibroblast Growth Factor Beta (FGF-B) among others. This cascade then starts recruitment of other platelets, fibroblasts, white blood cells and starts the production of Endothelial Growth Factor (EGF), Vascular Endothelial Growth Factor (VEGF), and more of the above. It helps release Tumor Necrosis Factor (TNF), Interlukens (IL1, IL6, IL8, IL10) and many more hormones. Basically, a huge army is released to help repair the damaged or dying tissue. This cascade is heightened by increasing the concentration of the initial responders (PRP) and also helps rejuvenate older surrounding tissue. Thus, the increased vitality and youthful glow people get after facial treatments.
Platelet Rich Plasma is not a new product and though there have been inconclusive clinical trials in the field of Orthopedics, it definitely has shown benefits in Aesthetics. PRP helps boost collagen synthesis and restructures connective tissue as well as helps angiogenesis (blood vessel creation). It is perfect for the head, face, skin and hair, and helps hemostasis and coagulation. This is why PRP has a strong place in medicine and can help people rejuvenate their body.
I use PRP in my procedure because of the stimulating and rejuvenation effects as well as its amazing healing boost it provides to the area it is used. Most manufactures in the industry base the “concentration” of their final product on the highest concentration of platelets and/or one of the growth factors in the blood product compared to baseline concentrations circulating in the blood. The truth is that the “Concentration” of the PRP varies based on the each individuals amount of circulating blood products, proteins, and hormones. Thus, even though the centrifuge that is used to spin the blood down will consistently concentrate the blood by the same proportion every time, the final quantity of ingredients will depend on the amount of ingredients floating around in the donor’s blood at the start. Personally, I use a 5x concentrated PRP but I have the capacity to go up to 14x concentration with my Magellan Arteriocyte but I choose more volume over less so that I can treat the entire scalp when I perform hair transplantations or simply to boost hair growth. Additionally, this limits the total amount of blood I have to draw from my patients.
At Capitis Medical & Aesthetics, we do perform microneedling with PRP (aka vampire facial) and use it to boost hair growth as a sole treatment in both Women and Men. I also use it as an adjunctive tool in my hair surgeries to help expedite the healing and recovery of my patients.
I hope this summary provide a more detailed but by all means far from extensive review of how Platelet Rich Plasma works.
Why Hair Restoration?
by Joshua Crose D.O.
Imagine waking up and stumbling into the bathroom in the morning. You splash some water on your face and run your hands through your hair and notice a bunch of hairs stuck to your wet hand? Or looking down in the shower and watching a thick ring of hairs forming a circle around the drain? Distressing? Probably So. Especially for the millions of people, men and women, who notice their thinning hair progressing on a daily basis in the mirror. Hair loss is a common distressing element in many peoples lives and it afflicts them at much earlier ages than they would like to admit. Fortunately, there are many options to address this issue in today’s advancing world of aesthetic medicine.
As a Hair Restoration Specialist, I take pride in keeping up with the best options for my clients and always try to find an option that will work for them. Some of these options include medicines, herbal-based products, Low Laser Light Therapy, PRP injections, injectable growth factors and serums derived from stem cells or amniotic fluid, microneedling, and hair transplantation. Not every option is appropriate for each patient and should be discussed to clarify expectations as well as timeframes for efficacy.
AGA Hair Loss
Hair loss, or alopecia, has many different etiologies. Androgenic Alopecia (AGA) is the most common form of hair loss and affects approximately 25% of men but it can affect women too. It is caused by increased sensitivity of hair follicles and their papilla to Dihydrotestosterone (DHT). Unfortunately, this is genetic and if inherited there is little to stop the increased sensitivity to this hormone at this time in medicine. Currently, Propecia (finasteride 1mg) is used to treat this problem by blocking type II 5-alpha-reductase from converting testosterone into DHT. It works well with great clinical results to help thicken small, thinning hair and restart growth in dormant Telegen hairs but as soon as this medicine is stopped the hair loss process commences again. Regardless, it is a wonderful maintenance medicine that is taken once a day with minimal side effects but unfortunately it is not available to women of childbearing age.
In people with AGA pattern balding, hair transplantation is a great option as the hairs that grow in the back of our scalp do not display the same DHT receptors on their roots. Thus, they are not susceptible to the same decaying processes bestowed upon their brethren on the top of the scalp. So, for many men, and some women, hair transplantation is a great option. I personally offer Follicular Unite Extraction (FUE) predominately with the ARTAS iX robot but I also perform smaller cases manually. This process carefully dissects individual follicles from the back of the scalp that are then placed into a small incisions in the thinning or balding area of the scalp. They are carefully placed to emulate natural growth patterns of the individual’s hair. After 3-7 months, the majority of the new hairs have started to grow and will bestow a natural look to the patient.
Hair represents youthfulness as well as virility. It has a way of consciously and subconsciously affecting our perceptions, attractiveness, and most importantly – our confidence. I don’t believe everyone has to have hair and many men can look good with shaved heads, but for many others, this is not an option. Now, there are options to help address hair loss issues and I can help you find them.
In future postings, I will explain the benefits of some of the other regenerative medicine options. Feel free to contact me via this website or on my Instagram account.