PRP mechanism and
indications
Dr Gita Faghihi
Assoc.Professor,dermatology department
Isf Uni.Med.Sci.
The most natural
injectable
Definition:
• Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets.
• As a concentrated source of autologous platelets, (17-19 folds / 3.3million /mm3)
PRP contains ,and releases (through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.
BUFFY COAT =PLATELETS + LEUCOCYTES
پالکتها از مترشحه فاکتورهای
PDGF(3 isomeres of platelet-derived growth factor (PDGFaa, PDGFBB, and PDGFaB),
significant role in blood vessel formation,
the cellular division of fibroblasts (the most common cells in connective tissue),
and in synthesizing the extracellular matrix and collagen
Other important growth factors include:
(TGFB1 and TGFB2), vascular endothelial growth factor, and
epithelial growth factor.
PRP
PRP stem cells growth factors• Biosynthesis Collagen Elastin and • Angiogenesis
Main indications of PRP:Sport related injuries:Aschilles tendinitis,,teniss elbow... osteoarthritis,muscle injuriesbone repair regenerationnerve injury
Clinical applications
In humans, PRP has been investigated and used as clinical tool for several types of medical treatments, including: • cardiac muscle injury, • plastic surgery, and maxillofacial
surgery.
anti-aging medicine and beauty sciences.
Indications as a whole
Botulinum toxin limited benefit for lines not due to muscle activity.
dermal fillers are generally used to establish the volume loss in the tear trough, can’t really use
fillers for the fine lines. This is where PRP really useful as it really helps
thinning eyelid
The most favorite area for
PRP is around the eyes.
Peri-orbital rejuvenation is a difficult area
Very important indicationsof PRP
• Periorbital (wrinkles fat pads and dark circles)
• Loose skin
• Saggy skin
biostimulation technique with own patient”s cells
autologous cellular regeneration ( ACR)
Xylocaine-P gel before injection for giving anesthesia
Injection levels are both in dermis and hypodermis,,some what overcorrected
Frequency and intervals of treatments:
For:anti-aging procedures
Most patients will require 2-5 treatments two months apart with results starting to show after 3-4 weeks.
Another protocol (Asian Clinic)Dr Naomi..
2 to 3 sessions of PRP each spaced about 1-2 months apart.reassess the patient about a month after the last treatment (usually at about 3 to 7 months after the first session)
to determine whether the patient has achieved the expected results or whether more sessions are required. the older patients probably need another treatments every 6 months or so ,..
Other indications: stimulating hair regrowth,
skin laxity on the body and
improving the appearance of stretch marks and
scars
Androgenetic alopecia one important indication of
PRPespecially when other treatments and HT surgery
are not accessible.
Hair follicle stem cells are activated and enhanced
growth, and the results are better to be seen after
hair transplantation.
Effective improvement (hair loss)
by PRp lasts about one year
Advantages of PRP therapy
• Autology: your own blood• Tissue regeneration and rejuvenation• Safety: non-allergenic and free from concerns over transmissible diseases such as HIV, Hepatitis B & C, CJD and so on• Faster healing: no fibrosis formation compared to some long term fillers, for example• Easy to use: dermal and hypodermal injections require only one syringe and one needle• Convenience: PRP harvesting can be easily and quickly performed in clinic. A sterile and registered specific kit for the blood puncture, the preparation of the plasma and the materials is used.• Cost effectiveness
SIDE EFFECTS OF PRP FACIAL REJUVENATION
• Pain and faint , headache, for first 12-24 hours are mild• Swelling and redness 1-3 days • bruising (2 weeks,, masked by make-up,,) • In rare cases, skin cellulitis may occur which can be treated
with antibiotics and cold compresses
• Possibility of small venule thrombosis,,• hyperpigmentation
PRP in people over 60 years of age
Although not impossible but they are poor responders.
Exclusion criteriae for PRP • Persons with active skin disease (such as : SLE,
porphyria, )• cancer chemotherapy,• severe metabolic and systemic
disorders(especially advanced diabetes and severe asthma….)
• abnormal platelet function (i.e. blood disorders)• Anti-coagulation therapy • underlying sepsis
Exclusion criteriae for PRP
• NSAIDS drugs during one week before
• History of recent stroke
• (heavy) Cigarette smoking
• Active infection at the inject. site
What to avoidpost—op care
• Avoid massaging or rubbing the treated area for first 48 hours after the treatment.
• Also avoid facial peels , and laser treatments for the first 4 weeks.
HPL(human platelet lysate)
• 2-10 times more growth factors than PRP and long term storation time
• Readily available growth factors faster regeneration
• Do not have platelet membrane ,no risk of allo-immunization
Platelet-Rich Plasma: Evidence to SupportIts UseCLINICAL CONTROVERSIES IN ORAL AND MAXILLOFACIAL SURGERY: PART TWOJ Oral Maxillofac Surg62:489-496, 2004
Robert E. Marx, DDS*University of Miami, FL, USe-mail: [email protected]
Reference:
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