PRP's multiple applications

Platelet-rich plasma (PRP) is not offered by a majority of aesthetic medicine experts even though the aesthetic benefits it generates are dramatic. When done properly, PRP creates impressive results both as an isolated procedure or when incorporated into a treatment plan with hyaluronic acid fillers, neuromodulators and technology.

Scott K. M. Barr, M.D., FRCSCScott K. M. Barr, M.D., F.R.C.S.C., plastic surgeon, director of Barr Plastic Surgery, and Medical Consultant at SKIN Medispa in Sudbury, Ontario, Canada, spoke to peers during the annual meeting of the Canadian Association of Aesthetic Medicine (Toronto, Nov., 2015).

PRP produces no aesthetic result if practitioners don't follow strict guidelines in performing the treatment, Dr. Barr says. Indeed, there are patient and physician factors that directly influence the outcome of a PRP treatment. 

"There is a list of medications that patients cannot take if they are undergoing PRP therapy because they (medications) affect the function of the platelets," he says.

Dr. Barr's in-house staff provides patients with a list of medications that patients would need to stop using at least 10 days before and after a PRP procedure. 

"We always ensure that the patients are aware of this list at the time of their consult," Dr. Barr says. "Patients do not consider Advil a medicine that is worth mentioning, for example, but it affects the regenerative power of platelets. Vitamin E would also affect platelets."

In addition, there are some platelet conditions that would make a patient's outcome less dramatic, he notes.

Most offerings in aesthetic medicine are safe when provided by experienced physicians, and it is no truer for PRP, according to Dr. Barr.

"PRP is extremely safe," he says. "It uses the healing powers of a patient’s own platelets. Nineteen growth factors are released from the platelets and the rejuvenation occurs over the three months after the PRP is done. We are capturing the body’s rejuvenating potential and placing it where it can provide the maximal aesthetic benefit."

NEXT: A place for PRP

A place for PRP

Indeed, Dr. Barr put forth that ideal PRP patients are those seeking to harness the natural aesthetic powers of their own platelets to augment their facial rejuvenation, alone or in combination with neuromodulators, volume restoration and technology.

Another advantage of PRP is that the procedure can be done in a clinician's office and produces virtually no downtime in the treatment of wrinkles, melasma, and acne scars. Exceptionally, there is some downtime when it is used to treat the lower eyelids.

"In the lower lids, patients will experience some fullness for 36 hours," he says. "This can be hidden with sunglasses or 'cheaters', but many will choose to spend time at home after they treat their lower lids. Many of our patients choose to do this on a Friday and are back doing whatever they want by Sunday."

PRP is effective as a stand-alone therapy when treating the thin skin, lower lid pigmentation and fine lines, Dr. Barr.

"For more significant peri-orbital aging, we correct a long, lower lid and deep tear trough with HAs and the brow position, crows (crow's feet) and mid-brow furrows with neuromodulators during the same sitting as the PRP treatment," he said. "The impact of PRP on the lower lids lasts about two years. You can create a phenomenal outcome."

The feedback that Dr. Barr receives from patients is that PRP enhances skin quality. "There are textural changes, and the changes are noticeable to patients," he said in an interview.

Dr. Barr has found success with PRP in erasing forehead wrinkles and necklace lines on the neck. "We tell patients it is like their platelets cause a 'photoshop' improvement on their lines," he said.

NEXT: Combining therapies

Combining therapies

Still, PRP can be used in combination with neuromodulators and hyaluronic acid fillers to produce optimal outcomes in aesthetic rejuvenation.  "We optimize the synergistic effect when we combine different modalities and treatments," Dr. Barr says.

Dr. Barr is aware that many physicians layer PRP on top of skin that has been exposed to a procedure such as microneedling. While there is evidence that this does produce improvement in the skin quality, he questions whether patients are receiving the maximal impact of their PRP treatment.

"I am not convinced that it (PRP) will absorb into the skin," he says. "In my experience, it makes more sense to inject it into the dermis so the full duration of PRP is realized, rather than having it lost when the PRP is washed from the face."

In terms of mixing PRP with HA fillers and injecting them in a depot fashion in the deeper injection planes, Dr. Barr says he has not seen any definitive research to show any long-term benefit when this is done.

It is critical to allow intervals of at least six weeks between PRP treatments, and the number of treatments will vary depending on the purpose of the treatment.

"It would be two treatments for eyelids and fine rhytids, and for melasma or for acne scars, there may be three or four treatments," Dr. Barr says.

One of the newer applications of PRP is for the treatment of hair loss, he notes.

"It is used to reverse the hair loss in men and women as part of a multi-step treatment of the scalp that is done under local anaesthesia," Dr. Barr says. "It appears to 'reset' the hair follicles and reduce the impact of DHT(dihydrotestosterone) on hairs that have the receptor for DHT. This takes about an hour and many patients have seen a reversal of their hair loss or, at a minimum, a prevention of further hair loss." 

Additionally, Dr. Barr places PRP augmentation solution to the recipient sites and the grafts during hair replacement procedures.

"We have seen a dramatic increase in the hair counts and density much earlier than in the past. Using PRP, our outcomes are the best we have seen since we started hair transplants over 11 years ago," Dr. Barr says. "Patients are amazed at the early and long-term outcomes they are seeing."

Another condition where Dr. Barr has seen success with PRP is in the treatment of melasma.

"This is a long-term problem for many women, and especially young mothers due to the hormone changes with pregnancy and BCP," Dr. Barr says. "Melasma has historically shown resistance even to optimized topical treatment protocols. Using PRP, we have seen many women experience a dramatic improvement in their melasma. In addition, patients treated with PRP have noted that their melasma doesn’t return as aggressively with sun exposure. This has proven to be a great treatment option when used in combination with optimized skin care for women that have been plagued with this condition."  

Managing patient expectations in terms of results achieved with PRP is critical, he says.

"You need to tell your patients that they won't see final outcomes for about three months after the last session," he notes.

Dr. Barr suggests using one of the proven PRP systems and getting peer-to-peer training to learn many of the nuances of PRP treatments.

"We use the Selphyl^® system in our office, but there are many manufacturers of high-quality PRP systems. The system should separate all of the available platelets and serum from the red blood cells and white blood cells," he explains. "The final outcome is then determined by patient education and physician technique."

He suggests treating a few staff members who interact directly with patients in a clinician's practice.

"They will become a great resource and referral base for the rest of your patient population," he says.