PRP Archives | The Aesthetic Clinique

Lasers versus Radiofrequency Microneedling (RFM) for Acne Scars

Traditionally, lasers were the gold standard for acne scars. Specifically, ablative lasers, CO2 and Erbium, have been advocated over the nonablative lasers such as Fraxel 1550. In 2013, radiofrequency microneedling (RFM) was approved in the US and the dominance of lasers for acne scars has come under scrutiny. While there are indications for both technologies, this blog will elucidate the decision tree for which technology to use.

Fundamentally, ablative laser energy (heat) is generated outside the body and is driven into the skin at a temperature that causes ablation (vaporization) of the tissue ~ 100 C. Radiofrequency Microneedling generates it’s heat within the tissue by passing current through it. As the current encounters resistance (impedance), heat is produced to a level of coagulation ~ 65-70 C.

The number one concern with ablative laser is healing. While fractional technologies improve the downtime and risks, outcomes are sacrificed. Sometimes several treatments are recommended to match the results that fully ablative lasers would achieve. Downtimes are still around a week or longer with fractional CO2. More importantly, since the laser heats and ablates the most superficial skin layers, the risk of post inflammatory hyperpigmentation (PIH) is almost unavoidable in skin types 4-6. While PIH is reversible in most cases, it can take months in some cases. Wound care is essential with ablative lasers, particularly use of occlusive emollients, to maintain a moist wound for best healing. Unfortunately, occluding acne prone skin often leads to acne breakouts. When breakouts occur, there is risks of actually creating more acne scarring and becoming counter productive.

Healing with RFM is easier and less risky. While there are devices with uncoated needles, the author only advocates the coated or insulated needles. (Uncoated will have similar healing properties as the lasers). Using coated needles, the only injury to the superficial layers of skin are needle punctures. In essence, the device “bypasses” the epidermis. The heat generated from the RF will be in the deeper aspects of the skin, where there are no melanocytes, the pigment producing cells. While there is swelling, redness, and sometimes bruising, the downtime is less with RFM when compared to ablative lasers, usually 3-4 days (individuals do vary!). More importantly, the skin surface heals quickly (similar to microneedling) and there is no need for occlusive emollients.

The depths of acne scars is highly variable, and there can be superficial and deep scars in the same individual. This is probably the most important factor as to what technology to choose. RFM has the advantage for improving deep scars. While depths of RFM aren’t accurate in most devices, in the Genius they are. The Genius is able to reliably place coagulation zones down to 3.5mm. Of note, 3.5mm is typically much too deep to attack acne scars and typical settings are usually up to 2.5mm. Lasers can typically reach 1.5-1.7mm. The energy delivered diminishes as the pulse goes deeper because the energy is absorbed by the upper layers of the dermis. So for the superficial scars – boxcar specifically – give the advantage to the ablative lasers (Look up Dr. Lim 360 degree laser treatment). Keep in mind that the RFM devices can go superficial and treat boxcar scars too.

RFM

Positives:

Safer for all skin types
Less downtime
Deeper penetration
Less PIH risk
Less wound care
Safe on all areas of the body

Negatives:

Not as good with superficial scars but can still treat them
Doesn’t resurface so no pigmentation improvements

Ablative Laser

Positives:

Good for superficial scars – boxcar
Improves pigmentation

Negatives

Long(er) downtime
Higher risk of PIH in types 4-6
Doesn’t treat deeper scars as well
More wound care that can lead to more acne
Higher risks of infection/scarring than RFM
Can’t be used off-face as safely as RFM

Keep in mind that acne scars require multiple modalities such as TCA Cross, subcision, fillers, skincare, PRP, amniotic growth factors to achieve optimal results. Multiple treatments are always required upfront, but also as the aging process causes collagen and fat pad volume loss.

The 5 Most Popular Instagram Cosmetic Procedures That Don’t Work

Instagram is being used as a marketing tool for all types of industries. Unfortunately, you can’t believe everything you see touted. This is especially true for aesthetic procedures. As with any, make sure you do your research, the before and after pictures are actually comparable and aren’t using lighting “tricks”, and the provider is experienced and reputable.

Lip flip with Botox – This procedure claims that the lip will turn up and make the lip fuller for very little money. If you weaken the muscles around the lips with Botox, there is no way this can end up lifting the lip. It also risks changing the smile, having difficulty with sipping and whistling.
Thread Lifts – The procedure consists of placing barbed sutures just deep to the dermis. The barbs engage into the skin and by pulling laterally and upward, they are supposed to lift and tighten. The posts on Instagram mainly show providers pulling on the sutures and watching the skin move. The problem is the sutures aren’t anchored in most cases and are attached to mobile skin. It’s impossible to lift when the entire are desiring lift is move. In addition, the barbs pull through their attachments very quickly, much sooner than collagen can be created to help anchor the suture. The side effects – visible threads, redness, puckering, pain – are as high as 34% in one study. In the same study, visible improvements were not apparent at 12 months. The noticeable changes in the author’s opinion are extremely mild and can be achieved with fillers in a more predictable and longer lasting correction.
Low Density PRP – PRP is short for platelet rich plasma. Unfortunately, there is no standard and the concentration for PRP is all over the map. In the majority of cases, 10-12cc of blood is being drawn to get 5-6cc of PRP. In these cases, the concentration is only about 2x (2 times the normal blood concentration) and all that has been done is the red blood cells have been removed by centrifugation. The benefits of PRP have been studied and optimal concentration levels to promote angiogenesis (new blood vessel growth) have been shown to be about 6X. If you are getting only a small test tube of blood drawn, you probably aren’t getting much benefit from the PRP.
MicroBotox for Necklace (“Tech Neck”) Lines: Horizontal neck lines are often called “Tech Neck” because some people believe they are caused by look down at your phone or computer. Providers are reporting improvements with injecting Botox in the lines in very small but multiple injections. In the author’s opinion, this is not the correct solution and these require filler +/- RFM (Genius) for optimal results. Static lines are not responsive to Botox. Dynamic wrinkles are what respond to Botox.
Using Radiofrequency That Doesn’t Penetrate Skin for Tightening: When an RF device is used to stimulate skin tightening, it must achieve 65-70 C to achieve coagulation. Anything short of coagulation causes temporary collagen contraction and denaturing but very minimal long-term effects. The epidermis needs to be kept at 42C or lower to avoid burns or hyperpigmentation. It is impossible to achieve coagulation in the dermis and still keep the skin surface at 42C or lower. So all the no downtime skin surface RF devices will need to be performed multiple times, have extremely variable results, and often very poor tightening effects. Optimal RF results require the energy to be introduced beneath the skin surface such as RF microneedling (Infini, Genius) or FaceTite/Accutite.

Remember, it all boils down to science whether a procedure works. If the science doesn’t make sense, the procedure probably doesn’t work.

2019 UPDATE: State-of-the-Art Acne Scar Treatments

Acne scarring has significant debilitating effects on one’s overall self-worth and confidence. Millions in the US are affected. There have been improvements in techniques and energy devices in past few years which have led to better outcomes for acne scar treatments.

Subcision – This is process of breaking up deeply tethered scar bands associated mainly with atrophic/rolling scars. Subcision has be performed for acne scars for decades and just using this procedure alone has proven to lead to significant acne scar improvements. Recently there have been a couple publications suggesting that cannula subcision had better outcomes, less downtime, and less discomfort than the traditional method of using a Nokor needle. A cannula has a blunt tip so it is also safer – less chance for cutting a nerve or blood vessel than the knife-like edge of the Nokor needle. In the study, both patients and the performing doctor rated the results better when using the cannula. Subcision is particularly important, in Dr. Weiner’s opinion, to be performed prior to any energy device for tethered scars. This is based on the fact that RF and laser will preferentially travel through collagen – which is high is water content – than fat or most other tissue. Scars are predominantly collagen, so it makes sense to cut the connection of the scar to the deeper tissue. Through personal communication with Dr. Davin Lim, biopsies he performed have shown scar band that reach the deeper fat pads from tethered acne scars. Transmission of the energy through the scar can theoretical lead to collagen contraction and deepening of the tethered scar. Sometimes fillers are placed at the time of the subcision to improve the volume loss associated with the scarring. Some hypothesize that putting a “spacer of filler” might improve results as well. Dilute lidocaine during the initial passes allows for this procedure to be well tolerated.

TCA CROSS – TCA (Trichloroacetic Acid) is a chemical peel used to improved acne scarring by placing minute quantities in the scar using a toothpick. CROSS stands for Chemical Reconstruction of Skin Scars. The most common use of this procedure is for ice pick and small boxcar scars. The process of causing a controlled chemical burn, allows for the body to heal from the deepest part of the scar towards the skin surface. This makes the scar smaller in diameter and shallower. Usually a series of 3-6 treatments are needed, with 3-4 weeks between treatments. There will be some mild scabbing for a few days which needs to be kept moistened for best results. Risk include widening of the scar or post inflammatory hyperpigmentation (PIH).

Radiofrequency Microneedling – This technology (RFM) has been available in the US for about 6 years and has revolutionized acne scar treatment. Using needles which are insulated, energy is delivered into the scar tissue directly and bypassing the epidermis, for the most part. The insulation protects the skin surface from heating so darker skin type individuals are at much less risk of PIH (post inflammatory hyperpigmentation) vs a laser treatment. The needles allow for deeper penetration than lasers as well. Overall, downtime is less than ablative lasers in most individuals (when insulated needles, proper technique, and appropriate settings are used). With acne scarring affecting darker skin types disproportionately, this is an excellent alternative to lasers. The Genius has recently been FDA approved and is now the “best of bread” RF microneedling device. There is now impedance feedback from the needles which allows for improved and exact energy delivery. The resistance in the tissues being treated is measured and this is important because throughout one’s face, there are differences, as well as between different individuals. Also, as tissue are heated or subcised, the resistance changes. Prior to Genius, there was no idea of how much energy was being delivered. There is now an accurate total energy for each pulse and a cumulative total. Other improvements include needle design-sharper, stronger motor, and feedback regarding quality of each pulse fired.

There is a myth that needs to be busted. Deeper does not mean better for acne scars.

The needles must stay within the scar for best results. If the needles go beneath the dermis, there is a risk for heating the fat and fat loss. Let it be known that the actual depth of the needles in most RFM devices is less than the settings, and becomes less accurate, the deeper the settings are. There is inherent resistance of the skin to penetration and many needles aren’t sharp enough or motors aren’t strong enough to get to the desired levels in the time required. This has also been addressed with the Genius and it’s depths are very accurate after extensive testing.

In addition, higher energy levels on any device which doesn’t monitor impedance, can actually result in very little energy delivered. Once the tissue is heating beyond a critical level, the resistance becomes so high that energy output cuts off. However, when higher energy levels are desired when using the Genius, the energy is adjusted to the increasing impedance and it is successfully delivered.

Fillers – Fillers are a very integral part of improving acne scars. They are extremely useful for the atrophic scars and the lipoatrophy associated with these scars. The aging process leads to dermal thinning and fat atrophy, which makes the acne scars appear worse, even if active acne has long been controlled. Fillers need to be injected deeply for correcting large areas of volume loss and superficially in minute quantities for focal defects. A hyaluronic acid filler will give about 12 months of improvement vs Bellafill which can give near permanent improvements. Bellafill does require a skin test to see if one has a allergy to the bovine collagen (0.5% chance) which needs 3-4 weeks to determine. There is some who feel fillers in areas of subcision will prevent re-adhesion of the scars. Most failures from other treatments are related to not recognizing the need to fillers to improve the acne scars.

Lasers – Erbium/CO2 ablative lasers still are beneficial for acne scars but have more downtime and risks vs RFM. Deeper skin imperfections are not improved with lasers and require fillers. These devices are best reserved for more superficial scars, mainly boxcar scars. Non ablative lasers are less affective but safer and in the author’s opinion give very minor results.

Microneedling – Also know as “Collagen Induction Therapy” CIT, has become popular in recent years. There are rollers available for home use and then there are medical grade devices which go to depths of 2mm or deeper and create thousands of penetrations per second. Rollers should be not be used at home for 2 reasons – questionable sterility at home and they tear tissue more than the in-office devices. Often these treatments are combined with topicals and PRP. It is highly recommended to not use any products on the skin which would normal not be injected. There have been many cases of infection and granulomas from these practices. Even when done in the office with PRP or amniotic membrane products, the efficacy of this procedure is minimal, and should be reserved for only mild acne scarring.

PRP/Amniotic membrane products – There is some date to support that better results and faster recovery with less side effects if PRP or amniotic membrane products are used during acne scar treatments. There is a movement more towards amniotic/placental products and away from PRP because there are more growth factors/healing properties in these vs PRP.

LLLT – There is a plethora of studies to suggest that using low level laser light (LLLT) is beneficial to results and healing times. The most researched device is Healite, and this should be performed immediately following all acne scar procedures which use energy devices. It calms the skin and improves circulation.

Acne scarring procedures are continuing to improve as technology and techniques evolve. One must understand that results require months to fully appreciate and multiple treatments (3-5 or more) are often needed to optimize results. Expectations need to discussed with providers/patients so that all are on the same page as to what one can achieve with treatments.

Dr. Weiner is an Acne Scar Center of Excellence designated by Bellafill and is a specialist on acne scars. He is a lecturer and trainer for Bellafill. He has become one of the leading authorities on Radiofrequency Microneedling and travels the globe lecturing on this technology. He performed the FDA trails for the Genius. He recently authored a chapter on RF Microneedling which soon will be published in the Facial Plastic Clinics of North America. He also wrote a recent chapter on Radiofrequency Safety and Complications which will be part of a book titled “Complications in Minimally Invasive Facial Rejuvenation: Avoidance and Management” by Paul Carniol, MD

Deceptive Practices Used in Before and After Photos

“A picture is worth a thousand words”. It’s true, seeing a great before and after speaks volumes for a certain physician’s or practitioner’s abilities. Unfortunately, there are some deceptive practices that can trick the eyes into believing results are better than they are really are. Instagram is a showcase for the aesthetic industry, but there is no oversight as to the claims made on the photos displayed. The bullet points below will help one to develop a critical eye to discern the truth from the “fictional results”.

Lightening must be the same in both pictures. A common misleading practice is to have a dark before picture and a light after picture. In the lighter picture, wrinkles and shadows are going to be less, and fool the observing into thinking these were related to the procedure.
Angle of the neck/head must be the same in both pictures. Take a look at the nose and jaw to see if the head is in the exact same position. If the head is tilted more upward in the after picture, the neck will appear to have less fullness, less wrinkles, and be firmer. This is particularly popular in the Kybella before and after photos.
The expression must be the same in both pictures. If a patients is partially smiling in the before and not in the after, the wrinkles around the mouth and cheek will appear falsely improved.
Sculptra pictures should have at least a 3-6 month interval. Sculptra is always mixed with water or saline for reconstitution. The immediate results after injection reflect merely the effects of the water/saline and not that of Sculptra. The collagen stimulation from Sculptra will take at least 3 months to appreciate, with 6-9 months being even a better gauge of results.
Using company photos or other physician’s photos without noting this or giving the appropriate credit on their websites or posts is also a common practice.
If make-up is used, it must be similar in both photos. Too often the before has none and the after has make-up.

Perfect before and after photos are very challenging. Even when results are extraordinaire, there are often difficulties trying to capture these changes with the camera. However, purposely trying to “enhance” photos with the practices above must be pointed out to the practitioners.

Introducing the Concept of “Age Freezing”

The nonsurgical aesthetic industry has finally hit an important milestone. Using a combination of techniques, cosmetic physicians are now able to halt, and even reverse, the age-related changes which occur to one’s face. In the past, technologies would allow for turning back time for a few years but eventually, the inevitable and undeniable signs of aging would occur. As lasers, radiofrequency (RF), filler and neuromodulator techniques have improved, the aging face is a thing of the past. The concept of “age freezing”, keeping ones looks for a decade or more, is not merely a dream, but reality. More importantly, this all can be done without surgery!

Not everyone is a candidate for “Age Freezing” unfortunately. The stipulations are:

Must be a nonsmoker – There are several significant skin and health issues associated with smoker which can’t be overcome. Many procedures require healing and collagen stimulation which are inhibited by smoking.
Free of chronic debilitating disease – There are tolls long term diseases take on the body which lead to premature aging, cellular changes.
Stable weight – As Katherine Deneuve once stated, at the age of 40, you must decide between your ass or your face. If you lose too much weight, fat is lost from your face. In most instances, this can be overcome but not always. However, in patients with significant weight gains, there can be some difficulties maintaining the same look one had in the years prior.
Alcohol consumption in moderation – Alcohol can take a toll on the body in the long run when taken in excess. 1-2 drinks per day is the recommended maximum intake that the author recommends.
Healthy lifestyle and diet – Although this topic overlaps some of the previously mentioned necessities, a good exercise regime is also required. The benefits of exercise on weight, hormones, circulation all benefit the facial appearance. Obviously, a well-rounded diet full of antioxidants, vitamins, and nutrients is beneficial too. There is research to support telomere lengthening with these measures as well.

The requisite procedures for “Age Freezing” are:

Neurotoxins on a regular basis. Relaxing the hyperdynamic muscles of the face with either Dysport or Botox needs to be performed at least 3 times per year. The regularity is needed to keep the muscles weak and prohibiting them from regaining strength.
Dermal Fillers for lost volume. Fillers are the epicenter of the whole “Age Freezing” concept. Beginning in the mid 30’s, at least a cc of volume is lost per year. This is the result of fat, bone, and muscle loss. Replacing and keeping up with this process is tantamount to looking young. Large volumes are best replaced with using Sculptra, a collagen stimulating filler. It is best to recreate the foundation with Sculptra. Superficial fine tuning is best performed with a hyaluronic acid filler, such as Restylane. New techniques using blunt cannulas permitted safer, less downtime procedures. A comprehensive understanding of the aging process has enlightened our specialty as to what needs to be corrected for accomplishing age reversal.
Skin Tightening to reverse gravity. The constant downward pull due to gravity leads to skin laxity, above and beyond what is attributable to volume loss. Devices that heat up the dermis will stimulate collagen and tissue contraction. Devices vary in their ability to tighten, often with a tradeoff of more downtime/discomfort/risk for more results. Ablative lasers, CO2 and Erbium, will give the most tightening for lasers. Radiofrequency can also be used, with the microneedling RF, such as Infini, giving the best results. A new procedure called JPlasma, looks like it may have promise in significant tightening, but does have about 14 days of downtime and a month of redness.
Skin Resurfacing to improve pigmentation, fine lines, and thicken the dermis. The aging process, primarily due to sun exposure, causes skin to thin with loss of collagen and elastin. Dyspigmentation, pigmentation problems, occurs as well. Renewing the surface of the skin can be accomplished using lasers, such as the Fraxel Dual, or chemical peels. Microneedling can thicken the skin by producing small injuries in the dermis with very little downtime or risks. There may be benefit to adding PRP, platelet rich plasma, to the skin, but the jury is still out.
Skin Care is essential to achieve the optimal results from any of the above mention procedures as well as to improve one’s skin health. Retin A or Retinol should be a staple in one’s nightly regime. These products stimulate skin turnover, reversal of pigmentation problems, better hydration with hyaluronic acid stimulation, and collagen production. Blemishes/Acne breakouts are improved with these products as well.
Oral Supplements are key to good, healthy skin. Oxidants are the source of disease, cancer, aging, and skin damage. To neutralize the oxidative stress, strong anti-oxidant supplement(s) are necessary. Examples include: superoxide dismutase, fish oils, resveratrol, Polypodium leucotomos, turmeric, and glutathione. In addition, the antiaging benefits of Metformin are hard to dismiss with the current research published. Lengthening one’s telomeres with TA65 is probably beneficial as well.

One must understand that the “Age Freezing” concept is a process. It is a lifestyle, a choice. It is not a “one and done” procedure. It consists of regular visits to an aesthetic physician. There are big steps and little steps along the way. The author has dozens of “Age Freezing” patients whom look younger and better, 10 or more years after initiating treatments. “Age Freezing” will eliminated the need for future cosmetic surgery.

Treating Post Inflammatory Hyperpigmentation (PIH)

Melanocytes are the cells responsible for the pigmentation in the skin. Their activity can be increased in response to inflammation. When skin becomes hyperpigmented from an injury, it is called “post inflammatory hyperpigmentation” or PIH. This is particularly prevalent in darker skin individuals, where there is more melanocytic activity, but can occur in lighter skin individuals as well.

The widely accepted scale for skin pigmentation types is the Fitzpatrick Scale. The Fitzpatrick Skin Type 1 are extremely light skinned, have blue eyes, and burn extremely rapidly with sun exposure. Type 6 individuals have very dark skin, dark eyes, and tolerate prolonged sun exposure without burning. In general, the type 4-6 skin types are the ones at risk for PIH.

PIH is possible after the following:

Laser procedures (mainly laser resurfacing)
Acne
Surgical incisions
Chemical peels
Burns
Infections
Radiofrequency (Infini is low risk)

The best way to treat PIH is prevention, if possible. Prevention consists of calming down the melanocyte metabolism. The standard recommendations are Retin A and hydroquinones. If there is a procedure a darker skin individual is planning that has risks of PIH, this regime should be started at 3 weeks prior to the procedure. It should be continued at least a month and up to 3 months afterwards. These 2 topicals are also standard therapy for patients with PIH.

Prolonged inflammation after a procedure (more than a week) in a darker skin individual, is a risk for PIH. The practitioner needs to recognize this and treat the inflammation appropriately. If there is prolonged redness of the skin, steroids and/or vascular lasers are needed to reduce this. If infection suspected, antibiotics are needed. Calming the skin is essential to prevent PIH.

The timing of PIH is very predictable. It almost always occurs about 3 weeks after a “at risk” procedure is performed.

If there is already PIH, treatments which can be used are:

Topicals such as Retin A, hydroquinone, and steroids; Triluma contains all 3
Chemical Peels
Gentle laser treatments with a 1064 laser (nanosecond or picosecond)
Possibly PRP with microneedling (experimental but minimal risk)
Antibiotics for ongoing infections
Laser hair removal for PIH associated with folliculitis

In general, PIH is best prevented then trying to treat after it occurs. Recognizing risk factors with certain procedures is the key to success. Treating prolonged redness is often overlooked and must be treated aggressively rather than taking a “wait and see” approach.

Not All PRP is Actually Rich in Platelets…Do The Math!

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There is an increasing recognition of the power of PRP (Platelet Rich Plasma). Platelets contain a high concentration of growth factors and immune modulators which have been shown to improve wound healing, improve hair growth, and possibly rejuvenate skin and other areas of the body. The “Vampire Facial and Facelift” have become popular procedures in medspas and refers to applying PRP into the skin surface with microneedling devices (facial) or more deeply with injections (facelift). Wound care centers have great success at expediting healing in chronic would which have failed conventional therapy. Many orthopedic joint problems have been improved or resolved with PRP injections into the joint area. Cardiac surgeons have noted a significant drop in wound problems by using preventative treatments with PRP. Hair growth has been documented with PRP scalp injections and improvement in hair transplant results are found by bathing the follicles in PRP prior to implantation has been noted. Laser resurfacing has been shown to heal faster when PRP is applied immediately to the skin. It is clear, PRP has significant benefits for multiple medical ailments.

What’s even better news is that using PRP is extremely safe! Essentially what PRP consists of is using your own blood and isolating a concentrated portion of it, the platelets. This is where the lack of regulation can be abused. Since the FDA has considered PRP to be “minimal manipulation” of taking something out of the body and then placing it back, there is no FDA approval needed and oversight is minimal. The problem then becomes that there is tremendous variation is what one office considers PRP versus another office and concentrations of platelets can be all over the map.

Blood is essentially 2 components – Red blood cells (RBC) and plasma. In normal individuals, RBC’s make up about 40% of the blood (hemoglobin of 40). Plasma is serum and platelets, the other 60%. So in a 10 cc blood sample, about 5cc can be considered useful for making PRP. Through a process of centrifugation, the RBC’s can be removed, and the concentration of platelets can be increased. It has been shown by studies, that the “sweet spot” for PRP is a platelet concentration of 6X (1.5 milllion/ml) the normal value found in blood. Higher concentrations have been shown in some studies to actually be counter productive and lead to more inflammation, and lower concentrations have less improvements.

So, doing the math, if only a 10cc tube of blood is drawn, only about 1cc of useful PRP is obtainable if shooting for the 6X goal. A cc of PRP is 1/5 of a teaspoon…not much. Much higher volumes are needed to get an adequate amount of PRP to be useful (the author uses 60-120cc blood volumes). There was one study presented at the IMCAS conference in Paris over 2 years ago (which the author attended) which looked at the concentration of platelets using 14 different devices. In about half the devices, the platelets weren’t even concentrated more than what is found in normal blood. Only half the remaining were in the therapeutic “sweet spot” of 6X concentration.

Bottom Line: If only 10-20cc of blood are being drawn, then the final product is either not the ideal concentration of PRP (6X) or the volume of PRP is too small to be useful!

There is no doubt that there are clear benefits to PRP in the areas of wound healing, orthopedics, and hair restoration. However, with the lack of FDA oversight, many patients who think they are receiving therapeutic doses of PRP, are actually getting suboptimal doses or just plain plasma, which has little to no benefits. When seeking out PRP treatments, make sure that provider knows the concentration of platelets that his/her device is producing, and the math makes sense.

Hair and Eyebrow Restoration Completely NonSurgical using PRP and ACell

PRP was injected for hair regeneration, from Prime Journal article

PRP was injected for hair restoration, from Prime Journal article, one treatment

PRP was injected for alopecia areata. From Prime Journal, one treatment

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PRP is “Platelet Rich Plasma”, a portion of whole blood that is separated from the red blood cells through centrifuging. It should contain concentrations of platelets that are at least 4 times that of what is found in whole blood to get the maximum benefits. Its use in medical conditions started in the 1990’s mainly by Orthopedic Surgeons, Dentists, and Oral Surgeons, but has recently been expanded to the Cosmetic Surgery arena.

(Please note: Not all PRP is the same! Most PRP systems don’t get the concentration of the platelets above the 4x level needed to get the full benefits from PRP. The system that has proven to have consistent 4-7x concentrations is the Magellan “TruPRP” system. It cost much more that the other systems, but the results will be superior to all other PRP systems available on the market. In a recent lecture that Dr. Weiner attended in Paris at IMCAS 2014, 13 different PRP machines were evaluated. Some systems didn’t even result in platelets that had higher concentrations than whole blood!)

When an injury occurs in the body, platelets are the “first responders”. Platelets have been found to contain the following growth factors and cytokines:

Platelet derived growth factors
Transforming growth factor beta
Fibroblast growth factor
Insulin-like growth factor 1
Insulin-like growth factor 2
Vascular endothelial growth factor
Epidermal growth factor
Interleukin 8
Keratinocyte growth factor
Connective tissue growth factor

PRP use in hair restoration began during hair transplantation 5-7 years ago. Surgeons found that bathing the harvested hair follicles led to improvements in the “take” of the transplanted follicle as well as more hair growth, and denser hair growth. Injecting PRP in the harvested area led to improved healing of the scar. It was then discovered that when PRP was then injected into areas of hair loss without transplanting hair, that there was new hair growth. Adding ACell (a derivative of porcine bladder) and Vitamin D3 and B complex gave even further improvements. In a study published in “Prime” Journal, patients were found to have improvements in their hair growth from 12-63%, and notably, there was improvements in all the patients studied. Growth seems to start at about 4 months, and starts to fade at about 11 months. Improvements are more dramatic in females than in males.

The mechanism proposed for the improvements seen is that the PRP leads to increased vascularization of the hair follicles, leading to a “waking up” of previously poorly perfused hair follicles. The growth factors also stimulate the hair follicles to produce hair.

Interesting findings have been thickening of hairs that have been growing but have miniturized (become thin). It will not cause hair to grow in areas of scarring or in areas where there was never hair. It’s also been found that new hair growth is sometimes pigmented in areas where hair had turned gray, representing a “youthful” follicle.

Recommendations are for at least one treatment yearly for females, and 2 for males. Topicals such as Rogaine or Propecia should be continued.

The process starts by drawing blood, 60-120cc. It is put in the Magellan processor to separate the PRP, which takes about 15 minutes per 60cc of blood. During this time, the scalp in numbed up with both topical creams as well as injections. When numb, the scalp in injected with the vitamin and mineral mixture as well as with the ACell solution. The PRP injection in then performed. The final process is using the Dermapen microneedling device to create very fine holes in the scalp. A by product of the Magellan PRP system is “PPP” which is platelet poor plasma. PPP has growth factors, but to a lesser degree than PRP. This solution is spread on top of the scalp and will be left there overnight. Washing the hair can be done the following morning. Sometimes extra PPP will be given to the patient to apply to the scalp at home. The total in office time is about an hour or an hour and 15 minutes. A second treatment (for men) is scheduled at 2-3 months.

Dr. Weiner is a Facial Plastic Surgeon who laid down his scalpel in 2005 and concentrates solely on noninvasive and minimally invasive Cosmetic Procedures. He is Johns Hopkins trained and Board Certified.

Website: http://www.theclinique.net

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Facebook: https://www.facebook.com/TheAestheticClinique

PRP and it’s Uses in Cosmetic Procedures: Facial Rejuvenation and Hair Growth Restoration

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PRP is “Platelet Rich Plasma”, a portion of whole blood that is separated from the blood through centrifuging. It should contain concentrations of platelets that are at least 4 times that of what is found in ordinary blood to get the maximal benefits. Its use in medical conditions started in the 1990’s mainly by Orthopedic Surgeons and Oral Surgeons but has recently been expanded to the Cosmetic Surgery arena.

(Not all PRP is the same! Most PRP systems don’t get the concentration of the platelets above the 4x level needed to get the full benefits from PRP. The system that has proven to have consistent 4-7x concentration is the Magellan “TruPRP” system. It costs the most but the results will be superior to all other PRP systems available on the market. In a recent lecture Dr. Weiner attending in Paris at IMCAS, 13 different PRP machines were evaluated. Some systems didn’t even result in platelets which were higher concentrations than whole blood!)

When an injury occurs, platelets are the “first responders”. Platelets have been found to contain the following growth factors and cytokines:

The end result of the combination of these growth factors is increasing the vascularity to the injured area, decreasing the inflamation, laying down new collagen, healing the injured tissue and generation of new tissue.

Studies have shown the benefits of these growth factors in multiple different areas of medicine:

Improved healing in orthopedic injuries
Faster and better integration of bone grafts
Improvements in healing of chronic wounds such as diabetic foot ulcers
Improved outcomes with hair transplants

About 3 years ago, Dr. Charles Runels, devised a new PRP procedure which he called, “The Vampire Facelift”, for facial rejuvenation. The procedure involves injecting dermal fillers, Juvederm, and combining it with injections PRP into the face. The theory is that the PRP will release all the above mentioned growth factors and cytokines and turn on “the healing process” in the aging face. The benefits of the “Vampire Facelift” are:

Collagen stimulation
Neovascularization (new blood supply to the skin)
Collagen remodeling (for scars)
Dermal thickening
Stimulation of fat growth leading to volumization of areas where fat has been lost

PRP has been used in conjunction with hair transplants for at least the last 5-7 years. Studies have shown that there is improved “take” of the grafts, faster growth of the transplanted follicles, as well as more plentiful hair growth. The PRP is bathed over the follicles prior to their transplanting as well as injected into the recipient and donor site areas. In the past few years, PRP with ACell (a membrane from pig bladder) has been injected into areas of hair loss WITHOUT TRANSPLANTS and results have been very promising. In a study published in the peer reviewed journal “Prime”, hair growth was seen in ALL patients, and ranged from 12-63% improvement. Women seem to have greater improvements than men for this treatment. It is recommended that men get 2 treatments, about 2-4 months apart, but women only need one. Once a year touch ups are needed.

The use of PRP is entering a new frontier in the area of cosmetic enhancements. Its benefits continue to be discovered in different applications and areas. It has no side effects because you are using one’s own tissue to heal and enhance your own body. It also is in nearly limitless supply. It seems only a matter of time when PRP will be mainstream for anti-aging treatments.