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Dr. Barry Eppley

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Archive for the ‘platelet-rich plasma’ Category

Platelet-Rich Plasma (PRP) Injections as a Hair Loss Treatment

Wednesday, September 4th, 2013


The use of platelet-rich plasma (PRP) injections epitomizes the statement ‘heal thine own self’. Using a patient’s blood, a platelet extract is obtained by centrifugation that can be spot injected to an area of need. Since platelets are well known to be storehouses of growth factors and cytokines, their administration into a variety of wound problems has been shown to expedite healing. Conversely, their application to many cosmetic conerns, such as aging and wrinkles, has shown inconsistent results.

Scalp hair loss or alopecia is a multifactorial issue of which genetics have been shown to be as much a factor as any other identifiable factors. There are a wide variety of hair loss treatments from topical and oral medications to light therapies to hair transplantation surgery. The void between these treatment options is an injectable approach. The concept of adding stimulatory agents to the scalp by direct injection is certainly possible but the question would be what should the injected agent be. That answer is unknown but PRP would be a logical candidate, offering complete safety with potential effectiveness due to its growth factor content.

In the July 2013 issue of the European Journal of Plastic Surgery, an article was published entitled ‘Platelet-Rich Plasma Injection is Effective and Safe for the Treatment of Alopecia’. Over a one year period, 42 patients (mainly men) with androgenic alopecia had their balding scalps injected with 8 to 12 ccs of PRP. Prior to injection a hair pull test was performed. The injections were repeated five times over 2 months or every 10 days. Three months after the last injections, the results were assessed by photographs, hair pull tests and the patient’s satisfaction.

Before the injections, 90% of the patients had a hair pull test which averaged 8 hairs. After the third injection sessions, the hair pull test had decreased to an average of 3 hairs. Photographs showed a significant improvement in hair density and a high resultant high patient satisfaction. Better results were seen in patients who had noticeable hair loss that was less than two years old. Mediocre results were seen in patients with advanced hair loss and marked hair loss patterns.

This study shows that PRP injections into the scalp are ‘simple’, have no real risk and have some demonstrable effectiveness for slowing hair loss and inducing some hair regrowth. Why they may work is speculative. Numerous theories abound such as direct stimulation of the hair follicles by improved vascularity to activation of adult stem cells. The reality is no one knows for sure.

It is no surprise that PRP would have some regenerative effect on hair growth. But how practical is it? It requires repeated injections and I don’t think most patients would call putting 30 or 40 needle sticks into the scalp as ‘simple’, even though technically it is. How often and for how long must the injections be done? Although not stated, just like topical Rogaine or oral Propecia, I suspect treatments must be continued to have a maintained effect. It is not just as simple as that the injections ‘turn back on’ permanently the hair follicles ability for renewed regrowth. (that would require a genetic transformation)

PRP may have a role to play in hair loss treatments but papers such as this one are promising but not yet definitive on its benefits.

Dr. Barry Eppley

Indianapolis, Indiana

Stem Cells and PRP in Plastic Surgery – Anti-Aging Hope or Hype?

Sunday, July 14th, 2013


Some have said that the power to slow down aging or to ‘heal thineself’ does not come from some external source such as potion or pills but from within. This has led to the popularity of two natural materials derived from blood and fat. Stem cells (in fat) and platelets are located throughout the body and can be relatively easily harvested and prepared into an injectable form. This permits them to delivered into almost any body site to create either improved healing or a tissue enhancement effect. This has enabled such autologous injections to be used for a wide variety of medical applications including aesthetic and anti-aging applications.

The use of embryonic stem cells in numerous medical diseases is controversial. But the use of adult stem cells for their potential cosmetic and anti-aging effects is not open to as much criticism as there does not seem currently to be much downside. The debate with their use is whether they can live up to the hype. Numerous anectodal claims are made about such injections as creating youthfulness, adding permanent tissue volume and improving the appearance of the skin. This has led to a number of procedures being touted, particularly on the internet, with such names as stem cell facelifts and stem cell-enriched fat grafts. The names suggests that they are better than the traditional procedures.

But stem cell injections in plastic surgery today are, most of the time, fat injections that undoubtably contain stem cells but in what quantity and what activity is completely unknown. Although not cleared by the FDA for this use, there are machines available that can process fat to get a stem cell concentrate which can be injected. The problem with fat-derived stem cells is no one knows for sure what happens when they are injected or if there are any significant adverse effects long-term from doing so. It is reasonably assured that fat injections are completely harmless and that stem cell injections are similarly so, but that is a long way from being shown to be absolutely so.

Conversely, evidence that stem cell injections have any positive anti-aging effects by themselves has not yet been forthcoming. There is no doubt that the promise of stem cells is great in terms of potential tissue regeneration and some observable anti-aging effects on the skin. But there is very little data from human clinical studies that currently support any of the hype or marketing claims some doctors make. Injecting stem cells under the skin has not been proven to improve the appearance of the overlying skin. (fat injections are more promising based on the volume addition) The clinical results to date are isolated case presentations and subjective observations and substantial research is still needed to figure out the potential of stem cells. Thus for now, stem cell injections like stem cell containing skin serums, must be viewed as suspect.

Unlike stem cells, the positive effects of platelets on healing is more established. Wound healing is known to be mediated by a complex array of cellular and protein and peptide interactions. Platelets play a major role in this process. Platelet-rich plasma (PRP) is blood plasma that has a high concentration of platelets due to processing techniques. During the procedure, about 60cc of blood is removed from the patient and and the PRP concentrate is then obtained by a centrifugation process. This creates a few ccs of concentrated platelets (platelet plug) that can be added to a variety of plastic surgery procedures to theoretically improve their results. Due to its platelet contents, PRP contains many different growth factors and cytokines that have potent cellular and tissue stimulation effects.

While PRP can be used alone as an injection, its small quantity (usually about 3ccs) lends itself to be mixed or combined with other materials as part of the injectate. These could include fat or, more commonly, synthetic injectable fillers. There are several commercial aesthetic products which do just that with marketed brand names such as Selphyl and the Vampire Facelift. These products create either a platelet-rich fibrin matrix or are mixed or done right after the placement of such well known fillers as Juvederm and Restylane. The benefits of PRP in these facial rejuvenation techniques, while appealing, has not been fully substantiated in widespread clinical use and ongoing patient treatments continue to evaluate what role concentrated platelets may provide for volume retention and any other anti-aging benefits.

Stem cells and PRP are naturally derived products but that does not necessarily confer that more of them in one spot will be better than what we have residing in our bodies now. Their appeal is undeniable but that has not proven just yet that their benefits are equally so.

Dr. Barry Eppley

Indianapolis, Indiana

Topical Platelet-Rich Plasma (PRP and Facial Skin Rejuvenation)

Friday, March 15th, 2013


Just a few days ago, Kim Kardashian was in the news again with another plastic surgery adventure. This time it was about her receiving a so-called ‘blood facial’. Photos show her with blood apparently oozing or dripping from her face. A shockin as these pictures are, the ‘blood facial’ is not as gruesome as it appears to be but is actually based on well-known science and a recent method of promoting healing of various tissues throughout the body. Whether it is effective for facial rejuvenation and skin care is another matter…but more on that later.

The basis of the blood behind the ‘blood facial’  is known as PRP or platelet-rich plasma. This is an extract from whole blood which creates a concentrate of platelets. Platelets are well known to have high levels of grow factors which play a major role in how humans heal their own wounds. PRP is far from new and has been used extensively in medicine in every area of surgery, from orthopedics to podiatry. It has been used in plastic surgery from facelifts to tummy tucks to complicated wounds. I have mixed it for years in with fat when doing fat injections as a theoretical boost to fa tcell survival and stem cell conversion. There are now a variety of kits from numerous manufactureres to proces and prepare PRP for injection.

PRP is prepared by first taking a small amount of blood from the patient and using a centrifuge to separate into various layers. This creates a more solid layer of red and white blood cells and a plasma and platelet layer. It is the platelet plug and the plasma which makes the small but potent PRP material which is usually just a few ccs in volume. When loaded into a syringe it is ready for application.

While PRP is traditionally injected under the skin or mixed with other materials (e.g., fat) for injection, this is not how it was used in the Kim Kardashian story. In her case, it was dripped onto her face and then massaged ‘into’ her skin. While this sounds like it would be beneficial, this is a great example of what I call a ‘truism’.  It is assumed to be true because it just seems like it should. It sounds so logical that how it not be true? While PRP injected under the skin may stimulate collagen formation, that does not necessarily mean it would stimulate collagen growth in the skin when appled to it on the outside. Quite frankly, there is exactly zero scientific evidence that PRP has any skin benefits at all when applied topically. Some call topical PRP use controversial, but that would be an understatement. And just because a celebrity had the treatment done does not give it any more scientific credibility. (it makes for great TV and publicity however)

PRP has more credible uses for facial rejuvenation such as the interestingly named Vampire Facelift.  In this treatment, PRP is injected into the face in conjunction with collagen in a mixture known as Selphyl. It is purported to stimulate collagen growth and create a result that last up to two years after the injections. Patient results have been mixed but at least there is some theoretical science behind it…which is more than topical applied PRP can say.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review – Selphyl PRP Injectable Gel

Wednesday, October 3rd, 2012


Injectable fillers have achieved tremendous popularity and can be used for a wide variety of facial aesthetic needs. But most injectable fillers are merely temporary fillers that add volume and then disappears as the material absorbs. But a few contemporary fillers take a different approach, using natural materials whose intent is to stimulate local cellular and tissue growth which then creates the volumetric effect.

One of these autologous fillers is known as Selphyl. This is a unique system that creates a platelet-rich plasma (PRP) preparation from a small amount of blood. While PRP products are not new, what is unique about Selphyl is that it contains a fibrin matrix (Platelet-Rich Fibrin Matrix, PRFM) that wraps the platelets in its membrane allowing a sustained release of its growth factors after implantation. Such sustained release has the capability to promote the growth of new tissue through blood vessel and collagen stimulation, creating a natural tissue regeneration/augmentation.

The Selphyl system comes in a kit that allows the PRFM to be prepared in the office if necessary and takes about 30 minutes to do. Volumetric fill volumes are available in 4, 8 and 16ccs. It contains no synthetic or animal products, thus there is no chance of any allergic or immunologic reactions. While it is only FDA-approved for orthopedics, it is being widely used off-label in facial aesthetic applications for injection into wrinkles, folds, acne scars, hollows, tear troughs and in larger volumes for a ‘liquid facelift’. Best results are obtained with multiple injection treatments spaced four to six weeks apart, presumably due to the stimulation and build-up of collagen.

PRFM can be combined with other fillers, most notably fat. While theoretical, the introduction of stabilized platelets with fat and stem cells may allow more fat to survive or more stem cells to convert to fat cells.

Selphyl and its PRFM matrix is part of an evolving set of aesthetic treatments that are designed to stimulate collagen, improve the quality of the overlying skin and create an overall anti-aging effect. Patients are naturally attracted to an all-natural filler approach that employs local tissue regeneration to achieve the aesthetic goal.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma Facial Injections – Youth Serum?

Monday, August 27th, 2012


The search for a ‘magic serum’ that has the ability to rejuvenate the face and its overlying skin is both an unsolved hope and an endless quest. There are more topical creams and lotions that allege to create more youthful skin that one could ever purchase. But attention recently has turned to  injectable options to be placed under the skin. The use of synthetic injectable fillers has been around for more than ten years and their effects, profound as they may be, are not permanent and the evidence is weak that they cause any real skin changes.

Another injectable ‘rejuvenative serum’ is that of platelet-rich plasma. (PRP) Derived from the patient’s own blood, it can be defined as the portion of the plasma fraction of blood in which the level of platelets is higher than normal. This platelet concentrate results in high levels of a variety of growth factors from PDGF, FGF, EGF, VEGF and TGF-beta.  PRP has been studied extensively in wound healing and beneficial effects have been seen from chronic wounds to bone grafting. Such benefits in challenged wounds have logically raised the question of whether it would have rejuvenative effects in aging tissues.

There have been few well controlled clinical studies that have evaluated the effects of PRP on facial rejuvenation in an objective scientific manner.  In contrast, there is a large amount of marketing and hype that has surrounded such PRP facial injections. As with many aesthetic treatments largely driven by economic gain, marketing often gets way ahead of actual scientific proof. But of the handful of clinical aesthetic PRP injections, skin texture improvement and wrinkle reductions were seen and patient satisfaction with the treatments are usually more favorable than unfavorable. Despite reported patient satisfactions, I find that most of the before and after pictures of the patients in these clinical articles as underwhelming.

One highly important variable in any PRP treatment, aesthetic or otherwise, is dose. More specifically, what was the platelet concentration that was used and were the platelets truly viable? Most experimental studies have shown that it takes at least a 4X to 5X increase over one’s baseline platelet concentration to get a clinical response. Whatever devices that a clinician may use has to minimally obtain these concentrations to have any hope at being effective. The other important issue is that it likely takes a series of treatments, pulsed dosing if you will, to get a really significant clinical response. What that frequency should be and the practicality of it are unknown issues at present.

Because the effects of PRP may not be immediately evident (after the small amount of swelling subsides), some clinicians and manufacturers use a treatment approach that combined the PRP with either a collagen matrix or with off-the-shelf injectable fillers. Either approach makes more sense both biologically and clinically and is what I currently use in my practice.  There are advantages to either approach and it ultimately comes down to the cost of the adjunctive filler as well as the volume needed for the injection treatment. The filler provides the benefit of an immediate and sustained response by volumetric expansion.

The simplest and most inexpensive filler is to use the patient’s own fat as part of the PRP injectate. In this approach the PRP really becomes the adjunctive part and the fat is by volume the largest component. Despite the appeal of this approach, it has not yet been conclusively shown that it is better than fat injections alone. One experimental study has shown that there was no demonstrated improvement with PRP-fat mixtures. Based on the volume of PRP to fat, it seems more likely that it would be more effective in smaller volume facial fat injections that larger body procedures.

Is PRP the ‘magic serum’ that we seek for autologous aesthetic enhancements? The evidence to prove it and the best technique to achieve it remain elusive. But the appeal of PRP remains. In certain wounds, PRP has illustrated the ability of the body to ‘heal itself’. But in aesthetic improvements the ability to make yourself ‘grow younger’ has not yet been realized.

Dr. Barry Eppley

Indianapolis, Indiana

Injectable Facial Rejuvenation

Tuesday, July 10th, 2012

The desire to correct an aging facial appearance has been around as along as there is recorded history. Facelift surgery in various forms has been employed now for over one hundred years. Today’s facelift techniques are very diverse and use manipulations of all tissue levels down to the bone to achieve often dramatic improvements. Younger patients with very early signs of aging enjoy the benefits of facelifting albeit with more limited procedures geared towards the need for less dramatic changes.

But no matter how it is done, a facelift procedure is invasive and many patients want to avoid surgery if at all possible. Some patients are so opposed to surgery that they will choose any procedure  that simply isn’t surgery. With the widespread and growing use of injectable fillers and promising autologous therapies like platelet-rich plasma (PRP) and stem cells, newer methods of ‘non-surgical facelifts’ have emerged. Some of these have very catchy names and good marketing efforts behind them, which combined with the ability to do them outside of a traditional operating room setting, has caught the attention and imagination of people concerned about their aging facial appearance.

The basic concept of all of these techniques is that they are injectable. While the name ‘facelift’ has become attached them, this is not an accurate name for them. They do not achieve the same effect as a facelift nor should they be construed as having much other similarity to a facelift either. Their use of the facelift name is a marketing manuever. The only similarity between a true facelift and these injection techniques is that they treat the same problem…facial aging concerns. Therefore, the proper name for them should be Injectable Facial Rejuvenation (IFR) which signifies their non-surgical nature They may provide some degree of rejuvenation but they definitely don’t lift tissues in the conventional sense.

In reviewing the available options for Injectable Facial Rejuvenation, it is important to recognize that most of them are not standardized treatment methods and are not sanctioned by the FDA to be used in this fashion. Because these techniques have emerged largely from marketing and patient recruitment means, and not from scientific or clinical studies, there is no way to compare their effectiveness other than anectodal reports and patient testimonials. This is why how one practitioner performs one injectable technique may be different than another. Such provider variability makes it impossible to assess the effectiveness of one IFR method, let alone if one IFR method is more effective than another.

The Liquid Facelift uses either one or a variety of off-the-shelf FDA-approved injectable fillers. These could include any of the many hyaluronic-acid based fillers, such as Restylane or Juvederm, or the particulated fillers such as Sculptra or Radiesse. The concept is the select placement of them into volume-deficient or sagging facial areas that expands them, thus creating some degree of a lifting effect. This is more expansion than a lifting result. Its effects will subside as the filler absorbs. It is postulated but not proven that these fillers have a long-term collagen stimulatory effect.

The Vampire Facelift is the ultimate marketer in IFR because it is a company that sells its technique for use. Its foundation is the use of platelet-rich plasma (PRP), an autologous platelet concentrate extract which contains growth factors and cytokines. Such factors have proven laboratory performance of accelerated healing. When introduced under the skin, it is presumed that it may have some rejuvenative or stimulatory properties. This technique is also combined with injectable fillers. The theory is that the PRP and the fillers in combination may lead to an enhanced and sustained collagen response. Whether this is enough to wake up the living dead is speculative.

The Stem Cell Facelift primarily employs the injection of fat or allegedly concentrated extracts of stem cells. Stem cells have caught the imagination of the cosmetic surgery world with the belief that they will provide some rejuvenative effect. This concept is theoretically appealing but has little scientific proof that this really occurs. Most ‘stem cell extracts’ are just concentrated fat from liposuction harvests. As such, it is impossible to know how many stem cells and what their potential is in any fat concentrate. Because of the widespread uncertainty of the value and effectiveness of stem cells, the American Society of Plastic Surgeons has issued a position statement that any of its members promoting or marketing stem cell techniques as unethical behavior. In addition, the FDA has recently issued a ban on any company that grows patient stem cells for treatment. All stem cell therapies, even using the patient’s own stem cells, must be done under a clinical study protocol. This does not exclude the common use of fat injections in which stem cells exist amongst the fat cells and are incidentally injected. But promoting it as a stem cell procedure is not viewed favorably.

The Acupuncture Facelift employs the traditional Chinese technique of the introduction of needles to free up chi or energy. Allegedly, introducing needles into the face causes the production of collagen and elastin to plump up the skin. After a series of 10 treatments, wrinkles and deeper lines are purportedly reduced and skin is lifted. More likely, some mild swelling occurs as a result of the needles and results in some slight temporary skin fullness but no documented and proven lifting effect that is sustained as ever been studied or proven. This limited injection or needle approach to facial rejuvenation is the greatest stretch in calling it a facelift technique.

Injectable Facial Rejuvenation has a role to play in treating facial aging concerns but should be understood in proper context. They are not facelifts and will not lift up sagging facial tissues. They are principally plumpers or volumizers and achieve any wrinkle or fold reduction through this effect.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Platelet-Rich Plasma Facial Rejuvenation

Wednesday, July 4th, 2012

There are numerous types of injectable fillers, of which the majority are those synthetically derived. But there are a few autogenous or more natural fillers that are available. One is the use of your own fat as an injection after it is harvested by liposuction and concentrated. The other is an extract from your own blood, known as platelet-rich plasma. (PRP) By taking a draw of blood and spinning it with a centrifuge, a concentrated platelet plug is obtained which can be injected. Platelets are chocked full of growth factors and cytokines which help heal tissues and can stimulate tissue growth. When injected under the skin, they have been shown to diminish wrinkles and improve skin texture and tone. PRP is finding numerous rejuvenation and anti-aging benefits in the face either used alone or in combination with fat and other synthetic injectable fillers. Who would have thought that one has the ability to look younger from what is circulating within us. This is perhaps not surprising given that blood cells are replaced every 3 weeks and new platelets every few months.  

Autologous (Patient-Derived) Fillers For Facial Rejuvenation

Saturday, June 16th, 2012

Filling of the deflated and aging face has become as popular as any method of facelifting. Using numerous and differing combinations of injectable fillers, certain areas of the face can be volumetrically expanded. To some degree and in the right locations, this does create a lifting effect although the use of that term is a bit overstated. Filling can certainly have a facial rejuvenating effect but it should never be confused with repositioning tissues.


Facelifts have a prominent role in facial rejuvenation, as they should, but they provide virtually no volumetric enhancement. For some patients, particularly those women with thinner faces, a facelift may actually have a negative volumetric effect. As the tissues are tightened across the cheek and lateral facial areas, an almost collapsing effect can be seen with less visible midface fullness. This is one reason many contemporary facelifts employ the use of injectable fillers, particularly using the patient’s own fat.


There are numerous proponents for filling and lifting in facial rejuvenation and much of the controversy about which is better is rooted in the doctor’s specialty and training. For those who are trained and experienced in facelift surgery (e.g., board-certified plastic surgeons), it is more of a matter of mixing in fillers with traditional facelift techniques to get the best overall surgical result. For those doctor’s who practice is limited to non-surgical approaches to facial rejuvenation, the use of injectable fillers is the backbone of their offerings. They understandably are devout believers in the exclusivity of their approach and that has lead to a lot of creative marketing that largely uses the concept of a liquid or filler ‘facelift’ treatment.


These different facial rejuvenation approaches are confusing for potential patients. Much of that comes from the hope and perception that that a more youthful appearance can be obtained by a simple injection rather than a surgical tissue lifting approach. Aiding this potential confusion has been the more recent technologic innovations in autologous tissue harvesting using one’s own blood, fat and stem cells. Their liquid compositions make them easy to be used as injectable agents. While the science behind their effectiveness in facial rejuvenation is largely limited to photographic demonstration, their autologous nature nonetheless makes them very appealing to patients…who are susceptible to overzealous promotion.


But marketing issues aside, these autologous filling agents do have real clinical value. It is just a matter of how much and at what cost. The most proven autologous filler is fat. For effective facial volumizing, it is the most cost effective because there is virtually an unlimited source. But its harvest and placement may require some form of anesthesia and more equipment for processing. This makes it harder to apply as an isolated injectable filler in an office setting. Because it is packed with cellular material (adipocytes, fibroblasts, stem and blood cells), fat would seem to have real tissue stimulating, and maybe even anti-aging, effects. At the least, injected fat can add sustained volume even if it is not always completely predictable.


The other autologous injectable filling agent is that derived from blood. PRP or platelet-rich plasma is a processed extract from a patient’s blood. It is easy to draw in an office, created by centrifugation and readily injectable because it is a pure liquid and not ‘chunky’ like fat. It has no cellular component and relies on its effect through high concentrations of growth factors in the isolated platelets. PDGF, bFGF, EGF, VEGF and other growth factors have all been found in PRP concentrates. It has been injected alone, or more commonly combined with synthetic hyaluronic fillers, to create a ‘blood-derived facelift’. In theory, it has a collagen-stimulating effect but its sustained effect is unproven beyond that of the lifespan on the synthetic filler. As long as the patient understands that this is a bridging or delay therapy until one is ready to commit to a surgical approach, they will not be disappointed.


Autologous injectable facial rejuvenation can use either fat or PRP, both patient-derived agents. They each have a role to play in facial anti-aging therapies but they are not interchangeable. PRP is used exclusively in non-surgical approaches while fat injections can be used in both surgical and non-surgical treatments.


Dr. Barry Eppley

Indianapolis, Indiana

Product Reviews: The Vampire Facelift

Friday, March 4th, 2011

One new interesting, but unusually named, cosmetic procedure is that of the “Vampire Facelift.” In truth, it is not really a facelift nor is it used by vampires or will make you look like one. The  Vampire Facelift is far less scary and has much more science to it than most science fiction tales. It is based on the more well known and highly popular injectable filler concept.


It works by injecting its magical potion underneath the skin, much like its manmade counterparts such as Juvederm or Radiesse. But instead of using a prepackaged synthetic material, the Vampire Facelift (trademarked name by the company Selphyl) uses the patient’s own blood to make the injectable filler. A small amount of blood is first extracted from the patient. Then a device separates the platelet portion from the red blood cells. The concentrated platelets are then combined with the company’s  proprietary synthetic mixture and the composite is now ready for injection. The entire preparation process takes less than ten minutes to complete and can be done in an office setting.


The principle of this approach is that platelets are heavily endowed with growth factors. These potent little growth stimulants can induce the growth of new collagen. Collagen, of course, is what gives skin its fullness and suppleness. The implantation of a concentrated platelet mixture could help rejuvenate thin and aging tissues and overlying skin…in theory. It is also appealing to patients in that it is an organic approach to rejuvenation using one’s own tissues to help repair itself.


While this cosmetic application of a platelet concentrate is new, the concept is not. PRP (platelet-rich plasma) concentrates have enjoyed widespread use in healthcare in the past decade, particular in orthopedic and musculoskeletal medicine. Numerous companies have PRP technology and application devices. What makes Selphy unique is that they have made a more simple in-office device at a low cost, which are the requirements needed if cosmetic use will gain any popularity.


While the Vampire facelift (perhaps better understood as a PRP filler) treatment sounds intriguing, it is not known if it will last any longer than that of off-the-shelf injectable fillers. The theory is biologically appealing but whether it actually works has not been conclusively shown. I commonly mix PRP concentrates with fat injections with the theory that the platelets may stimulate better fat preservation or stem cell conversion into adipocytes and/or fibroblasts. This is employing the identical approach but with a different substrate. Time will tell if these biologic injectable mixtures will live up to their theoretical benefits.  


Dr. Barry Eppley

Indianapolis, Indiana

Fat Injections to the Face – A Concept Which Continues To Intrique

Thursday, July 17th, 2008

Despite the many off-the-shelf injectable fillers which currently exist, none of them can promise permanent results or complete biocompatibility and lack of any type of foreign-body reaction in everyone. Only one’s own fat, when done as an injection, can potentially fulfill those promises. But fat has another problem…..its survival after injection is unpredictable and it can not be injected very easily into small places or directly into the skin due to its irregular thick flow and the need for a large-bore needle from which it is introduced. But despite these drawbacks, the allure of fat as a filler material continues and its ample donor source (for most patients) perpetuates the mystique of a simple transfer from someplace undesired to a more desireable one.
There is no getting around the fact that fat injections are unpredictable. While there are some that blame a surgeon’s outcomes on their methods, an honest assessment of results will show that, even in the best of hands, the fate of fat transfer is not technique dependent alone. There is still much about fat biology that we do not know or understand. Many factors other than method of harvest and preparation influences its transplantation outcome including source, patient age, and the recipient site. It is naive to think that the important but relatively simple step of concentration after harvest is the dominant step that controls how much fat survives later. It is important for sure but it can be only one of the contributing factors. Much active research work is going on right now to study many of these other factors including how fat differs between donor sites and what other factors may be added to fat to improve its survival after injection.
The face is a fortunate site for fat injections in that the relatively small volumes needed have a better chance of survival. The smaller volume to surface area caused by linear injection patterns favors a quicker ingrowth of blood vessels which provides nourishment to traumatized and starving fat cells. As a result, fat does better in the face than any other bodily area. I currently strain all harvested fat and/or do a few minutes of centrifugation to get out most of the liquid debris and pack presumably good fat material into a syringe. Using 1cc syringes and a 16 gauge needle provides a relatively smooth outflow of fat into the desired facial areas.
One biologic approach that I am currently looking at is the addition of PRP or platelet-rich plasma to a fat graft concentrate. PRP is derived from the patient’s blood and is a spin down of concentrated platelets which can be easily added to any fat graft mixture. The dosing (amount of PRP) per fat graft that is necessary is unknown and must be studied further, but I am empirically using 1cc of PRP per 10cc of fat. Early results, particularly in the lips which can be easily followed and assessed, are promising.At the least, PRP is not harmful in any way as it is derived from each individual patient.
The conceptual allure and simplicity of the fat injection makes it a useful facial augmentation technique. It may not have guaranteed survival and is ideally a procedure best done in the operating room at the time of other more major interventions. The future will undoubtably make its use more widespread as a better understanding of fat biology is realized.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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