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Dr. Barry Eppley

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Posts Tagged ‘platelet-rich plasma’

The Use of PRP in Fat Grafting

Monday, February 22nd, 2016


Injectable Fat-grafting, also known as lipofilling, has become a standard plastic surgery treatment in a wide variety of aesthetic and reconstructive needs of the face and body. Although technical improvements have increased the concentration of fat cells injected, the amount of fat graft survival is still unpredictable and far less than 100%.

Platelet Rich Plasma injections Indianapolis Dr Barry EppleyVarious methods have been suggested to increase graft take beyond mere concentration including the addition of adipocyte-derived stem cells (ADSC) or platelet rich plasma (PRP) to name the most common methods. How effective these fat graft supplements are, however, is speculative and has yet to be studied in any randomized clinical trials.

Beyond the volumetric enhancement observed after an injectable fat grafting procedure, skin rejuvenation benefits do occur such as improved skin elasticity and suppleness as well as reduced pore size. The presence of ADSC and PRP in a fat graft has been suggested to aid wound healing as well as produce tissue rejuvenation. These supplements achieve these improvements either by improved fat cell survival, stem cell conversion, or new blood vessel ingrowth through the effects of numerous growth factors. They influence the migration, proliferation and differentiation of several cell-types including endothelial cells for angiogenesis and fibroblasts for deposition of extracellular matrix.

Fat Graft Gravity Separation Dr Barry Eppley IndianapolisThe effects of PRP is probably most likely due to improved vascularization. It is generally accepted that the growth factors present in PRP stimulate wound healing, tissue remodeling and revascularization. Different concentrations of PRP have shown to induce varying effects on fibroblast and endothelial cells.  The ideal ratio of fat to PRP volume has not been established in human fat grafting. One would logically assume that  the more PRP the better. The maximum PRP that can be mixed into a fat graft is going to be a function of the size of the fat graft. In the face higher rations of PRP:fat graft are gong to be able to be obtained. Given that most disposable PRP-kits produce just 3 to 4 mls of PRP concentrate, the ratio could be anywhere from 5% to 15% in facial fat graft volumes of 10 to 35cc injectate.

Fat Graft Survival Indianapolis Dr Barry EppleySeveral cell culture studies have shown that PRP is a dose-dependent inducer of ADSCs with a two- to fivefold increase in cell numbers when compared to controls. Since increasing the number of ADSCs in a fat graft had been shown to have a positive effect on graft take, PRP offers a relatively simple method to do so. In larger body fat grafting (e.g., buttock augmentation), however, the ratio of PRP to fat graft volume is so low (< 1%) that it would have no effect.

Despite positive laboratory in vitro results of PRP in fat grafting, more recent clinical studies have failed to show a positive difference with its use on fat graft survival. Thus the use of PRP in fat grafting, while theoretically appealing, yet remains to show convincing clinical proof of its effectiveness. But its natural derivation as an extract of the patient and its simplicity of preparation will continue to have clinicians who believe in its science further its use in fat grafting.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet Rich Plasma (PRP) Injections for Hair Loss

Sunday, February 14th, 2016


Hair loss due to genetics in men and women is known as  androgenetic alopecia and is extremely common. A wide variety of methods have been used to treat this type of hair loss of which the pharmacologic treatments have been the most successful.  At the least they are the most documented by scientific scrutiny having to pass through FDA clinical trials.

The drugs Oral finasteride (Propecia) and topical minoxidil (Rogaine) each have proven to slow or cease hair loss and offer some variable amounts of hair regrowth. Side effects, however, cause some patients to avoid their use or eventually cease using them.

Platelet Rich Plasma injections Indianapolis Dr Barry EppleyMore recently another type of stimulating agent, platelet-rich plasma (PRP), has been applied to treat hair loss. Since this is a natural concentrate from the patient’s blood, it does not require FDA approval to use for any medical purpose. Thus no FDA-sanctioned clinical trial has ever been done on PRP for hair loss and its benefits have largely been anectodal.

PRP injections for hair lossIn the Online First January 2016 issue of the European Journal of Plastic Surgery, the article entitled ‘Management of Androgenetic Alopecia: A Comparative Clinical Study between Plasma Rich Growth Factors and Topical Minoxidil’ was published. The purpose of this clinical study was to compare the effectiveness of plasma rich plasma (PRP) versus topical minoxidil treatments in genetically-driven hair loss patients. Almost 400 patients (379 to be exact) were treated with either platelet rich plasma or minoxidil. Diagnostic trichograms were done prior to and 4 months after treatment to analyze the anagen/telogen hair change improvement.

PRP scalp injectionsTheir results shows that platelet rich plasma treated patients had higher anagen hair increase improvement compared to minoxidil treated patients. (6.9 vs 4.6, p?<?0.05). Telogen hair decrease improvement was also higher in the platelet rich plasma treated group. (5.7?vs 2.6?, p?<?0.05). Photographs showed an overall improvement in both volume and quality of hair for both types of treatments. No adverse effects for either treatment were seen. The authors conclude that platelet rich plasma is a safe and effective treatment for androgeneic alopecia and offers improved results over that of topical minoxidil.

PRP Hair Loss Treatments Dr Barry Eppley IndianapolisThis is the first study that has demonstrated in a large series of patients the benefits of platelet rich plasma injections in the treatment of hair loss. Even at its worst, one can conclude that platelet rich plasma is at least as effective as minoxidil. The benefits of PRP hair loss treatment is that it is a single treatment session and has no side effects. Its negatives are that it is much more expensive than minoxidil and would likely have to be repeated every 4 to 6 months to maintain its effects. There is no information currently that would indicate as to how many times PRP injections would be need to be repeated to majntain or improve hair growth.

Dr. Barry Eppley

Indianapolis, Indiana

Injectable Facial Rejuvenation with Platelet-Rich Plasma (PRP)

Sunday, October 4th, 2015


PRP (platelet-rich plasma) has earned a role in a variety of facial rejuvenation procedures. One of its most well recognized uses due to social media and marketing is in the Vampire Facelift procedure. Its name is an obvious spinoff of the use of PRP which requires a blood draw to create the platelet concentrate. It is not a pure PRP procedure as it requires the use of injectable fillers to create the facial volume needed. In theory the PRP acts as a stimulant for soft tissue rejuvenation with its own growth factors and other stimulants…although that is far from proven science.

PRP injectable facial rejuvenation is an all natural treatment. There is no chance of allergic reactions or fear of foreign body interactions in response to these plasma concentrate injections. But what it is not is a facelift by any definition of this procedure. It does not reshape, tighten or otherwise involve removal of loose or sagging tissues as a traditional facelift does. Conversely it is a plumping procedure by adding volume through the use of the combination of PRP and hyaluronic acid-based fillers. The plumping helps stretch out some wrinkles and creates a bit of a tissue lift in some facial areas.

Platelet Rich Plasma injections Indianapolis Dr Barry EppleyWhile PRP is known for its healing properties, its success in causing cell stimulation and rejuvenation in normal people to help ‘reverse’ or treat aging tissues is more speculative. Stimulating tissue repair in injured tissues is one thing, making the body create new cells to treat otherwise normal tissues, albeit aging ones, is more of a biologic stretch. But this is the contention of the Vampire Facelift approach. Inject PRP under the skin and the body takes it from there presumably generating new collagen from stimulated fibroblasts.

There is no question that these injection treatments are safe as they involve PRP and other well known injectable fillers. There is very little possibility of any untoward reactions and complications. It is just a question of how much skin benefit is obtained from injecting the plasma and platelets and whether it provides any longevity benefit to the hyaluronic acid fillers that are also simultaneously placed.

The injection procedure does create some mild bruising and swelling for a few days that, at its worst, completely resolves within a week after the procedure. With the use of blunt injection cannulas, the creation of bruising is virtually eliminated. The effects of volume addition are seen immediately, any tissue stimulation occurs much later. (weeks to months) Whatever tissue stimulation and growth that may occur from the injections is not known how well or long it will persist. There is no question that repeated treatments produce better results. Stacking two to four treatments several months apart will create the optimal facial rejuvenative effect.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma (PRP) – How Does It Work?

Friday, September 25th, 2015


Platelet Rich Plasma injections Indianapolis Dr Barry EppleyPlatelet-Rich Plasma (PRP) injections have come into vogue to treat a wide variety of medical conditions. It has also become popular in aesthetic surgery as part of the ever expanding number of non-surgical and minimally invasive treatment options. Since PRP is a blood extract it is perceived as a natural healing and rejuvenative therapy. It truly defines the concept of ‘heal thine self’, introducing a high concentrate of platelets to the target tissues.

But what is in platelets that makes them so potentially useful? Platelet rich plasma is the processed clear plasma that is separated from the red blood cells from the patients’ own blood.  But it is the platelets that have the active ingredients.There are many bioactive molecules that are in the granules inside the platelets. These include growth factors, adhesive proteins, clotting factors, fibrinolytic factors, proteases and membrane glycoproteins. But it is the growth factors in PRP that has received the greatest attention and with a name like ‘growth factor’ it is easy to understand why.

The growth factors that have been identified in the platelets in PRP is a lengthy list. These include PD-EGF (platelet-derived epidermal growth factor), PDGF-A  and B (platelet-derived growth factor), TGF-B1(transforming growth factor), IGF I and II (insulin-like growth factor), VEGF (vascular endothelial growth factor), ECGF (endothelial cell growth factor), bFGF (basic fibroblast growth factor) and CTGF. (connective tissue growth factor) These growth factors work by sending signals to numerous cell types, such as stem cells in the target tissues, allowing them to induce repair and the stimulus to produce new cells.

Platelet Rich Plasma Injections in Facial RejuvenationThe aesthetic use of PRP has largely focused on skin rejuvenation and, lately, that of hair restoration. It is often combined with other known aesthetic agents to create a synergistic effect. While some mix it with injectable fillers and fat, the most common usage today is with skin microneedling and laser resurfacing. Microchannels are made in the skin using microneedles on a roller or the fractional laser. PRP is applied and is then absorbed into the skin through these channels to provide a stimulatory effect on the underlying tissues and cells right under the skin. Adjuvant treatment with platelet-rich plasma is yet another advancement in the quest for an improved facial skin appearance.

Another method to deliver PRP directly is with blunt microcannulas or needles placed right into and under the skin. This is how treatments are largely done for hair restoration. This can be done as a treatment of hair loss in both men and women. It can also be done either before or after hair transplantation or both. It is somewhat like adding fertilizer to the lawn or garden both before and after planting.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Platelet Rich Plasma and Hydroxyapatite Granule Maxillary Defect Reconstruction

Saturday, August 22nd, 2015


Background: The nasopalatine cyst is a well known pathology of the maxilla that often presents as an asymptomatic anterior palatal swelling. It usually develops behind the maxillary incisors and is thought to be caused by the ductal tissue within the incisive canals. It appears radiographically as a round or heart-shaped mass in occlusal plane or 2D CT x-rays or as a very distinct round tumor in 3D CT facial scans. While benign it can cause significant bony erosion through its expansile growth.  By the time it appears as an anterior palatal swelling the amount of bony destruction is significant.

Treatment of the nasopalatine cyst is done through excision by raising a posteriorly based soft tissue flap. When removing the cyst lining from the palatine bony defect it is important to get all of the cystic lining up into the nasopalatine ducts to prevent recurrence. When the resultant bony defect is small no reconstruction is needed. But by the time a nasopalatine cyst is discovered the bony defect is large and ensuring bony fill is often needed to provide hard tissue support to the maxillary incisor teeth. While an autologous bone graft is ideal patients understandably would like to avoid a graft harvest.

Demineralized bone substitutes as well as hydroxyapatite synthetic grafts are appealing in the facial bony defect that has good vascularity and numerous walls to contain it. This may be enough for some patients but agents that can accelerate or magnify the bony response are appealing. One such healing is that of platelet-rich plasma.

Platelet-rich plasma (PRP) has been used in a wide variety of bony and soft tissue applications to expedite healing and tissue repair. As an extract of a patient’s blood, the platelet concentrate is known to contain powerful growth factors which are important participants in the wound healing process. PRP undoubtably has its greatest effect when it is combined with other natural tissue grafts such as bone and fat grafts. But it can also be useful with allogeneic and synthetic type grafts which have no cellular component and rely heavily on the body providing the proper healing milieu.

Nasopalatine Cyst x-ray Dr Barry Eppley IndianapolisCase Study: This 26 year-old female presented with a painless swelling of her anterior palate. It measured 3 x 3 cms. She had a prior history of dental trauma as a teenager that resulted in endodontic treatment (root canals) of her anterior incisor teeth. An occlusal radiograph showed an irregular radiolucent mass of the anterior palate. She did not want a bone graft harvested should it be needed.

PRP and HA granules mixture for nasopalatine defect reconstruction dr barry eppley indianapolisNasopalatine Defect Reconstruction with Platelet Rich Plasma and Hydroxyapatite Granules Dr Barry Eppley IndianapolisUnder general anesthesia the anterior palate was exposed by raising a soft tissue flap. The cystic mass and its lining were removed down to the apices of the roots of the teeth. This left a bony defect that partially exposed the palatal surfaces of the tooth roots. Reconstruction of the bony defect was done by a combination of hydroxyapatite granules and PRP. She went on to a completely healed wound with teeth retention and stability.

Hydroxyapatite granules is one of the oldest synthetic bone grafts that can still be successful to its inorganic calcium phosphate similarity to natural bone. When mixed with PRP the surrounding bony ingrowth into the material is accelerated ensuring a rapid and complete bony fill of the defect.


  1. Nasopalatine cysts can develop from periapical abscesses/non-viable tissue from teeth that had previously undergone root canals.
  2. Excision of the complete nasopalatine cyst is necessary for a long-term cure without recurrence.
  3. PRP mixed with synthetic bone grafts can be successful reconstruction strategy for larger maxillary bony defects.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma (PRP) in Fat Grafting

Saturday, July 18th, 2015


Fat Injection Indianapolis Dr Barry EppleyFat grafting is one of the great innovations in plastic surgery of the past decade as a stand alone procedure or as a complement to many other plastic surgery procedures. As a natural graft material with usually good availability, it is an unrivaled aesthetic and reconstructive soft tissue reconstruction method. But despite its many attributes, fat grafting is not a completely reliable soft tissue creation method. Much investigation and study has gone into fat harvest and graft preparation and injection, but no universal method has been discovered that can consistently produce a consistently reliable graft take.

One fat graft preparation method that has been looked at over the years is the addition of a ‘priming’ or stimulating agent. The objective is to either improve how many of the intact transplanted fat cells will survive or increase conversion of the coincidental stem cells that are known to exist in fat to become new lipid-laden fat cells. Done years ago by mixing in insulin, today’s potential fat graft stimulator is platelet-rich plasma. (PRP) High concentrations of platelets would theoretically have a favorable effect on both adipocytes and stem cells.

Platelet Rich Plasma Injections Indianapolis Dr Barry EppleyPRP is a natural blood extract product that is rich in growth factors that have well documented effectiveness in wound healing. Through such growth factors as PDGF, TGF beta and VEGF, improved blood vessel ingrowth and deposition of extracellular matrix has been shown in many animal studies. Animal studies have also shown that PRP can improve fat graft take and reduce the formation of oil cysts most likely due to its revascularization effects. But despite the theory and animal research the use of PRP in fat grafting remains speculative with few clinical studies that have even investigated its potential effects.

Like any drug, the effects of PRP on fat would be expected to be dose dependent. Given that the average PRP volume extracted from a 20 to 60cc blood draw would be just a few ccs, its addition for example to a BBL (Brazilian Butt Lift) would be expected to have no effect on fat graft survival. In facial fat grafting, however, where graft volumes could be expected  to be between one and 50ccs, a few ccs of PRP would be more likely to be effective. Thus it likely all comes down to an expected concentration effect.

No one yet knows what the ratio of PRP to fat graft volume should be or would be expected to work. I currently operate on the theory that PRP should be used when the fat graft to PRP ratio is at least 10:1 or a 10% PRP composition volumetric ratio. Studies have shown that PRP may have its strongest effect on the differentiation of adipocyte-derived stem cells into fat cells. This may make the greatest contribution to final graft volume persistence. While vascular budding or endothelial sprouting may have a more minor effect.

The use of PRP in fat grafting (lipofilling) remains more theoretical than proven science. But the lack of any side effects with PRP allows for the its liberal clinical use and investigation.

Dr. Barry Eppley

Indianapolis, Indiana

PRP (Platelet Rich Plasma) Therapy for Hair Regeneration

Thursday, January 8th, 2015


Hair loss is incredibly common for both men and women. The use of non-surgical topical Minoxidil and oral Propecia as well as surgical hair tranplantation are well known and offer hair maintenance and hair restoration benefits to many. But between these two type of treatmets lies an intermediate hair therapy that has been historically lacking…a form of injectable therapy. That role is now beginnning to be filled with PRP therapy. PRP injections are a non-surgical method of hair stimulation that can be used for both men and women.

Platelet Rich Plasma Injections Indianapolis Dr Barry EppleyWhat is PRP? PRP (platelet rich plasma) is an extract of human blood that is an isolated concentration of platelets which contain high levels of specific growth factors that are well known to induce tissue regeneration and healing. When injected into the scalp, a growing body of medical evidence indicates that it is promising treatment option to promote hair growth. It is important to understand that PRP is derived directly from the patient so it is a completely natural blood product. While PRP has been around for years it has largely been a technology relegated to the hospital and use in major surgery. With today’s technologic advancements, PRP is now available to be used in an office setting for numerous aesthetic treatments such as hair regeneration.

How does PRP for hair growth work? It is postulated that PRP can cause the growth of hair through stimulation of the stem cells located in the dermal papilla of the hair follicle.(bulb) It is very likely that it may stimulate other structures in the hair follicle as well. PRP may induce a hair follicle to change from the resting staten (telogen) to the growth phase.(anagen) This may ‘wake up’ dormant hair follicle and/or may cause active ones to grow faster or develop slightly thicker hair shafts.

How is PRP done? A small amount of blood is drawn in the office, mixed with an antocoagulant and spun in a centrifuge for around 10 minutes. This process separates the blood into various fractions, one of which is the platelet layer or platelet rich plasma fraction. The pure PRP can then be injected into the scalp using small needles directly below the skin (hair follicles are below the skin not in it) or the microneedling can be done onto which it is applied topically. Treatments can be repeated every four months if needed to see optimal results. (hair follicle take months to grow out and see a visible shaft)

PRP Hair Regeneration Men Dr Barry Eppley IndianapolisPRP Hair Regeneration for Women Dr Barry Eppley IndianapolisWho is a good candidate for PRP hair regeneration? While individual results vary and no guarantee can be given that hair will grow, PRP works best in thinning hair. It will not take a ‘desert’ and turn it into a lush garden. It is not a magic potion that can make hair appear that has been completely absent for decades. Rather it requires some follicles to be present for its stimulatory effects to be seen. This is why it works just as well for women (maybe even better than men) because they may have more active follicles initially anyway. PRP is a good adjunctive therapy to be used both before and after hair transplantation. It is also an excellent treatment for those patients who have lost their hair from chemotherapy. (follicles induced into telogen by chemical poisons)

PRP is an emerging non surgical based therapy for natural stimulation for thinning hair. PRP is completely safe and natural because it contains the patient’s own blood product. The scientific evaluation of the effectiveness of PRP therapy for hair regeneration is currently under clinical trial investigation and its efficacy is currently based on anectodal and case report evidence only. Thus it should not be considered FDA approved or view as a ‘baldness cure’.

PRP therapy is a natural alternative for improving hair growth for those patients who do not want surgical hair transplantation. Conversely it is also an adjunctive therapy for those that have already undergone hair transplants. Although results will vary from patient to patient, PRP injections offer improvement in hair caliber and thickness for natural thinning and miniaturization or as a stimulus for newly implanted follicles.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma (PRP) Use In Facial Laser Resurfacing

Sunday, January 4th, 2015


Fractional Laser Resurfacing Face Dr Barry Eppley IndianapolisLaser resurfacing is a long-standing treatment that can have a profound rejuvenative effect on wrinkled and sun damaged facial skin. By burning off the top layer of skin and allowing it heal, a fresh skin surface is created with fewer surface imperfections.While effective, it is associated with a significant healing time, discomfort and  temporary facial redness. This has been improved by changing from a fully ablative laser treatment, which treats the entire skin surface, to a fractional approach.

Fractional laser resurfacing treats a portion or fraction of the skin surface’s  (usually 5% to 22%) but with deeper channels cut down into the thickness of the skin. This has the dual effect of shortening healing time due to less injured skin surface and causing greater collagen regeneration and tightening. But despite the advantages and reduced recovery time of the fractional laser, adjuvant treatments are still sought to reduce healing time and facilitate a faster recovery. One such treatment is that of platelet-rich plasma. (PRP)

Platelet Rich Plasma PRP Therapy Dr Barry Eppley IndianapolisPlatelet-rich plasma (PRP) has been used for many applications in various surgical fields for its ability to improve wound healing, hemostasis, and graft survival. It is a blood concentrate that is full of platelets. Platelets contain many different growth factors and cytokines in high concentrations which serve as the theoretical basis for the use of PRP in tissue repair. Studies are mixed as to its true effectiveness across a broad spectrum of applications. But the superficial nature of laser resurfaced skin seems like a good application for it.

In the Online First edition of the November/December 2014 issue of JAMA Facial Plastic Surgery, a study was pubished entitled ‘Evaluation of the Effect of Platelet-Rich Plasma on Recovery After Ablative Fractional Photothermolysis’. This was a blinded study using small human forearm test sites that were treated with fractional laser treatments at consistent depths in both arms. The treated sites were immediately treated with either topical PRP or saline. (control) Significant improvement was seen in PRP-treated arms compared to controls in all 15 treated patients. Improvement was defined as the erythema rating of the untreated arm minus the erythema rating of the PRP-treated arm. Patients noticed a reduction in the amount of redness, swelling, itching and pain in the PRP-treated sites.

These study results suggest that PRP can improve the healing rate of facial laser resurfacing sites. It presumably does so by creating a faster rate of skin cells growing across the injured skin surface through earlier induction of cell turnover. It is interesting that such positive results were seen with just one application immediately after the laser resurfacing. Given the reduced cost to acquire a single concentrate of PRP today, it should enjoy broader useage.

Dr. Barry Eppley

Indianapolis, Indiana

PRP-Enriched Fat Injection Buttock Augmentation

Thursday, October 3rd, 2013


The most popular method of buttock augmentation is by fat injections. Known as the Brazilian Butt Lift (BBL), it is singularly responsible for the dramatic rise in the number of buttock augmentation procedures performed. While fat is not the most reliable method of adding buttock volume, an implant is, it offers a natural material that has an assured positive body contouring effect.

To improve the reliability of injected fat survival, numerous methods of graft harvest, concentration and injection have been proposed and tried. At this point, the differences in these three basic graft procedures is not really that different amongst experienced physicians performing buttock augmentation. Adding pharmacologic agents to the fat has not been well explored up to the present due to the lack of knowing what may be successful.

The most logical additive to fat is PRP, platelet-rich plasma. It is a natural concentrate from the patient’s own blood and has an established history of aiding wound healing and generating angiogenesis through its growth factor and cytokine content. It can be easily added to fat grafts and has been done anecdotally for all kinds of fat grafting with variably reported results.

In the September 2013 issue of the European Journal of Cosmetic Surgery, an article appeared entitled ‘Results and Long-Term Patient Satisfaction After Gluteal Augmentation With Platelet-Rich Plasma-Enriched Autologous Fat’. In this paper, a study was done to investigate the long-term results and patient satisfaction after PRP-enriched lipofilling of the buttocks for aesthetic augmentation. In twenty-four (24) patients, both buttocks were injected with PRP-enriched fat and liposuction done on surrounding contour zones. The mean fat injected was just over 475cc for both sides. No infections, hematoma, seromas or liponecrosis (oil cysts) occurred. Patients were followed out to nearly four years with high patient satisfaction at 3 months after surgery with a slight decline over the remaining study period.

This small study concludes that PRP-enhanced lipofilling is safe with a low complication rate. This would be expected. The real question is does it improve fat injected buttock augmentation results? Unfortunately this study, regardless of the number of patients treated, can not really answer this question. Unless each patient served as their own control (one buttock got regular fat and the other PRP-enriched fat), the results can not be  directly compared.

The other problem with adding PRP to large volumes of fat is the ‘dosing’. Usually only about 6ccs of PRP can be obtained from a 60cc blood draw. When mixed in with hundreds of ccs of fat (in this study 475cc to be exact), it only adds <1% to the total fat injectate. Whether such a small ‘dose’ of PRP is enough to make a difference is unknown but suspect. In smaller volume fat injections like in the face where 5 to 30ccs are more typically injected, this amount of PRP is more likely to have a stimulating graft benefit.

Dr. Barry Eppley

Indianapolis, Indiana

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

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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