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Dr. Barry Eppley

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Posts Tagged ‘prp injections’

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

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

Quantification of Platelet-Rich Plasma Mixtures for Use in Plastic Surgery

Wednesday, March 30th, 2011

Using elements of one’s own blood to heal wounds or to regenerate new tissues is a new and popular concept in plastic surgery. Whether they are applied to help heal defects in reconstructive plastic surgery or to aid in augmentation of deficient or aging tissues in cosmetic plastic surgery is a technologic development of the adage, ‘heal thyself’. One of the key elements in blood that is essential to these processes is the power-packed platelet. Chocked full of healing agents known as cytokines or growth factors, these attract and stimulate cells to an injured site which can produce the building blocks that form new tissue.

Extracting and isolating these platelets for injection and mixing with other components has become known as generating a platelet-rich plasma or PRP mixture. Such platelet-rich plasma mixtures is now used clinically in a wide variety of surgical applications. In plastic surgery, I currently use them to mix with fat injections or with grafting materials to enhance their take and survival. As popularity of this technology expands, a variety of devices to produce PRP have become available. How effective these devices are at isolating platelets and their growth factors is often not well characterized.

I conducted a study* to fully characterize PRP produced from a commercially available device. PRP was created from whole blood drawn from 10 cosmetic surgery patients using the GPS®III device (Biomet Biologics, Warsaw, IN). Complete blood counts (CBC) were gathered on whole blood and PRP to compare cellular compositions. Cytokine content for EGF, PDGF-BB, PDGF-AB, IL-1ra, IGF-1, VEGF, TGF-?1, and TGF-?2 were analyzed using ELISAs. Additional ELISAs were used to determine platelet activation by sP-selectin and thrombospondin-1 expression. CBC analysis revealed a 92 ± 15% recovery of platelets and 54 ± 14% recovery of white blood cells in the PRP. The cytokines EGF (6.1 fold increase), PDGF-BB (6.0 fold increase), PDGF-AB (4.8 fold increase), IL-1ra (3.6 fold increase), VEGF (3.4 fold increase), and TGF-?1 (13.4 fold increase) were statistically increased in the serum of PRP compared to the serum of whole blood. There was no statistically significant platelet activation during the production of the PRP compared to whole blood.

The PRP produced in this study contained a high number of concentrated platelets that remained inactivated during the separation process. This is exactly what one wants to see as any activation of the platelets as a result of the preparation process makes them virtually useless to implant. The cytokine levels were very significant in the PRP concentrate which suggests it would have a beneficial effect for tissue healing and regeneration. These numbers indicate that continued work with PRP is justified to discover what applications in plastic surgery in which it may be most effective.

Dr. Barry Eppley

Indianapolis, Indiana

*Instrumental in doing this study were Jennifer Woodall-May Ph.D. and Mike Leach from the Biomet Corporation.

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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