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Dr. Barry Eppley

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Posts Tagged ‘prp’

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

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

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

Injectable Fat Grafting into the Face – Location vs. Volume Survival

Sunday, August 16th, 2009

Facial contour problems arise from a variety of reasons including birth defects, traumatic injuries, cancer, certain diseases such as HIV, the aging process and certain aesthetic concerns. Provided that the underlying bone structure is normal, treatments are directed at the concept of adding volume. Volumetric addition today is often done by fat grafting. Transplanted fat offers a natural soft tissue solution that has even been shown to have a regenerative effect on the facial recipient.

 The vexing problem with fat grafting is that it is not consistent. Its survival is not completely predictable despite improved methods of harvesting and processing. A lot of plastic surgeons have also had the experience that different parts of the face may fare better than others.

The influence of the facial recipient site on fat grafting was evaluated and published in the August  2009 issue of the journal Plastic and Reconstructive Surgery. They specifically looked at this issue in reconstruction cases of facial volume loss due to traumatic or congenital deformities. They analyzed 100 such patients who had structural fat grafting to the face with patient satisfaction surveys and objective assessment by a five-member panel. What they found was a highly variable rate of success based on different facial areas. The cheeks, lateral facial areas and chin was highest  while the lips and temple areas were the poorest. The forehead, eyebrows, and nose had intermediate success. Equally significant was the eight cases of before and afters that was impressive, particularly the burn patients.

This report is significant in that it shows overall that fat grafting is useful, even in difficult reconstructive cases. The concept that it somehow changes the quality of the abnormal tissue beds is not only appealing but may well be true. Despite the lack of any scientific evidence to date for why this would occur, it is likely that the stem cells from the fat graft can differentiate into different connective tissue lines. This has certainly been demonstrated in cell cultures.

The intriguing questions from this  study is why do the results vary in different parts of the face and how does this translate to cosmetic applications. The most likely explanation for the variances of results is that the recipient beds differ. The cheeks, side of the face and chin naturally have fat and fat grafts will do better when put into such a natural scaffold. The lips and temple area have little to no fat and the grafts are being put into non-like sites where growth and conversion of fat cells is not well supported. As for the cosmetic patient, it would be fair to say that the results would be just as good if not better than in reconstructive cases. The differences in success, however, would see the same variability as we have observed clinically.

In my Indianapolis plastic surgery practice, I occasionally will add  PRP (platelet-rich plasma) to smaller volume fat grafts as a growth factor booster. Whether this would improve the results seen in this study is unknown, but remains theoretically appealing with no downside. The use of PRP with fat grafting is most relevant in the face due to the limited volume of PRP obtainable and the volume of fat being injected. The volumetric ratios would lead one to believe it would be more successful with a 1cc PRP:10 –  20cc fat mix ratio being possible.

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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