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ORLANDO – Platelet-rich plasma offers much for patients and dermatologists: It’s low-risk, has a low cost of entry, and usefully augments other medications and procedures for androgenetic alopecia and facial rejuvenation.
But there’s work to be done in standardizing its use and really understanding where, when, and for whom platelet-rich plasma (PRP) will be best used, said Dierdre Hooper, MD, a dermatologist in private practice in New Orleans.
As far back as the 1970s, PRP was used as a transfusion product, with use expanding during the following decade. “It’s really the ‘everywhere’ product,’” said Dr. Hooper, speaking at the Aesthetic, Surgical, and Clinical Dermatology Conference (ODAC).
Over the course of the past four decades, PRP has been explored for musculoskeletal healing, in gynecology, urology, cardiac surgery, ophthalmology, and for plastic surgery. “Initial skepticism has given way as some evidence is building,” said Dr. Hooper.
PRP, considered a biologic product, is produced by centrifuging a donor venipuncture. Among the pros of using PRP in a clinical practice, said Dr. Hooper, is the fact that numerous clinical studies do show benefit. The risk is low, as is the cost, and downtime is brief. All of these contribute to attractiveness to patients, who also like the idea of an all-natural product with an autologous source.
But consensus is lacking about some key aspects of utilization, including the best mode of preparation and optimal treatment schedule. Outcomes can be unpredictable, making it tough to say how cost-effective the regimen will be for a particular patient. “The ‘cons’ just come down to no consensus,” said Dr. Hooper.
Some of the basic science makes a compelling case for PRP: Activated platelets have secretory granules. These modify the pericellular milieu through release of a variety of growth factors by secretory granules. “We all were taught back in the day that platelets adhere to promote clotting, but they do a lot more than that – when the platelet is activated, it releases growth factors,” said Dr. Hooper. “Big picture? Think: This is how we heal.”
After blood collection, the sample is centrifuged. The goal of centrifuging is to achieve a platelet concentration of 1 to 1.5 million platelets per mL, or four to six times the platelet concentration seen in whole blood. In practice, there are variations in the mode of preparation, and in an individual’s platelet level at the time of venipuncture, said Dr. Hooper, so it’s hard to know what the platelet “dose” is from PRP.
After centrifuging, the sample will be stratified into a bottom portion, consisting primarily of red blood cells, a middle portion that’s the PRP, and a top portion that is platelet-poor plasma. Dr. Hooper draws up and saves the platelet- poor plasma as well, since it probably also contains some growth factors. She’ll save that for application or injection after a PRP treatment for some patients.
Dermatology presents a host of uses for PRP. In addition to application after microneedling or resurfacing and injectable aesthetic uses, PRP can also be used to treat melasma, acne scarring, and androgenetic alopecia.
The strongest data for PRP currently are for androgenetic alopecia, said Dr. Hooper, because that’s where most of the work has been done to date. Growth factors in PRP can target the dermal papillae, shortening the anagen phase. “You will improve the anagen:telogen ratio and increase hair density and thickness,” she said.
“When you talk to your hair loss patients, there are drawbacks” with home therapy such as minoxidil and finasteride, said Dr. Hooper. “Compliance is an issue. I’m a firm believer in combination treatment for hair loss.” Studies have shown increased hair thickness and moderately decreased hair loss with PRP. Anecdotally, said Dr. Hooper, hair becomes coarser, feeling fuller and thicker; one study found that about a quarter of patients reported this effect.
Through experience, Dr. Hooper’s learned some pearls for using PRP for androgenetic alopecia. Her male patients appreciate the use of a chilling device to help with pain, especially since Dr. Hooper uses a triple-needle syringe to stamp the scalp as she injects the PRP. Depending on how her patients are tolerating the procedure, she’ll follow up by injecting some platelet-poor plasma as well.
An additional pearl? “Have your patients bring a baseball cap.” Between procedure preparation, some oozing of PRP, and bleeding from injection sites, men don’t leave as well-coiffed as when they entered, she said.
Dr. Hooper has patients return four times over the course of 6 months for androgenetic alopecia, with repeat treatments about every 6 months thereafter.
Several studies have looked at using intradermal PRP for facial rejuvenation, with largely positive results. “Once again, we see consistent efficacy with no side effects,” said Dr. Hooper. She will use PRP either intradermally or topically after microneedling or fractional ablative laser resurfacing.
If it’s being used topically, Dr. Hooper will simply wipe the PRP on after the resurfacing treatment. For microneedling, “As we finish one zone, we topically apply the PRP and move on,” she said, adding that she instructs the patient not to wash her face until bedtime.
“I like injectable delivery for PRP as well,” said Dr. Hooper. She will often use it for crepey skin under the eyes as an add-on to other treatments, she said.
Her patients report that one major upside of post-resurfacing PRP is that they feel they recover more quickly. “Less erythema and less recovery time – that’s something that’s always helpful,” said Dr. Hooper. She uses the same treatment schedule for rejuvenation as for alopecia.
Some studies have shown promise for injected PRP for striae, said Dr. Hooper. She has just begun using injected PRP for striae in her practice and is encouraged by early results she’s seeing. It’s easier for patients than using multiple at-home treatments: “I think it’s just an option, they can pop in 3 times over the next few months” for some added benefit, she said.
Scanning the audience, Dr. Hooper said, “I see a lot of younger faces out there. I would challenge you to do the studies” to build evidence-based protocols for PRP in dermatology, since lack of consensus still hinders both adoption and high-quality research.
Dr. Hooper reported multiple financial relationships with pharmaceutical and cosmetic companies.
SOURCE: Hooper, D. ODAC 2018.
ORLANDO – Platelet-rich plasma offers much for patients and dermatologists: It’s low-risk, has a low cost of entry, and usefully augments other medications and procedures for androgenetic alopecia and facial rejuvenation.
But there’s work to be done in standardizing its use and really understanding where, when, and for whom platelet-rich plasma (PRP) will be best used, said Dierdre Hooper, MD, a dermatologist in private practice in New Orleans.
As far back as the 1970s, PRP was used as a transfusion product, with use expanding during the following decade. “It’s really the ‘everywhere’ product,’” said Dr. Hooper, speaking at the Aesthetic, Surgical, and Clinical Dermatology Conference (ODAC).
Over the course of the past four decades, PRP has been explored for musculoskeletal healing, in gynecology, urology, cardiac surgery, ophthalmology, and for plastic surgery. “Initial skepticism has given way as some evidence is building,” said Dr. Hooper.
PRP, considered a biologic product, is produced by centrifuging a donor venipuncture. Among the pros of using PRP in a clinical practice, said Dr. Hooper, is the fact that numerous clinical studies do show benefit. The risk is low, as is the cost, and downtime is brief. All of these contribute to attractiveness to patients, who also like the idea of an all-natural product with an autologous source.
But consensus is lacking about some key aspects of utilization, including the best mode of preparation and optimal treatment schedule. Outcomes can be unpredictable, making it tough to say how cost-effective the regimen will be for a particular patient. “The ‘cons’ just come down to no consensus,” said Dr. Hooper.
Some of the basic science makes a compelling case for PRP: Activated platelets have secretory granules. These modify the pericellular milieu through release of a variety of growth factors by secretory granules. “We all were taught back in the day that platelets adhere to promote clotting, but they do a lot more than that – when the platelet is activated, it releases growth factors,” said Dr. Hooper. “Big picture? Think: This is how we heal.”
After blood collection, the sample is centrifuged. The goal of centrifuging is to achieve a platelet concentration of 1 to 1.5 million platelets per mL, or four to six times the platelet concentration seen in whole blood. In practice, there are variations in the mode of preparation, and in an individual’s platelet level at the time of venipuncture, said Dr. Hooper, so it’s hard to know what the platelet “dose” is from PRP.
After centrifuging, the sample will be stratified into a bottom portion, consisting primarily of red blood cells, a middle portion that’s the PRP, and a top portion that is platelet-poor plasma. Dr. Hooper draws up and saves the platelet- poor plasma as well, since it probably also contains some growth factors. She’ll save that for application or injection after a PRP treatment for some patients.
Dermatology presents a host of uses for PRP. In addition to application after microneedling or resurfacing and injectable aesthetic uses, PRP can also be used to treat melasma, acne scarring, and androgenetic alopecia.
The strongest data for PRP currently are for androgenetic alopecia, said Dr. Hooper, because that’s where most of the work has been done to date. Growth factors in PRP can target the dermal papillae, shortening the anagen phase. “You will improve the anagen:telogen ratio and increase hair density and thickness,” she said.
“When you talk to your hair loss patients, there are drawbacks” with home therapy such as minoxidil and finasteride, said Dr. Hooper. “Compliance is an issue. I’m a firm believer in combination treatment for hair loss.” Studies have shown increased hair thickness and moderately decreased hair loss with PRP. Anecdotally, said Dr. Hooper, hair becomes coarser, feeling fuller and thicker; one study found that about a quarter of patients reported this effect.
Through experience, Dr. Hooper’s learned some pearls for using PRP for androgenetic alopecia. Her male patients appreciate the use of a chilling device to help with pain, especially since Dr. Hooper uses a triple-needle syringe to stamp the scalp as she injects the PRP. Depending on how her patients are tolerating the procedure, she’ll follow up by injecting some platelet-poor plasma as well.
An additional pearl? “Have your patients bring a baseball cap.” Between procedure preparation, some oozing of PRP, and bleeding from injection sites, men don’t leave as well-coiffed as when they entered, she said.
Dr. Hooper has patients return four times over the course of 6 months for androgenetic alopecia, with repeat treatments about every 6 months thereafter.
Several studies have looked at using intradermal PRP for facial rejuvenation, with largely positive results. “Once again, we see consistent efficacy with no side effects,” said Dr. Hooper. She will use PRP either intradermally or topically after microneedling or fractional ablative laser resurfacing.
If it’s being used topically, Dr. Hooper will simply wipe the PRP on after the resurfacing treatment. For microneedling, “As we finish one zone, we topically apply the PRP and move on,” she said, adding that she instructs the patient not to wash her face until bedtime.
“I like injectable delivery for PRP as well,” said Dr. Hooper. She will often use it for crepey skin under the eyes as an add-on to other treatments, she said.
Her patients report that one major upside of post-resurfacing PRP is that they feel they recover more quickly. “Less erythema and less recovery time – that’s something that’s always helpful,” said Dr. Hooper. She uses the same treatment schedule for rejuvenation as for alopecia.
Some studies have shown promise for injected PRP for striae, said Dr. Hooper. She has just begun using injected PRP for striae in her practice and is encouraged by early results she’s seeing. It’s easier for patients than using multiple at-home treatments: “I think it’s just an option, they can pop in 3 times over the next few months” for some added benefit, she said.
Scanning the audience, Dr. Hooper said, “I see a lot of younger faces out there. I would challenge you to do the studies” to build evidence-based protocols for PRP in dermatology, since lack of consensus still hinders both adoption and high-quality research.
Dr. Hooper reported multiple financial relationships with pharmaceutical and cosmetic companies.
SOURCE: Hooper, D. ODAC 2018.
ORLANDO – Platelet-rich plasma offers much for patients and dermatologists: It’s low-risk, has a low cost of entry, and usefully augments other medications and procedures for androgenetic alopecia and facial rejuvenation.
But there’s work to be done in standardizing its use and really understanding where, when, and for whom platelet-rich plasma (PRP) will be best used, said Dierdre Hooper, MD, a dermatologist in private practice in New Orleans.
As far back as the 1970s, PRP was used as a transfusion product, with use expanding during the following decade. “It’s really the ‘everywhere’ product,’” said Dr. Hooper, speaking at the Aesthetic, Surgical, and Clinical Dermatology Conference (ODAC).
Over the course of the past four decades, PRP has been explored for musculoskeletal healing, in gynecology, urology, cardiac surgery, ophthalmology, and for plastic surgery. “Initial skepticism has given way as some evidence is building,” said Dr. Hooper.
PRP, considered a biologic product, is produced by centrifuging a donor venipuncture. Among the pros of using PRP in a clinical practice, said Dr. Hooper, is the fact that numerous clinical studies do show benefit. The risk is low, as is the cost, and downtime is brief. All of these contribute to attractiveness to patients, who also like the idea of an all-natural product with an autologous source.
But consensus is lacking about some key aspects of utilization, including the best mode of preparation and optimal treatment schedule. Outcomes can be unpredictable, making it tough to say how cost-effective the regimen will be for a particular patient. “The ‘cons’ just come down to no consensus,” said Dr. Hooper.
Some of the basic science makes a compelling case for PRP: Activated platelets have secretory granules. These modify the pericellular milieu through release of a variety of growth factors by secretory granules. “We all were taught back in the day that platelets adhere to promote clotting, but they do a lot more than that – when the platelet is activated, it releases growth factors,” said Dr. Hooper. “Big picture? Think: This is how we heal.”
After blood collection, the sample is centrifuged. The goal of centrifuging is to achieve a platelet concentration of 1 to 1.5 million platelets per mL, or four to six times the platelet concentration seen in whole blood. In practice, there are variations in the mode of preparation, and in an individual’s platelet level at the time of venipuncture, said Dr. Hooper, so it’s hard to know what the platelet “dose” is from PRP.
After centrifuging, the sample will be stratified into a bottom portion, consisting primarily of red blood cells, a middle portion that’s the PRP, and a top portion that is platelet-poor plasma. Dr. Hooper draws up and saves the platelet- poor plasma as well, since it probably also contains some growth factors. She’ll save that for application or injection after a PRP treatment for some patients.
Dermatology presents a host of uses for PRP. In addition to application after microneedling or resurfacing and injectable aesthetic uses, PRP can also be used to treat melasma, acne scarring, and androgenetic alopecia.
The strongest data for PRP currently are for androgenetic alopecia, said Dr. Hooper, because that’s where most of the work has been done to date. Growth factors in PRP can target the dermal papillae, shortening the anagen phase. “You will improve the anagen:telogen ratio and increase hair density and thickness,” she said.
“When you talk to your hair loss patients, there are drawbacks” with home therapy such as minoxidil and finasteride, said Dr. Hooper. “Compliance is an issue. I’m a firm believer in combination treatment for hair loss.” Studies have shown increased hair thickness and moderately decreased hair loss with PRP. Anecdotally, said Dr. Hooper, hair becomes coarser, feeling fuller and thicker; one study found that about a quarter of patients reported this effect.
Through experience, Dr. Hooper’s learned some pearls for using PRP for androgenetic alopecia. Her male patients appreciate the use of a chilling device to help with pain, especially since Dr. Hooper uses a triple-needle syringe to stamp the scalp as she injects the PRP. Depending on how her patients are tolerating the procedure, she’ll follow up by injecting some platelet-poor plasma as well.
An additional pearl? “Have your patients bring a baseball cap.” Between procedure preparation, some oozing of PRP, and bleeding from injection sites, men don’t leave as well-coiffed as when they entered, she said.
Dr. Hooper has patients return four times over the course of 6 months for androgenetic alopecia, with repeat treatments about every 6 months thereafter.
Several studies have looked at using intradermal PRP for facial rejuvenation, with largely positive results. “Once again, we see consistent efficacy with no side effects,” said Dr. Hooper. She will use PRP either intradermally or topically after microneedling or fractional ablative laser resurfacing.
If it’s being used topically, Dr. Hooper will simply wipe the PRP on after the resurfacing treatment. For microneedling, “As we finish one zone, we topically apply the PRP and move on,” she said, adding that she instructs the patient not to wash her face until bedtime.
“I like injectable delivery for PRP as well,” said Dr. Hooper. She will often use it for crepey skin under the eyes as an add-on to other treatments, she said.
Her patients report that one major upside of post-resurfacing PRP is that they feel they recover more quickly. “Less erythema and less recovery time – that’s something that’s always helpful,” said Dr. Hooper. She uses the same treatment schedule for rejuvenation as for alopecia.
Some studies have shown promise for injected PRP for striae, said Dr. Hooper. She has just begun using injected PRP for striae in her practice and is encouraged by early results she’s seeing. It’s easier for patients than using multiple at-home treatments: “I think it’s just an option, they can pop in 3 times over the next few months” for some added benefit, she said.
Scanning the audience, Dr. Hooper said, “I see a lot of younger faces out there. I would challenge you to do the studies” to build evidence-based protocols for PRP in dermatology, since lack of consensus still hinders both adoption and high-quality research.
Dr. Hooper reported multiple financial relationships with pharmaceutical and cosmetic companies.
SOURCE: Hooper, D. ODAC 2018.
EXPERT ANALYSIS FROM ODAC 2019