PRP: WHERE ARE WE? Jeffrey Rapaport, MD, PA Fellow, American Academy of Dermatology Fellow, American Society for Dermatologic Surgery AAD Presenta9on Hand Outs 2.17.2018
Large Volume/Double Spin/Complex Systems Small Volume/ Single Spin/Simple Systems Separator Gel Systems VS. Floa%ng Buoy Systems Buffy Coat Emcyte Designed for low to medium platelet Concentration (1.4X-4X) Less inflammation - Ideal for Dermatologic Applications Floa%ng Buoy Systems Buffy Coat Harvest Computer-Aided Systems Magellan Arthrex Angel ACP Designed for Orthopedics Lower Platelet Concentration (2x) Low inflammation no separator gel easy to mix RBC Designed for Orthopedics Higher Platelet Concentration (5x+) High inflammation High RBC and Granulocytes
Patient Indication for PRP Treatment Primary: Androgenic Alopecia (Lower Ludwig or Hamilton preferred) Secondary: Alopecia Areata Traction Alopecia Scalp Disorders - Partial Effectiveness?? Telogen Effluvium CCCA, Frontal Fibrosing Alopecia, Lichen Planopilaris, Contraindications: Other Pregnancy or breast feeding, cancer or chemotherapy, keloid development, platelet count less than 105, local infection, hematologic/coagulation disorders, history of untreated thyroid disorders, untreated anemia, severe scalp psoriasis, history of untreated Vitamin D deficiency, body dysmorphic disorder, untreated Hyperandrogenism Syndromes
SKIN (S): Thick, with many close-set hair follicles and their associated sebaceous and sweat glands. Firmly joined to next deeper layer SUBCUTANEOUS TISSUE (C), SUPERFICIAL FASCIA: Thick; strong with fiber bundles woven together, with fat interspaced Contains superficial vessels and nerves Hair follicles of skin project into this layer MUSCULOAPONEUROTIC (A): Represents the deep fascia In forehead and occipital regions the frontalis and occipitalis muscles are located here. In temporal region, auricular muscles are also in this layer Galea aponeurotica, a dense, thin, fibrous sheet that unites the frontal and occipital muscles of cranial vault SUBAPONEUROTIC LAYER (L): Very loose and scanty. Contains a few small vessels. The nature of this layer permits easy movement of layers A-C, which act as a unit, over the next layer PERICRANIUM (P): The periosteum of the bones. Except at sutures, is poorly fixed to bone
Numb patient s scalp with a topical numbing agent (optional) Have patient sign two labels (One label per tube) Draw blood into appropriate size tube (usually 22 ml) PRP can be concentrated for better outcomes Centrifuge at for 3500 RPM for 10 minutes (See centrifuge instructions) Draw up platelet poor plasma (PPP) using 10 cc syringe and Rigid Needle, leave platelet rich plasma (PRP) Invert the tube 10-20 times and collect PRP into syringe Optional Add.1 ml lidocaine Change needle to 27 or 30 x ½ gauge Lie patient down Remove topical anesthetic (optional) Thoroughly rinse the scalp until no numbing cream is left Sanitize the scalp with alcohol. The hair should be easily manipulated with a comb. Use 27 or 30 gauge x ½ inch needle and 3cc Syringe
Start Chiller or 50% O2/50% N2O Analgesia Have patient identify name and signature Subdermal depo injection technique Inject approximately.2 -.5 ml PRP distributed evenly in areas of hair loss Schedule 3-4 monthly treatments followed by a 3-6 month maintenance interval *For use with standard PRP. Not effective with activated PRP.
Mounting body of evidence FOR effectiveness of PRP for Hair Restoration Increased critical scientific data needed Standardization in PRP protocols including preparation, composition and activation More human studies with quantitative analysis, control groups, blinding, longer time frames, single variables, larger sample sizes, standardized outcome assessment (allowing metaanalysis)