PRP PRP mechanism and indications Dr Gita Faghihi Assoc.Professor,dermatology department Isf Uni.Med.Sci.

The most natural injectable

Definition: Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets folds / 3.3million / mm3 As a concentrated source of autologous platelets, (17-19 folds / 3.3million / mm3) PRP contains,and releases (through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue. stimulate healing of bone and soft tissue. BUFFY COAT =PLATELETS + LEUCOCYTES

فاکتورهای مترشحه از پلاکتها

PDGF (3 of platelet-derived growth factor ( PDGFaa, PDGFBB, and PDGFaB ), PDGF (3 isomeres of platelet-derived growth factor ( PDGFaa, PDGFBB, and PDGFaB ), significant role in blood vessel formation, the cellular division of fibroblasts (the most common cells in connective tissue), and in synthesizing the extracellular matrix and collagen

Other important growth factors include: (TGFB1 and TGFB2), vascular endothelial growth factor, and epithelial growth factor.

PRP PRP PRP stem cells growth factors Biosynthesis Collagen Elastin and Biosynthesis Collagen Elastin and Angiogenesis Angiogenesis

Main indications of PRP: Sport related injuries: Aschilles tendinitis,, teniss elbow... osteoarthritis, muscle injuries bone repair regeneration nerve injury

Clinical applications PRP In humans, PRP has been investigated and used as clinical tool for several types of medical treatments, including: cardiac muscle injury, plastic surgery, and maxillofacial surgery. anti-aging medicine and beauty sciences.

Indications as a whole

Botulinum toxin limited benefit for lines not due to muscle activity. dermal fillers are generally used to establish the volume loss in the tear trough, can’t really use fillers for the fine lines. This is where PRP really useful as it really helps thinning eyelid The most favorite area for PRP. is around the eyes. Peri-orbital rejuvenation Peri-orbital rejuvenation is a difficult area

Very important indications of PRP Periorbital (wrinkles fat pads and dark circles) Periorbital (wrinkles fat pads and dark circles) Loose skin Loose skin Saggy skin Saggy skin

biostimulation technique with own patient”s cells autologous cellular regeneration ( ACR)

Xylocaine-P gel before injection for giving anesthesia

Injection levels are both in dermis and hypodermis,,some what overcorrected

Frequency and intervals of treatments: anti-aging Most patients will require 2-5 treatments two months apart with results starting to show after 3-4 weeks. Frequency and intervals of treatments: For: anti-aging procedures Most patients will require 2-5 treatments two months apart with results starting to show after 3-4 weeks.

Dr Naomi.. Another protocol (Asian Clinic) Dr Naomi.. 2 to 3 sessions of PRP each spaced about 1-2 months apart. 3 to 7 reassess the patient about a month after the last treatment (usually at about 3 to 7 months after the first session) to determine whether the patient has achieved the expected results or whether more sessions are required. the older patients probably need another treatments every 6 months or so,..

Other indications: stimulating hair regrowth, skin laxity on the body and improving the appearance of stretch marks and scars

PRP Androgenetic alopecia one important indication of PRP especially when other treatments and HT surgery are not accessible.

better to be seen after hair transplantation Hair follicle stem cells are activated and enhanced growth, and the results are better to be seen after hair transplantation.

PRp Effective improvement (hair loss) by PRp lasts about one year

Advantages of PRP therapy Autology: your own blood Tissue regeneration and rejuvenation Safety: non-allergenic and free from concerns over transmissible diseases such as HIV, Hepatitis B & C, CJD and so on Faster healing: no fibrosis formation compared to some long term fillers, for example Easy to use: dermal and hypodermal injections require only one syringe and one needle Convenience: PRP harvesting can be easily and quickly performed in clinic. A sterile and registered specific kit for the blood puncture, the preparation of the plasma and the materials is used. Cost effectiveness

SIDE EFFECTS OF PRP FACIAL REJUVENATION Pain and faint, headache, for first hours are mild Pain and faint, headache, for first hours are mild Swelling and redness 1-3 days Swelling and redness 1-3 days bruising (2 weeks,, masked by make-up,,) bruising (2 weeks,, masked by make-up,,) In rare cases, skin cellulitis may occur which can be treated with antibiotics and cold compresses In rare cases, skin cellulitis may occur which can be treated with antibiotics and cold compresses Possibility of small venule thrombosis,, Possibility of small venule thrombosis,, hyperpigmentation hyperpigmentation

PRP over 60 years of age PRP in people over 60 years of age Although not impossible but they are poor responders.

Exclusion criteriae for PRP Persons with active skin disease (such as : SLE, porphyria, ) cancer chemotherapy, severe metabolic and systemic disorders(especially advanced diabetes and severe asthma….) abnormal platelet function (i.e. blood disorders) Anti-coagulation therapy underlying sepsis

Exclusion criteriae for PRP NSAIDS drugs during one week before History of recent stroke (heavy) Cigarette smoking Active infection at the inject. site

What to avoid post—op care Avoid massaging or rubbing the treated area for first 48 hours after the treatment. Avoid massaging or rubbing the treated area for first 48 hours after the treatment. Also avoid facial peels, and laser treatments for the first 4 weeks. Also avoid facial peels, and laser treatments for the first 4 weeks.

HPL(human platelet lysate) 2-10 times more growth factors than PRP and long term storation time Readily available growth factors faster regeneration Do not have platelet membrane,no risk of allo-immunization

Platelet-Rich Plasma: Evidence to Support Its Use CLINICAL CONTROVERSIES IN ORAL AND MAXILLOFACIAL SURGERY: PART TWO J Oral Maxillofac Surg 62: , 2004 Robert E. Marx, DDS* University of Miami, FL, US Reference:

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