Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP)

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Platelet rich plasma refers to a purified portion of your own circulating blood. Throughout our entire blood system, our blood cells carry infinitesimal amounts of highly potent healing factors, healing co-factors, growth factors, immune system proteins, and maintenance proteins. Platelet rich plasma is created by drawing a sample of blood from a patient using a small peripheral intravenous stick. Blood is atraumatically withdrawn from the patient, and then transferred sterilely to a sterile, biologic centrifuge. The sample is cycled using a proprietary formula, and a concentrated layer of all of the aforementioned healing and immune factors is created in a backdrop of platelet cells. Platelet cells are used to create a blood clot after we are hurt, and within each platelet cell exists a structure called an alpha particle. Within each alpha particle, there is a very large concentration again of healing factors, growth factors, and immune factors. The plasma is then enriched with organic calcium chloride, and thrombin (a blood coagulant), which causes the alpha particles to release all of their constituent healing factors.

The concept of platelet rich plasma continues to gain acceptance by both the public and the healthcare community at large.  Developed originally in the 1970’s, platelet rich plasma refers to a treatment strategy whereby the healing subunits and co-factors circulating in a patient’s blood system are captured, purified, and concentrated into a small sample of plasma.  That sample of plasma can then be used to improve facial aesthetics, improve skin quality, improve collagen induction with lasers and injectables, as well as many applications in Orthopedic surgery.  

What is Platelet Rich Plasma?

Platelet Rich Plasma (aka PRP) is derived from a patient’s own blood system.  To define PRP, it is important to understand the itinerant components present in your own blood.  Blood has three major components:

  1. Red Blood Cells, aka erythrocytes – These cells contain hemoglobin, and are responsible for delivering oxygen (O2) to your body’s cells.  They also collect carbon dioxide (CO2), which is a byproduct of oxygen metabolism, and bring it back to the lungs for removal.  Red Blood Cells are solid cells that are suspended in what we call plasma.  Plasma is the fancy doctor word for non-viscous fluid that carries cells.
  2. White Blood Cells, aka leukocytes – These cells are the backbone of your acquired immune system.  There are many types of leukocytes (Tcells, Bcells, etc.).  White Blood Cells are suspended in what we call plasma.  Plasma is the fancy doctor word for non-viscous fluid that carries cells.
  3. Platelets, aka platelets – These cells are responsible for allowing blood to clot after injury.  Platelets are very metabolically active cells, and they also play a critical role in the initial stages of wound healing.  Unlike the red and white cells, Platelets are intrinsically part of plasma, meaning they are not suspended or added.  Within each platelet, there are biologic storage units that hold all of the factors that our bodies use to regenerate after injury.  These platelet granules are activated by calcium (Ca2+) and thrombin, which is a protein found circulating in the blood stream.  When calcium ions and thrombin interact with platelets, the platelet cells “degranulate” and release all of the healing components our bodies use to heal after injury.

In summary, your blood is a suspended mixture of platelets bonded to plasma, red blood cells suspended in plasma, and white blood cells suspended in plasma. This structure, with red and white cells as a suspension in plasma versus platelets being an integral part of plasma allows us to separate out the healing components (platelets) from the unnecessary components (red and white).  As an analogy, think about oil and vinegar.  Oil is oil and vinegar is vinegar.  When you combine the two and shake them, they become one fluid to the naked eye, but in actuality the vinegar is just suspended in the oil.  Over time, the two separate fluid viscosities create a separation because the vinegar is water based and the oil is obviously oil based.  This is an example of a suspension, with vinegar being suspended in oil due to agitation/movement.

How is Platelet Rich Plasma made?

While your blood is more complex then salad dressing, it is a reasonable analogy to understand how we derive platelet rich plasma from your own bloodstream.  We use venipuncture to collect a sample of your blood, between 10 milliliters (1/8 of a shot glass) and 60 millileters (almost a full shot glass).  That blood is then centrifuged in a proprietary centrifuge to create separation between the three layers of blood.  We then remove the red blood cell and white blood cell components using the proprietary technology provided by RegenLab.  Their technology allows for the creation of patient derived thrombin and platelet rich plasma.  These two components are then injected, topically applied, or sprayed in combination with calcium ions to create its effect.  

Process for collecting platelet rich plasma.

PRP Process

Figure 1 – The diagram above shows the process for creating individualized platelet rich plasma.

In summary, this treatment is literally derived from your own system.  It is without question the most organic form of anti-aging rejuvenation that we have at Ocean Drive Plastic Surgery and MedSpa.  So, what do we use it for?

How is Platelet Rich Plasma used at Ocean Drive?

Dark Eye Circles

If you have excess pigment in your lower eyelids, platelet rich plasma offers you a natural and effective treatment for normalization of your skin tone and color.  While broadband light and HALO laser therapy are the gold standard for treatment, many patients do not want the extra cost or the downtime associated with those modalities.  For patients who want a less invasive treatment, microneedling with platelet rich plasma is the answer.  Most patients require 2-3 treatments over a 2-3 month period for maximal results, but recovery from each treatment is measured in minutes to hours rather than days to weeks.

Microneedling – aka the Vampire Facial

One of our most economical and effective therapies is microneedling with PRP.  Not only does the PRP increase the collagen induction effects of the microneedling, it also allows for treatment of superficial pigment, and improves overall healing after the microneedling procedure.  This is the treatment that was popularized by the Kardashians in early 2012.  Also, if you have dark pigment in your lower eyelids, look no further.

Dr. Durkin’s Facelift Surgery

All patients undergoing facelift surgery at Ocean Drive receive PRP intraoperatively.  We have clearly found that use of PRP during facelift surgery is profoundly advantageous for patient result and patient recovery.  Not only does this treatment markedly reduce bruising and swelling, the PRP acts as a supercharged healing agent, making recovery markedly superior.

Before Facelift PRP
Before PRP Facelift
One Day After Facelift
Postoperative Day 1 after Ocean Drive Limited Incision Facelift, laser resurfacing, and Fat Grafting.  Note the minimal degree of bruising 24 hours after a SMAS facelift, laser resurfacing, and fat injections.
After PRP Facelift
After PRP Facelift. Day 10 post-op facelift with platelet rich plasma. Bruising resolved, swelling is minimal and result is natural.

Upper and Lower Eyelid Surgery, Rhinoplasty

All patients are offered PRP for these procedures.  In patients that choose to use PRP, bruising and swelling are markedly reduced, and the patient experience during recovery is very much enhanced.  While we do not think that it improves the final result of surgery, it clearly improves healing following the procedure

Fat grafting procedures

Platelet rich plasma has been shown by multiple investigators to improve both recovery following fat grafting, as well as improving the amount of fat that survives after the transfer.  We believe that platelet rich plasma is a cornerstone of fat grafting, and use it by combining PRP with the fat graft to enhance graft take.

Ablative Laser Resurfacing

Patients who undergo ablative laser resurfacing are strongly encouraged to use platelet rich plasma, as it clearly improves both recovery and skin quality following treatment.  This type of laser is designed to markedly reduce wrinkles and skin irregularities while simultaneously acting to increase collagen production in the skin.  As such, PRP acts synergistically with this type of laser.

Halo Plus

Our most popular laser platform is made even easier and more effective with platelet rich plasma.  There is no question in our minds that PRP markedly improves skin quality and texture when combined with HALO hybrid fractionated laser.

Hair Restoration

Are you starting to thin along the scalp or eyebrows?  If in the early stages of hair loss, platelet rich plasma injections provide an incredibly natural and economic solution.  For patients who still have hair follicles, PRP injections can reverse the process of hair loss, and increase the amount of natural hair on your head and brow.  This specific treatment is one of Nick Woltjen’s best tricks.  It is used in every type of patient, from the naturally thinning patient like Dr. Durkin, to patients undergoing chemotherapy, and to patients who have lost hair follicles secondary to injury or surgery.  This process requires a series of injections, but response to therapy is well over 85%, especially when it is combined with Light Emitting Diode Laser therapy (LED).

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Microneedling

One of our most economical and effective therapies is microneedling with PRP.  Not only does the PRP increase the collagen induction effects of the microneedling, it also allows for treatment of superficial pigment, and improves overall healing after the microneedling procedure.  If you have dark pigment in your lower eyelids, look no further (see above).

What are the risks of Platelet Rich Plasma?

Very few.  There is no chance for allergic response as you are receiving the best healing components of yourself.  No significant risk factors exist for this treatment.

The Ocean Drive Difference

Not only have we invested in the finest platelet rich plasma technology available on the American market, we have been avid users of PRP since 2007.  We have a voluminous experience with this technology both inside and outside of the operating room.  As well, all patients have their blood drawn by licensed Registered Nurses on site at the spa or in clinic.  We do not have issues with being unable to draw blood, or multiple sticks to obtain blood.  Rather, when patients undergo PRP at Ocean Drive, our expertly trained, experienced surgical nurses(LINK TO OUR TEAM PAGE) will be the ones undertaking venipuncture.  Lastly, as we are a state certified surgical center, our dedication towards sterility, cleanliness, and efficiency are unparalleled.

PRP Therapy is Liquid Healing

In the end, we have a concentrated, plasma type fluid that represents liquid healing, literally. When obtaining the Ocean Drive® Facelift with Dr. Durkin, we produce your platelet rich plasma after you have entered a comfortable, twilight anesthesia. After completing the facelift internally, Dr. Durkin applies a concentrated dose of platelet rich plasma to your skin. First, we aerosolize your PRP it into a fine spray and then, spray your PRP to coat the entire undersurface of your skin as well as, the superficial layer of the SMAS and platysma. This fine spray acts to markedly reduce swelling, bruising, and redness caused during surgery, while secondarily acting as a “biologic glue”, promoting a soft, natural interface internally between the skin and SMAS. Platelet rich plasma has been used at our institution for over fifteen years, and we are convinced that it improves our outcomes while simultaneously reducing postoperative recovery time.

Platelet Rich Plasma Healing Factors

Connective Tissue Growth Factor (CTGF)

Epidermal growth factor (EGF)

Fibroblast growth Factor (FGF)

Insulin-like growth factor 1 (IGF-1)

Insulin-like growth factor 2 (IGF-2)

Interleukin 8 (IL-8)

Keratinocyte growth factor (KGF)

Platelet Derived Growth Factor (PDGF)

Transforming Growth Factor- Beta (TGF-B)

Uses of Platelet Rich Plasma

While we have utilized platelet rich plasma for over 20 years at our facility, the power and utility of platelet rich plasma is now being utilized widely in orthopedic surgery as well. Platelet rich plasma injections have been shown to reduce inflammation, improve tissue repair, and improve muscle and joint function. Specific areas where injections appear to offer benefit include the hip, knee, wrist, and thumb joints.

Platelet Rich Plasma in Vampire Facelift

PRP is also the driving force behind the so-called “Vampire Facelift”.   In a vampire facelift, blood from the patient is harvested, and PRP is purified. It is then introduced into the deep dermis via the Rejuvapen® microneedling device, where it interacts and improves overall skin quality. While we do offer the “vampire facelift” at Ocean Drive Plastic Surgery, the results of it as compared to using synthetic healing factors as listed above is the same, but without the blood draw, and the discomfort of an IV stick. In short, we do not see a clinical difference between standard, non-invasive methods and the use of PRP with microneedling. Lastly, we feel that the term “vampire facelift” is grossly misleading, as there is no injection present that can even come close to reproducing the outcomes of a surgical facelift.

Summary

In summary, platelet rich plasma is one of the cornerstones of our success when it comes to surgical facelift procedures. By working as an internal integration matrix, PRP helps to ensure that we are able to consistently produce natural facial aesthetic results during surgery. As we continue to study platelet rich plasma, we fully expect it to play a role in other rejuvenative therapies in the future.

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