Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland brought to you by SpaMedica. Hello and welcome, Dr. Stephen Mulholland here in Toronto, Canada, you’re on Plastic Surgery Talk, and we’re on our weekly podcast series. If you enjoy these podcasts, you find them educational or if you find them informative, fun, please subscribe, share and comment. Our podcast this week is another very, very topical area of aesthetic medicine, it’s an area that I’ve been doing for years, but it’s found sort of a place in the sexiness of what’s new. It’s called PRP. PRP is an acronym that we use for platelet rich plasma. We’ve been doing this for quite a long time, I think with social media and the Kardashians and the latest what’s new with the vampire lift, got a lot of traction over the last year, too.
The vampire lift is a specific way of using platelet rich plasma to create an enhanced aesthetic outcome non surgically. So, the topic today is PRP. There’s two kinds of ways we use PRP commonly. We use PRP for hair restoration and hair growth, and we can use PRP for anti aging and rejuvenation, so we take a patient’s blood, a simple little venotomy or like you’re donating blood. We take a small amount, a couple of syringes. We spin down that blood and we extract from that blood the stem cells and the growth factors. When applied in specific fashions and ways during an aesthetic treatment, either for hair restoration or anti aging wrinkle reduction, it can amplify and improve the results or the outcomes. So it’s using our own body’s stem cells, body’s growth factors, to improve the outcome of hair growth or anti aging skin rejuvenation.
So how does this PRP or a patient’s own stem cells and growth factors help if you have thinning hair? Well if we think what’s happening with thinning hair and male pattern hair loss or female pattern hair loss, in the male case it’s really just an excess of localized breakdown product of testosterone called DHT or Dihydrotestosterone. Because patients who suffer from male pattern hair loss have a weak enzyme, this DHT builds up and over many years it assaults and traumatizes the bulbs so the bulb withers away and doesn’t produce a shaft anymore. We’ll along comes our PRP, and with the very, very tiny needle, we inject the PRP directly in the scalp. The stem cells and the growth factors will reactivate some of those dormant follicles that had been stunned or put into shock by the DHT.
So it reactivates dormant cells, the dormant cells then with the stem cell enhancement and growth factor cascade start to produce hair shafts. The hair shafts grow, and we get thickening of the hair. So it’s good for men who have early pattern hair loss, they’ve crowned out a little bit, there’s some thinning of the hair, but they haven’t become a total George Costanza baldness. If you’ve had too much hair trauma for male pattern hair loss and DHT over too long a time, the bulbs are too dormant to restore and resuscitate with PRP. But if you have early to mid male pattern hair loss, we’ve had great success with PRP stimulating increased growth.
Now for women, with female pattern hair loss, which is generally not DHT related, women are even better responders to PRP, so usually a session of four can lead to a tremendous improvement in the growth of hair for women who suffer from female pattern hair loss. So how is PRP for hair restoration performed? Quite simply, we harvest a couple of tubes of blood like you might at any blood lab, we spin it down in our own medically sterile and certified centrifuge, we then decant off the non favorable products and we isolate the layers in the cells that harbor the platelet rich element and the growth factors, the stem cells.
Once we have that, it’s usually between a five and eleven CC draw or milliliters of this product, we are then going to take a very, very small, almost Botox sized syringe, and we’re going to inject those growth factors and stem cells right into the depth of the scalp where the bulbs live. Now this can be moderately uncomfortable, so how do we make this an experience that patients find tolerable if not fun, we use laughing gas or nitrous oxide. And so one of our podcasts on our series is on the use of Pro-Nox, or nitrous oxide to make our patients Medical Spa treatments if not acceptable, fun. We use laughing gas to make the PRP injection in the scalp acceptable if not fun.
It takes about thirty minutes or so to do the treatment, we use laughing gas to make it acceptable and eliminate the discomfort, and we do a treatment in covering the entire scalp where the thinning hair is occurring, and we do that once a month for four sessions. At the end of four sessions in general we’re going to see somewhere between 30-50% increased density in growth, usually a very visible improvement, especially with early to mid male pattern hair loss, and the results are often even more impressive with women, who have female pattern hair loss. So once a month for four months, and then we give it about two to three months for the growth to optimize, so by six months you’ve got usually a very significant improvement in density.
We then recommend that you come back once every six months, so once or twice a year, to maintain the results. You can combine this with low level light therapy, either at home or in the office, topical nutrient shampoos, any kind of nutrient supplement orally, but the most important factor in getting that regrowth non surgically is PRP or platelet rich plasma. So what about pain and discomfort during PRP? Whether it’s PRP for hair restoration, whether it’s PRP for skin rejuvenation, we’re always cognizant to take pain and reduce it to aesthetically acceptable discomfort if not fun pain. How do we do that? We use a number of techniques, topic anesthetic cream, we can use an air chiller, we can have squeezing vibration devices that we grab. We can use a [inaudible 00:06:31] inflammatory.
However, the most effective tool that I have found over the past couple of years to make this a fun experience is the use of nitrous oxide, or laughing gas. And so we have a whole podcast on the use of laughing gas, the use of laughing gas takes what could be reasonably uncomfortable, both the draw and the application where there’s fractional or treatment in the hair, and makes it fun pain, acceptable pain. So the use of laughing gas has rendered the treatment of PRP for male pattern hair loss, female pattern hair loss, even facial anti aging if not much more acceptable, even fun. Are there any risks associated with the use of PRP either for hair restoration, male or female pattern hair loss, or skin rejuvenation and anti aging? The answer is very, very few risks, which is why it’s so popular. There are risks associated with the treatment of anti aging, fractional resurfacing for wrinkle reduction, but when the add the PRP topically with a small needle, there’s virtually no risk.
There’s a small risk of a bruise at the site of the harvest, that will go away. The PRP is done in a sterile technique within your physician’s office so there’s no risk of contamination with another patient’s blood products. The topical application of PRP has essentially no risk to the user and generally we’ll leave it on the skin for about thirty minutes, clean it off before you leave so there’s no risk of other people around you with your topical blood products on your face. With the injection of PRP, there’s virtually no risk. The biggest risk is your expectations exceed what can be done. Yes, the fractional technique or the hair restoration technique should result in a noticeable improvement, either increases hair density or for rejuvenation, smoother, tighter, firmer, wrinkle reduced skin.
However, the results, like anything aesthetic medicine, may not quite meet your expectations. So the number one risk is your expectations exceed what the treatment can deliver. After that, there might be some localized bruising or swelling from the injection, but typically it’s one of the lowest risk treatments we have with a very big cost benefit reward making it so popular. Who’s a good candidate for PRP for hair restoration? The best candidates for a PRP hair restoration are first female pattern hair loss. Generally females don’t tend to go totally bald, they have what’s called a one or two modest hair thinning, diffuse. The underlying cause is not related to DHT typically. They tend to be quite responsive to PRP. So, females with early to middle female pattern hair loss are usually great candidates.
Males can also be very good candidates for PRP, but they need to be in the middle of their hair thinning recession. Typically it responds best in the middle and post to your scalp, but even the frontal temporal zones can respond. But not in the terminal stages of sort of friar tuck totally bald haven’t had hair for a long time. End stage male pattern hair loss typically not good candidates for PRP. But early hair loss, loss of density, male or female, typically respond very well. Are there any contrary indications? Very few. However, if there are specific blood conditions such as hemophilia or conditions where patients just don’t clot, drawing blood and spinning it down and re-injecting it is not advisable. That’s about the only contrary indication other than expectations. Make sure that you have realistic expectations so that you can set yourself up for success for this nice technique.
Is there much recovery associated with PRP and let’s say hair restoration or anti aging wrinkle reduction? Not really, it’s one of the least invasive treatments we have for hair restoration because it’s injected into the scalp, and the scalp generally has some hair. Even minor bruising or swelling you get from the PRP is camouflaged immediately, so there may be a little bit of swelling that you might notice around the eyes, around the temple in the first day or two after PRP, but essentially very, very little down time. Occasionally a patient will complain of a bruise that shows up above the eyebrow that’s drifted down from the scalp, but very, very, unusual, and you can always blame it on hitting your eyebrow on a car door or some other sort of secondary traumatic event.
For anti aging patients who are having a fractional injury, a fractional resurfacing of the skin and the PRP, the downtime is not from the PRP, the downtime is from the fractional treatment. So you might have a little redness from the micro needling for a day or two, redness plus crusting or discharge if it’s fractional seal to a fractional radio frequency. The cool thing about PRP, it takes that one week of fractional downtime after anti aging wrinkle reduction, and it makes the downtime and the recovery faster. So PRP helps speed up the downtime, but the downtime from anti aging PRP is the downtime of the fractional injury. For hair restoration PRP, virtually no downtime, you can go right back to your activities.
Now, what kind of results can you expect with PRP and hair restoration? If you’re a early, male pattern hair loss, you’ve got some crowning, some thinning in the middle part of your scalp, some frontal, temporal recession, a little bit of early thinning, you can anticipate a good 30-50% densification with the series of four PRP injects once a month for four months. Then, the ongoing process of that DHT, the genetic curse whittling away and hammering away at your bulbs is going to exist, so usually one treatment every six months should prolong and delay the progression of thinning, the genetic curse that you have. You might combine that with Propecia, testosterone blockade and Finasteride, low level light therapy, topical nutrient shampoos, and ultimately you might delay significantly your genetic propensity to the kind of baldness that you’re at risk of having, and PRP’s going to be a big part of bringing back that early density.
Eventually however, the genetic curse will play out, you’ll become thin and bald and then you transition into follicle unit extraction and hair transplantation. Likely some time before you’re bald, but sometime after the PRP ceases to be effective. That’s where a good center like SpaMedica or many centers out there that do both PRP and good FUE, non strip grab, non linear scar hair restoration, are going to be the best at assessing when PRP runs out of efficacy and FUE takes over. So what kind of cost could I expect for my PRP hair restoration? Well, it depends on the center, it depends on the city. However, the range of treatment costs that I see across North America, typically between 1500-1600 dollars and 3000 dollars for a series of four treatments. The treatments could be once a month for four months, allowing then three or four months to see what kind of amplified hair growth you’re going to get.
And then there’s a maintenance package you purchase, either pay as you play every six months, or you buy a two pack and you treat twice a year for maintenance. But those are the approximate prices that I see across clinics in North America when dealing with PRP and hair restoration. So how to select your PRP hair restoration center? Well, you want to pick a center that’s been doing hair restoration, hair assessment as part of their core business for a long time. Not some day spa that knows very little about hair, and offers only PRP. Because you want a center that’s experienced, that knows when PRP’s going to be a benefit, and when you need to add other restoration techniques, like FUE and hair transplantation and the transition between those two.
So I’d pick a center that’s dedicated to hair, I’d pick a center that’s been doing PRP for a long time, it has experience. A center that offers you pain minimization techniques like Pro-Nox or laughing gas or nitrous oxide. A center that has a good reputation for FUE, non linear scarring, non strip grab follicle extraction and transplantation techniques, because they’re going to know when you are not going to be a good PRP responder, you may need to move on to FUE. Or by the same token, if you’re doing FUE, they’ve got PRP techniques that help you get a better result from your FUE procedure, or minimize hair loss in other areas after FUE procedures. So a good hair restoration center, lots of experience with PRP, reputable PRP companies that they’re deploying such as Reagent or Eclipse or [Arctrex 00:14:52]. The Chroma PRP system.
And then technicians that have had hundreds of PRP treatments under their belt, are knowledgeable at assessing hair, and handle your blood products with sterility and ensuring that you’re getting a sterile and efficacious treatment during the PRP. Needles aren’t being reused. I’m sure we’ve all heard of that horrific case, the United States reusing PRP needles and causing Hepatitis C infection. So again, standard medical care during the manipulation and treatment with your blood products is a bare minimum. So, the more medical grade the clinic, the more plastic surgery oriented, the more dermatological oriented likely, the more of these variables are going to be covered off in your checklist of who to see for your PRP hair restoration treatment.
So thank you for joining me, Dr. Stephen Mulholland here in Toronto, Canada, on Plastic Surgery Talk. Another of our weekly podcast series, this one was on PRP. PRP hair restoration, a very, very popular topic and one that may benefit you. If you’ve found this podcast entertaining, informative, educational, please share, comment and subscribe.