Welcome to Plastic Surgery Talk with Dr. Stephen Mullholland, brought to you by Spa Medica.
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
So our podcast this week is on a very, very topical area of aesthetic medicine. It’s an area I’ve been doing for years, but has found sort of a place in the sexiest of what’s new and 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, the vampire lift got a lot of traction over the last year or two and the vampire lift is a specific way of using platelet rich plasma to create an enhanced aesthetic outcome nonsurgically.
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 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 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 in ways during the aesthetic treatment, either for hair restoration or anti-aging wrinkle reduction, it can amplify and improve the results and the outcome. So as using your own body stem cells, body’s growth factors to improve the outcome of hair growth or anti-aging skin rejuvenation. So what is PRP in the context of facial rejuvenation? And so PRP is taking the patient’s blood, spinning it down in a centrifuge and getting a very sterile collection of stem cells and growth factors.
Unto themselves, if we applied this topically or injected under the skin, it actually does very little. We need to create an inflammatory stimulus. We need to do something to the skin for the growth factors and the stem cells to amplify their production of collagen, to thicken the skin to smooth and wrinkles. So what do we do? We usually will do some type of fractural injury to the skin. The most entry level, done by most medical and day spas is microneedling now onto itself microneedling, which is tiny little needles that oscillate vertically into the skin and create a fractional mechanical injury, this stimulates some mild inflammation. Through the little channels created by the microneedles, the topical PRP can soak into the skin, can get down to where we need new collagen to be produced. We can also inject the PRP under the skin with a microcanula technique to stimulate the deeper aspects of the skin, to lay down more collagen and elastin.
And so if we do a little microneedling as the injury, we can create a more amplified response and get more collagen, more elastin, and a better looking skin rejuvenation with the use of PRP. The most medical use of PRP is following a fractional thermal injury where we take more of a medical approach to fractional injury, fractional carbon dioxide resurfacing, fractional radio-frequency resurfacing, and the thermal ablation creates a significant rejuvenation on its own, whereas microneedling is not very significant improvement, but certainly easier to do and offered by many nonmedical day spas. The fractional CO2, the fractional radio frequency like Fractora, or Infini, or Intensive creates a tremendous thermal experience in the dermis. Again, a fractional injury. If we add topical PRP or inject PRP under the skin or both, we can amplify the collagen response by 20%. We can heal the fractional injury about 30 to 40% faster, and so this is a randomized, double blinded proven benefit of PRP.
We get a better collagen response, we get faster healing. When we add PRP topically or as an injection after creating an inflammatory fractional injury and the combined therapy of fractional CO2, fractional radio-frequency and PRP is the state of the art fractional rejuvenation that we could add to the patient’s experience. What’s the treatment protocol for PRP and skin rejuvenation? Well, quite simply we create a fractional injury in the skin. It can be microneedling or a more medical and more substantive fractional carbon dioxide resurfacing, fractional erbium resurfacing, infrared fractional or fractional RF needle like Fractora.
Once you’ve created the fractional entry, we’ve already drawn the blood and we spinned it down and we extract the elements we need from that blood. We want the fraction and elements that have the platelet rich stem cells and growth factors. Normally we can get about a five cc draw for skin rejuvenation and we do the fractional treatment under a topical anesthesia and laughing gas, so we just Pro-Nox or nitrous oxide to minimize the discomfort of both the fractional treatment and then the topical addition of PRP is painless, so we take usually about 20% of our PRP draw.
We put it on the skin slowly so it’s absorbed through the channels that we created with the fractional injury. Then we take the other four ccs in a very small micro canula, and we inject it directly into and under the dermis. We get a top layer PRP edition and a bottom layer, and the goal is to increase by 20% or more the amount of collagen you’re going to produce and to get the wound healed up to 30% faster by the use of PRP during a fractural injury technique fractionally surfacing in a combined therapy for anti-aging. So it’s going to give you the best acne scar reduction you can probably get, we’re going to get a fractional wrinkle reduction and smoothing, enhanced tightening and even conditions such as dyschromia or brown discoloration, Melasma are going to improve more significantly with the addition of PRP.
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. And how do we do that? We use number of techniques, topical anesthetic cream. We can use an air chiller, we can have squeezy vibration devices that we grab. We can use a nonsteroidal antiinflammatory. However, the most effective tool that I’ve found over the past a 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, whether it’s fractional or treatment in the hair and makes it fun pain, acceptable pain. So they use of laughing gas has rendered the the treatment of PRP for male pattern hair loss, female pattern hair loss, and even facial anti-aging if not a much more acceptable, even fun.
Are there any risks associated 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 you add the PRP either topically or 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 30 minutes, clean it off before you leave so there’s no risk of other people around you with your topical blood burn 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 increase hair density or for rejuvenation, smoother, tighter, firmer wrinkle reduce 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 are the best candidates for this in anti-aging therapy? Typically people who’ve got mild to moderate wrinkles or mild to moderate acne scars who have realistic expectations and who want the best amplified result after a fractional treatment. So whether it’s microdermabrasion at the very entry level of fractional invasiveness or fractional CO2, fractional radiofrequency, if you want to get the best possible result, PRP added to that is always going to give you about 20, 25% more collagen, more amplified tightening, and it’s going to be your best result. But again, realistic expectations, your wrinkles are not going to be 100% improved. You’re going to get a nice noticeable improvement and more amplification and more outcome by the simple addition of your own stem cells and growth factors through the application of PRP. Are there any contraindications to anti-aging? Not really, as long as you don’t have any blood coagulation abnormalities such as hemophilia, and we can draw blood and not have risk of ongoing bleeding, and the realistic expectations are really the only two criteria that are important in deciding whether you can do PRP.
If you’ve had a previous skin cancer in the area, that is not a contraindication. If you have an undiagnosed open lesion or sore, clearly that should be diagnosed before we even do the fractional and rejuvenation, let alone the PRP. And so healthy skin, realistic expectations, no bleeding disorder. Those are the best candidates and early aging realistic expectations for wrinkle reduction. Those are the best candidates for a PRP anti-aging therapy. There’s not much recovery associated with PRP in, 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 downtime.
Occasionally a patient will complain of a bruise that shows up above the eyebrow that 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 fracture resurfacing 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 your microneedling for a day or two, redness plus crusting or discharge if it’s fractional CO2 or fractional radiofrequency. Now 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 activities. What kind of results can I expect with anti-aging PRP skin rejuvenation? Well, the wrinkle reduction part, the majority of the wrinkle reduction efficacy is going to be related to technique. So let’s say you’re in your mid-fifties, early sixties. You’ve got really significant wrinkles. You’re going to get a very significant improvement with fractional CO2 or or more medical grade fractional RF like Fractora or Morpheus or fractional blade FRF techniques. So that’s where the majority of your wrinkle reduction is going to come. You’re going to get an extra 20% to 25% boost in the smoothening and tightening by the addition of the PRP, so you can expect an amplified improvement over the technique of fractional injury that you’ve purchased. By the same token, if you have significant wrinkles and you buy a microneedling package, you’re not going to expect a huge wrinkle reduction from that microneedling, and so the amplification from the PRP will be less impressive.
So the moral of the story is for anti-aging PRP, purchase the fractional injury technique, that’s the best for your concern, be it acne scars, be it wrinkle reduction, be a skin laxity, Melasma, dyschromia. Purchase the best fractional injury technique, and then have the PRP layered on top of that to get the 20, 25% amplification in healing time and neocollagenesis or collagen production and tightening. What kind of costs can you expect to see for PRP and skin rejuvenation and anti-aging? Well, it depends on the clinic. Typically, if you are purchasing a single treatment program, fractional CO2, a fractional RF, to get the best possible wrinkle reduction, you’re going to have a one-time purchase amplification of PRP. The one-time purchase amplification PRP typically runs between $500 and $900 depending on the clinic, so you have your base costs for your fractional injury technique and then an additional, let’s say, on average $750 to add PRP to get that 25% amplification and collagen and and recovery time.
Some clinics will will offer a series of PRP, similar to hair restoration for anti-aging and where you might buy a less aggressive fractional technique. You’re doing once a month for three months and each time you’re going to put some PRP on top of the skin and under the skin. In those scenarios, you’re typically paying about $500 to $750 each treatment, or you buy a three pack for roughly $1,600 to $1,900 in addition to the fractional injury technique that you’ve purchased or the base injury technique. And so for anti-aging, either single treatment application with more aggressive fractional injury, or if you’re buying a package, you buy a series of three treatments done each time you come in for your less aggressive fractional rejuvenation. So how to best use your PRP provider? Well, clinics like Spa Medica have been doing PRP for a long time, long before it was sexy.
A good clinic like spa medical will have multiple fractional injury techniques, so you can pick what injury technique for any aging more fits your facial rejuvenation programs. So you can do microneedling, you can do fractional infrared, you can fractional CO2, fractional erbium, fractional radiofrequency. You can tailor the fractional injury to your anti-aging needs. And then of course you can purchase PRP to be amplified on top of that. You want to make sure they’re using an industry standard PRP, there’s different manufacturers. You want to make sure Eclipse, or Arthrex, or Chroma, or Reagent is one of the well-known PRP devices out there. It’s been around for a long time, and that they’ve got a technician that’s licensed or certified or experienced in drawing the blood, handling the blood and topically applying or reinjecting the platelet rich plasma growth factors and stem cells.
Thank you for joining me, Dr Stephen Mulholland here in Toronto, Canada on Plastic Surgery Talk, another weekly installment on our podcast series. This one was on PRP and anti aging and rejuvenative medicine. If you found this podcast and our series of podcasts, in fact, entertaining, educational, informative, then please share, subscribe, and comment. See you next time.