Platelet Rich Plasma

(PRP)

By
dr.Aldjoefrie Aesthetic
Institute
Surabaya
 Autologous Platelet-rich Plasma

What is plasma?
Fluid component of a persons blood
Contains platelets, white blood cells, stem cells, electrolytes,
enzymes, hormones, nutrients, anti-bodies, glucose, proteins, lipids
& albumin (powerful anti-oxidant), etc.
Why autologous?
Autologous means persons own (self donated) and not donated
from another person or from animal origin
Growth factors must be in genetically pre-determined ratios!
No risk of rejection and lower allergenic potential
How can A-PRP be obtained easily?
Venous blood sample is obtained from patients fore-arm
Centrifugation separates plasma & platelets & stem cells from red
blood cells
 What is Autologous Platelet-rich Plasma (a-PRP)?

A-Platelet rich plasma is a concentration of human

platelets in a small volume of plasma measured as
1,000,000 platelets per mm3 or 2-6 times the native
concentration of whole blood at a pH of 6.5 - 6.7
(whole blood pH = 7.0 - 7.2)
Also referred to as autologous platelet gel, plasma-
rich growth factors (PRGFs) or autologous platelet
concentrate
PRP is also a concentration of the 7 fundamental
protein growth factors that have been proved to be
actively secreted by platelets to initiate all wound
healing
PRP includes 3 proteins in blood known to act as cell
adhesion molecules: fibrin, fibronectin & vitronectin
 How are Platelets Activated?

Dermal collagen & exposed endothelial collagen

Arachidonic Acid (inflammation pathway)
Thromboxane A2 (inflammation pathway)
ADP
Thrombin (bovine has high allergenic potential)
Substrate bound ligands of Glycoprotein II a / III b
Vasopressin
Adrenaline (20% patients no receptor!)
CaCl2
Thermal: controlled heat (Radio-frequency)
Vibration via Vortex device
Cryo-activation
 The 5 Major Steps In The Platelet Activation Process

1. Formation of tri-dimensional 4. Stem cells

mesh (fibrin strand)or matrix. proliferation &
mitosis
3. Chemo-attraction or
migration of
macrophages and stem
cells

2. Release of growth factors

by the thrombocytes and 5. Stem cells
leukocytes. differentiation

(In addition ECM like fibronection,

vitronecton, thrombospondin)

*Platelets & Megacaryocytes vol.2 Dr J.Gibbins, M. Mahaut-Smith

Timelines in Wound Healing
 Benefits of a-PRP reported in the Healing Cascade

Tissue remodeling
% Wound closure

Tissue regeneration

Wound healing
Inflammation
without PRP
Haemostasis

Physiologic response: time

Tissue remodeling
By
By
% wound closure

Extra Cell. Matrix synth.

Tissue Extra Cell. Matrix concentratin
concentratin
& Cell differentiation
regeneration & Cell gg specific
specific
G.
G. Factors
Factors
Wound healing cells,
cells, wound
wound
Chemo
Chemo tactics
tactics
&
& mitotic
mitotic healing
healing time
time
with Inflammation can
G.
G. Factors
Factors can be
be
PRP Haemostasis Leukocytes
Leukocytes shortened
shortened
Plts
Plts G. significantly
Fibrin
Fibrin Factors
significantly
Plts
Factors
Plts agrgg
agrgg
vWF
vWF

Physiologic response: time

 Growth Factors Acting on Healing Cascade
Factor Name Principal Source Effects
PDGF aa Platelet derived Activated thrombocytes Mitogenes of mesenchymal stem
PDGF bb growth factors cells promote the synthesis of the
extracellular matrix
PDGF ab
TGF- alpha Transforming Activated thrombocytes Stimulation of DNA synthesis,
TGF- beta Growth Factors proliferation of various types of
cells. Favours the synthesis of
collagen
IGF- I Insulin-like Activated thrombocytes Stimulates the proliferation and
IGF- II Growth Factors differentiation of osteoblasts

EGF Epidermal Growth Activated thrombocytes Stimulates proliferation and

Factor differentiation of epidermis cells,
co-stimulating angiogenesis
VEGF Vascular Endothelial Leucosytes & Stimulate angiogenesis & chemo-
Growth Factor Endothelial cells attraction of osteoblasts

In addition the activated thrombocytes have onto their surface a multitude of

signalisation molecules eg. CD9, CD-W17, CD31, CD41, CD42a-d, CD51, CD-
W60, CD61, CD62P, CD63
 Visible effect in time of Healing and Discomfort
(randomized study USA)

WOUND HEALING PAIN REDUCTION

100 10
Healing with
PRP

Patient discomfort (pain)

Control sample
% of wound closing

Control sample

Pain with PRP

0 0

0 physiological process (days) 30 0 physiological process (days) 30

Journal of Oral & Maxillofacial Surgery, 2000; 58:45 Marx, Monteleone, Ghurani, Dr.
Robert Marx, University of Miami
 Advantages of A-PRP

Tissue regeneration & rejuvenation: neo-collagenesis (TGF & ), neo-

vascularisation (EGF & VEGF), & extracellular matrix formation (PDGF &
& ) NB: growth factors in genetically pre-determined ratio!
Bio-glue (fibrin glue): haemostasis & tissue adhesion in skin flaps, bone
grafts, trauma intra-surgery and post-surgery
Safety: non-allergenic & free from concerns over transmissible diseases
e.g. HIV, Hepatitis B & C, CJD, etc.
Autologous: no risk of rejection reaction
Wound healing time: increased
Physiological anti-biotic : anti-bodies & WBCs & proteolytic enzymes
Plasma includes: hormones, bio-transformed vitamins & other nutrients
Tissue engineering: in-vitro autologous tissue culture-medium.
Ease of use: dermal & hypodermal injections
Convenience: harvesting performed in doctors rooms (no external
laboratory required)
Cost effectiveness: 1 Plasma kit (2 tubes) delivers 12+ ml A-PRP
 Fields of Application of A-PRP
RESEARCH & DERMATOLOGY SURGERY
DEVELOPMENT INTERNAL
DENTAL MEDICINE
MEDICINE
GERONTOLOGY
Cardio-vascular
Cell separation surgery

Cutaneous
Autologous cell culture Abdominal surgery
reconstruction and
Dental extraction transplantation

Dental implantation

Autologous stem cells Maxillo-facial surgery
culture

Ulcer and chronic
wound therapy
(e.g. after radio Orthopaedic surgery
Cell differential
therapy)

Plastic & cosmetic
Tissue regeneration surgery/dermatology

Re-implantation of
Autologous cells,
extemporaneous or Treatment of severe
Healing remodelling cultivated in-vitro burns
 A-PRP Indications for dermatocosmetic
1. Skin rejuvenation:
injection (intradermis)
mesotherapy (intradermis)
topical plasma & Dermaroller micro-needling (intradermis)
2. Fine lines & wrinkles: ditto
3. Volumetric filling :
large volume injection of plasma intradermis and hypodermis of the tear
troughs, eyelids, naso-labial folds, marionette lines, peri-oral areas,
cheeks, forehead, glabella, neck & back of hands
A-PRP mixed with fillers such as hyaluronic acid (Esthelis, Juvederm,
Restylane, Teosyal, etc) and calciumhydroxyl-appatite (Radiesse) =
bio-active filler containing growth factors
4. Acne scarring:
subscision injections & topical plasma & skinroller/ skinneedling
5. Cellulite?
6. Striae (stretch marks)?
 SKIN TREATMENT ACTION LEVELS
MULTIDISCIPLINARY PROGRAM FOR THE REJUVENATION
OF THE FACE

DERMO
COSMETICIS FILLERS

PEELS
Wrinkles &
volumes
correction
Renewal of the
corneal layer

Germinative layer BIO

STIMULATION
Stimulation MyCells

Dermis Stimulation
Architectural skin
Hyperpigmentation reconstruction/
removal reorganization
 Pre-Treatment Patient Preparation
& Combination Therapy

High Dose Oral Vitamin C (1,000mg+) daily for 7 days

pre-treatment & post-treatment
Enhances wound healing (fibroblast stimulation)
Oral Vitamin A daily for 7 days pre- & post-treatment
Radio-Frequency
Immediately after treatment = platelet activation
Collagen fibre contraction (immediate)
Fibroblast induced neo-collagenesis (delayed)
Skinroller & Topical A-PRP
micro-surgical needling
Induces growth factor release
Topical Vitamin A
Topical Vitamin C
 Side-effects

Minor oedema
Seldom bruising
Eyelids can remain puffy for 2-3days
No infection
No allergy
 Potential Complications
(applicable to all dermal fillers)

Intra-vascular injection (thrombus/embolus)

- Venous
- Arterial
Nerve trauma (needle)
Secondary infection
NB: Beware of the peri-ocular area (eyelids) - no
coagulant used eg. thrombin or CaCl2
 Contra - Indications

Platelet Dysfunction Syndrome

Critical Thrombocytopenia
Hypofibrinogenaemia
Haemodynamic Instability
Auto-immune disease
Chronic oral steroid therapy
Chronic topical steroid therapy of treatment area
Malignancy
Chemo-therapy
Sepsis
Acute & Chronic Infections
Chronic Liver Pathology
Anti-coagulation therapy (warfarin, aspirin)
Pregnancy (for cosmetic indications)
 Why We Use MyCells?
Separator gel clear plasma
Glass tube non toxic
Complete sterilization process
Only 10cc blood needed
RCF larger plasma yield
FDA Regulatory certificates
Simple & easy to use
 Growth factors & Protein
Released by PLT

Growth Factor PRP PPP

(Platelet Rich Plasma)
(Platelet Rich Plasma) (Platelet Poor Plasma)
(Platelet Poor Plasma)

VEGF 220.478.1pg/ 72.932.5pg/m

ml l

EGF 269.1117.5pg 73.536.3pg/m

/ml l

PDGF-BB 2048.4645.8p 308125.8pg/

g/ml ml
PRP preparation(1) Collect blood from
central vein of
elbow
10cc for each tube

PRPandPPP

Gelseparator
Mycells Centrifuge:4000 G,
G Redblood
tube
7min. cell
After
centrifugation
PRP preparation(2)
Aspiration
and Blow of
PRP PRP

Sleeve
insertion
PPP
aspiration
PRP after PPP
aspiration

Aspiratio
n of PRP
PRP just before
injection
Forehead
Intradermal injections 0.05ml. Total
for forehead 3ml.

Upper eyelid
Subdermal injections 0.2ml each x 3.
Total 0.6ml.

Lower eyelid
Subdermal 0.2ml injections 1 cm
apart. Massage evenly. Total 1-2ml.
Cheeks
Subdermal & intradermal injections
Linear threading technique 0.2ml
per injection. Total 3-5ml per side.

Naso-labial folds
Subdermal & intradermal injections
Linear threading technique 0.2ml
per injection. Total 2-3 ml per side.

Lips
Vermillion border injections
Linear threading technique 0.2ml
per injection. Total 0.4ml per
quadrant.
Chin
Linear threading technique 0.2ml
per injection. Total 2-3ml per side.
 How do we inject PRP into the skin?

Now we are injecting the PRP using mesotherapy like

technique over the entire area to be treated.
Inject small spot (0.05cc to 0.1cc) into the skin.
Injecting layer is dermis and subcutaneous tissue.
KUBOTA JUNICHIRO CLINIC
PRP 30G needle 1cc syringe

injection

PRP just before injection

We usually inject PRP

using linear injection and
mesotherapy technique over
the entire area to be treated.
Inject as small spot(0.05cc to
0.1cc).
Injecting layers are intra-dermis
and subcutaneous tissue
respectively.
Dec. 2006 March June 2008
2007
6 time PRP injection
Alopecia with PRP Before
and after
PRP for wound healing in
acute and chronic ulcer