PRP, or Platelet Rich Plasma, has become somewhat of a star in the rapidly developing field of regenerative and stem-cell-based medicine. This particular treatment has gained popularity in previous years, most notably in the world of sport and exercise, as a viable option for people with both acute and chronic musculoskeletal injuries and conditions. Today, PRP is used in a wide range of applications, taking advantage of the healing and stimulation properties of the treatment to restore function in many parts of the body, including aesthetic concerns, hair loss and other medical conditions.
What is PRP exactly?
PRP stands for Platelet Rich Plasma, which is an extract of the golden liquid part of the blood, called the plasma. As the name suggests, the plasma contains platelets, which are known as the clotting agents of the blood, however they also play another important role. The platelets are responsible for the release of growth factors, and it is these growth factors which are responsible in large for the development of new cells and tissues. Imagine you cut your arm, for example. The blood carries platelets to the injury site to create a clot and stop the bleeding. Once the initial injury is managed, the platelets then release the growth factors, which begin the process of growing new tissue to replace the old, damaged tissue, which is also concurrently being removed by the body.
With PRP, we are taking a concentrated mixture of the platelets and injecting these directly into the treatment site. There is no cut, so to speak, however the platelets will still release the growth factors once they are activated, and the remodelling process will occur. If we look at something like hair loss, for example, this introduction of highly concentrated growth factors provides a stimulus for the follicles to grow new hair, an increase in blood (and hence oxygen) supply, and stimulation of the stem cell which in turn can cause the release of further levels of growth factors. In a way you can view it as adding fertiliser to the crop, a direct injection of the ingredients that the tissue needs in order to grow.
What else is in it?
As well as the growth factors, PRP contains a mix of other “ingredients” which are a vital part of the process. This is one of the concepts surrounding the treatment which is generally not well understood. The plasma which is extracted also contains other elements, such as progenitor cells, which are similar to stem cells, but are slightly more specific in their action, leukotrienes, which send important messages to the immune system in order to protect the new growing tissue, and cytokines, another immune cell secretion, among others. These other elements act in conjunction with the growth factors released from the platelets to create and maintain the delicate environment needed for the growth of the new tissue. This is an important process to understand. PRP is oftentimes referred to as a ‘stem cell treatment’, however it is clear that rather than simply injecting stem cells, you are introducing a complex cocktail of potent ingredients, all of which work in conjunction to regenerate the tissue or manage the injury. If you are missing some of the ingredients, you will not achieve the results.
When PRP is used for musculoskeletal injuries, in muscle, tendon, ligament, bone and so forth, it is often combined with dextrose, a form of glucose, in a process called Prolotherapy. The addition of the dextrose causes an acute inflammatory response in the target tissue, kickstarting the body’s own healing mechanism. By combining the PRP with this process, you provide an immediate solution of the aforementioned healing cocktail to the tissue, which demands these compounds as a result of the inflammation caused by the dextrose. You can also perform a mechanical irritation of the tissue, basically aggravating the tissue with the needle as you inject, to further create the inflammation response. This method of treatment can be particularly effective in chronic degenerative conditions, such as a tendinopathy of the elbow for example, where the body is failing to manage the injury normally and there is a loss of function due to pain or weakening of the tissue.
How long does it take to work?
How effective the treatment is, and how long it takes to generate results, depends on several factors. With musculoskeletal issues, it is possible to create adaptive remodeling relatively quickly. The severity of the injury, the health of the individual, the condition of the surrounding structures and the post-treatment management of the site (in terms of exercise or rehabilitation) will all play major roles in determining how long a person will spend before noting improvements or resolutions. In some cases, a single treatment can be enough to initiate the changes required. In other cases, multiple treatments over time, combined with adjunctive measures, may be required. Some cases may not be suitable at all for treatment and may require other forms of management. What is absolutely vital is a comprehensive examination and accurate diagnosis of the condition or injury before any treatments are even considered. Then, a precise and educated application of the treatment into the specific areas is absolutely imperative, as poor targeting and a poor understanding of the anatomy and the treatment action can result in no change or remodeling whatsoever.
How many sessions do I need?
In the case of aesthetic treatments, things are slightly different. If you are dealing with hair loss for example, or wrinkles and lines, loss of volume in the face, scarring, sagging and so forth, these are generally ongoing degenerative conditions occurring as a result of the normal aging process. As these are ongoing conditions, they will require ongoing management. Just as important in these situations is the initial assessment. It is important to determine the extent of the condition, any underlying contributing factors, the desired goals and outcomes and the realistic expectations of the treatment before developing a comprehensive treatment plan for each individual. In general, aesthetic PRP treatments are required on a repeat basis. For example, an average hair restoration protocol for PRP currently can consist of 3-6 PRP sessions per year, and this can change entirely depending on the individual, whether he/she is performing any adjunctive treatments, and all of the factors mentioned above.