PLATELET
RICH PLASMA: BEYOND AESTHETIC MEDICINE – NOT ALL PRP ARE CREATED EQUAL
You may have
heard about athletes like Tiger Woods and Kobe Bryant getting platelet-rich
plasma (PRP) injections to help heal an injury. Or the PRP Vampire facial made
popular by Kim Kardashian for cosmetic facial rejuvenation. In fact, PRP has
also been proven to promote hair growth in balding men (and women).
WHAT IS
PRP?
Platelets
are cells in your blood. Even though blood is primarily a liquid (plasma), it
also holds microscopic solid elements, or white blood cells, red blood cells,
and platelets. Platelets play an integral role in clotting blood, but they also
contain proteins known as growth factors, which support healing and recovery
processes. They make it clot when you get a cut. They also contain proteins and
growth factors that help the cut heal. PRP injections contain plasma that has
up to 10 times more platelets than normal blood plasma.
If you are
suffering from an injury to the ligaments or tendons in your hands, wrists, elbows, knees ;
a PRP injection can speed up the healing process. Your doctor may use a PRP
injection with surgery to help you recover faster.
HOW IS
PRP PERFORMED?
PRP
injections are quick procedures. For PRP therapy, a patient first provides a
blood sample, which goes through a process known as centrifugation to separate
and concentrate the platelets from the other cells. The PRP is then injected at
the injury site to treat various conditions.
In some
cases, they may use an ultrasound to see inside your joint. This helps them
guide the needle to the right place before injecting the platelets into the
injury.
PRP
Injection for De Quarvain’s Tenosynovitis
You won't
feel immediate relief after the injection. You will probably feel some soreness
in the joint for the first few days. The success rate for a PRP
injection is 80%, based on studies at the Mayo Clinic.
ARE PRP
INJECTIONS BETTER THAN SURGERY?
While there
are many patients for whom surgery may be a better option, there are many
others where PRP will provide better and faster results. For example, patients
who have excessive scar tissue within a tendon or ligament due to an
incompletely healed injury may face reduced joint function. The tendon or
ligament may be incompletely healed because there is insufficient blood supply to the injury site. The growth factors within PRP can help to enhance the
body’s own healing process and can also promote healing if surgery is indicated
down the line.
PRP can produce great results when used to treat mild knee arthritis for example but can often fail when used to treat more severe arthritis. For the more severe variety, better results can be obtained with PRP combined with t-SVF (tissue Stromal Vascular Fractionate). This is now called Platelet Rich Stroma (PRS) made popular by my friend and mentor during my DAFPRS (Dutch Association of Facial Plastic & Reconstructive Surgery) fellowship, plastic surgeon Dr Jeroen Stevens in the Netherlands. Some problems that may be too severe for PRP treatment such as bigger tendon or ligament tears -these may ultimately require surgery.
NOT ALL
PRP ARE CREATED EQUAL!
There are
two main types of PRP—red and amber. Here are the major differences:
Red—leukocyte
rich (LR)—has many red and white blood cells.
Amber—leukocyte
poor (LP)—has few red and white blood cells.
Based on medical
research, the red PRP seems to be less effective in treating tendons and joint
arthritis. Why? When the body detects a tsunami of red blood and white blood
cells, it believes a major injury has occurred and sends the area tons of
inflammatory cells, which shows up as swelling. In some patients, this may not
be a bad thing, but in other patients, the inflammation can cause the injury to
become worst instead of promoting healing (post injection flare-ups). The same
analogy is applied in aesthetic PRP where red PRP should not be injected into
the face of a patient with active acne vulgaris or rosacea.
While
several PRP platforms are in existence today, the quality of the application
(and related results) vary widely based upon several factors. These factors
range from the skills of the technician performing the service, to the
equipment being used, to the preparation and application techniques for a
particular patient.
Why can some
clinics offer PRP at bargain rate basement prices? Yes, the doctor can draw
blood into a simple test tube (and some cheap China made PRP kits), centrifuge
it, take the top portion and call it PRP. That’s called “bloody PRP” or “red
PRP” and it is the least effective containing maybe 1-1.5x platelets if you are lucky – and a whole lot of Red and White Blood Cells. This is what you should
not ever think of doing because it is not the real Platelet-Rich Plasma (PRP).
In some cases, this “bloody PRP” has been known to have caused
post-injection flare ups.
In a
nutshell, it is vital to use a proper PRP Kit (and not a simple test tube to
cut costs) and for the doctor to pick the correct type of PRP for a specific
problem. Some doctors
who use PRP don't bother with anything more than buying a simple open centrifuge
automated machine. The ability to adjust the processing to the unique
properties of the patient sample is not available in these machines and the
chances of infection with open systems are higher. Moreover, much higher
concentrations of platelets and the ability to customize various types of PRP
and concentrations to address the specific needs of a patient is available with
the more advanced PRP kits and system.
#plateletrichplasma
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Sincerely
Yours,
Dr Lee
Seng Khoo
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