PRP (Platelet-Rich Plasma)

PRP is a form of regenerative medicine with real science behind it

Dr. Mina explains that PRP is a type of regenerative medicine that concentrates platelets with growth factors, exosomes, and cytokines. It has the strongest evidence for hair regrowth but also helps with acne scarring and skin regeneration after laser treatments.

"PRP, it is not hype. It really does work. And it's a very cool component of regenerative medicine."

PRP varies between people based on sleep, hydration, medications, and age

Unlike standardized medications like Botox, PRP comes from your own blood and varies based on individual factors. Even your own PRP will differ between treatments depending on sleep, hydration, medications, and age.

"PRP comes from our own blood and every single person out there is different and unique. And guess what? Every single day, your blood will have different concentrations of platelets, depending on if you got a lot of sleep, if you're dehydrated, what medications you're on, your age."

PRF is not yet ready for cosmetic procedures - stick with PRP

PRF (platelet-rich fibrin) is a clot-like substance that may help with wound healing but has more complications when used for cosmetic procedures. Dr. Mina recommends sticking with proven PRP until better PRF data emerges.

"PRF looks the most promising for wound healing and not yet ready for prime time with cosmetic procedures, at least the data that we have."

PRP is FDA-compliant if your own cells are returned within 4 hours

Platelet-rich plasma uses your own blood spun down and re-injected within 4 hours, making it FDA-compliant. Results for rejuvenation have been strong.

"Right. And so the ruling is, I understand it, as long as you're taking a cell from you and you give it back within four hours, then that is allowed under the FDA guidelines. Interesting. There was this clinic in Florida a few years ago was touting stem cell therapies for macular degeneration, injected some stem cells into these patients' eyes, and they went blind really quickly, and they were not blind prior to the injections. That, to my understanding, caused a severe setback to the whole field. I'm old enough to remember when gene therapy was set back by about 10 years because a patient received gene therapy, which is now pretty common for certain diseases, and the patient died. It's unclear exactly why they died, but that delayed the field of gene therapy by at least a decade. I mean, this country is very conservative when it comes to the approval of new therapeutics. Sure. Yeah. Yeah. No, and I think like anything, there's going to be people who get too aggressive amount. I've heard of doctors injecting stem cells into people's discs and then they get discitis and infection and that can just spiral very quickly. I think you got to be reasonable in, you know, what you're trying to accomplish. I'm excited about stem cells and exosome therapy and PRP and PRF and using them as, you know, kind of biologics and because I think there's a lot to learn. I think we only know very little from what we've seen from working with our patients. It's been tremendous from a rejuvenation standpoint. I mean, we're,, it's taking from your own and then giving back your own within how the FDA outlines it, I think that's a great way to do it."

Proper PRP requires 5-9x platelet concentration with a two-spin process

Dr. Piccirillo provides the technical standard for PRP preparation: start with 30-60cc of blood, perform two centrifuge spins, and achieve 5-9x normal platelet concentration. Research shows a therapeutic sweet spot of 1-1.5 million platelets per microliter.

"and asked me, said, "Hey, our company has these now. "What they're touting is that while you're doing your surgery, "we can have the anesthesiologist "draw a couple tubes of blood. "We can process it in this machine, "and by the end of the surgery, "we're gonna give you a couple vials of plasma "that's gonna be very rich in platelets, "and it's gonna have growth factors"

Too few or too many platelets and PRP won't work

There is a critical dosing window for PRP effectiveness. Below 500,000 platelets per microliter won't trigger healing, and above 2 million actually inhibits the body's ability to heal. The sweet spot is around 1-1.5 million.

"We are adding this platelet-rich plasma, which is now what we know it as. But we were adding this to our bone graft, and we were seeing success. We were seeing increased rates of healing, even in spine fusions in former smokers, which was always just bad news. You never wanted to operate on them if you didn't have to. And we were getting some good bone growth."

The rule of threes for PRP results timing

Dr. Piccirillo shares his "rule of threes" for setting patient expectations: PRP is absorbed in 3 days, triggers a cellular reaction within 3 weeks, and delivers full results at 3 months. This timeline applies regardless of the body part being treated.

"So when you put PRP in a joint, that PRP that you put in there is gone in three days. And so that means that the body has absorbed it and has triggered a reaction inside the body to allow the body's own stem cells to go to that area and start a regeneration process."

PRP growth factors decline after age 45 and exosomes can restore potency

Research from Japan shows PRP growth factors and cytokines drop significantly starting around age 45. Exosomes derived from placental tissue can be added to an older patient's PRP to restore it to the potency of a 20-year-old's plasma.

"That's for any body part. That's whether you're doing it in joints or then, you know, as we started doing it in joints, probably around 2010 to 2012, some doctors, particularly Dr. Charles Reynolds, who was down in Fairhope, Alabama, started experimenting on other places you could use PRP. And people started using it for sexual health and using it for aesthetics and using it for hair growth."

The three phases of PRP healing explained like a house remodel

Dr. Priyanka Wali breaks down PRP for a general audience, explaining the three healing phases: inflammatory (platelets activate, growth factors release), proliferative (cells multiply), and remodeling (tissue repair and collagen rebuilding over up to a year). Sean Hayes reports his knee feels better three years after PRP.

"what happens is when they inject the platelet-rich plasma, there are three phases. So, the first phase is called the inflammatory phase, where all the platelets get activated, growth factors get released, and there's a bunch of reactions that happen. And then the second phase is called the proliferative phase, where different cells multiply."

How PRP activates growth factors to drive tissue repair

Dr. Singh explains how activated platelets release PDGF, TGF-beta, VEGF, and EGF which facilitate angiogenesis, chemotaxis, cell proliferation, and differentiation - all essential for tissue repair and regeneration.

"when platelets are activated is that they release a variety of growth factors, including platelet-derived growth factor, known as PDGF, transforming growth factor, beta, vascular endothelial growth factor, VEGF, and epidermal growth factor, EGF."

PRP outperforms hyaluronic acid for knee osteoarthritis

Multiple studies show PRP injection significantly improved pain and function compared to hyaluronic acid, the standard gel injection for knee arthritis. Evidence extends to hip arthritis as well.

"A systematic review and medical analysis in 2013 also concluded that PRP was more effective than hyaluronic acid in reducing pain and improving function."

Challenges with PRP standardization, placebo effect, and cost

Dr. Singh outlines the main challenges: lack of standardized preparation protocols leads to variable outcomes, the placebo effect is significant in subjective pain studies, optimal dosing is unclear, and PRP is expensive without insurance coverage.

"there is a large heterogeneity of PRP preparation. There's a lack of standardized protocols for administering and preparing PRP, which can contribute to variability in clinical outcomes."