At PRP Medical Aesthetics, one of the most common questions we are asked is “How much does PRP cost?” While this is of course a very important question, there are far more important questions to ask when considering PRP treatment including what type of PRP, whether the PRP is high or low concentration, whether or not the PRP is activated, the injection technique, the amount of PRP injected, the type of numbing or anesthetic used, etc.
A History of Platelet-rich Plasma
Platelets were first discovered by Giulio Bizzozzero in 1882.1 He carefully described anucleate fragments of bone marrow derived megakaryocytes circulating in the blood and the way they would clump together in response to injury. The term platelet-rich plasma (PRP) was first mentioned in the medical literature in 1954 in experiments done by Kingsley.2 In 1974, Ross et al described the first growth factor from platelets which promoted blood vessel wall healing.3
In 1986, Knighton et al were first to demonstrate that PRP could successfully promote healing in skin ulcers. They called it “platelet-derived wound healing factors (PDWHF).”4 Since then, many other growth factors (GF), have been discovered in PRP including vascular endothelial GF (VEGF), fibroblast GF (FGF, stimulates collagen production), platelet-derived GF, epidermal GF, hepatocyte GF, insulin-like GF 1 & 2, transforming growth factor-ß and more. There has been a tremendous increase in the amount of research showing the effectiveness of PRP in wound healing and other aspects of regenerative medicine, including the fields of orthopedic medicine, oral surgery, wound healing, and dermatology for skin and hair treatments.5,6
Not all PRP is the Same
Preparing PRP is a delicate process. There are a wide variety of different PRP preparation methods, and no consensus on which one yields the best results. Some methods are quicker (and cheaper), but may not give the same results are a more method which takes more processing time. In general, PRP preparation systems can be categorized into single vs double spin systems, and whether or not the PRP is activated prior to use.
What is the Best Concentration for PRP Treatment?
With PRP treatment, in order to be classified as PRP, there should be a platelet count of at least 1 million platelets/µL.7 Since normal concentration of blood is 200,000 platelets/µL, this is roughly five times concentration above baseline. It is impossible to achieve this level of concentration without a double-spin preparation technique. Interestingly, higher concentration is not always better. For example, studies have shown that platelet counts above 5 million platelets/µL can actually be harmful to healing.8,9 Overall, the best concentration of platelets for promoting healing and regeneration of tissue seems to be 5-8x over baseline.10,11
Which type of PRP Treatment is the best?
In 2019, a comprehensive review from the Mayo Clinic School of Medicine looked at 33 different PRP systems available on the market today.12 Only 10 of the 33 systems met the effective concentration levels described above. And 3 of these systems produced PRP with a concentration of platelets which was actually less than the starting blood sample. Of all the systems analyzed, the one produced by Emcyte had the highest platelet concentration, with 1.6 million platelets/µL. The lowest one was a single spin system made by Selphyl, which produced PRP with ~52% the platelet concentration of whole blood.
Different PRP Preparation Systems
As more manufacturers get into the PRP preparation market, there are a few important factors to consider. First, is the device approved by Health Canada (and/or the FDA)? This is important for obvious safety reasons. Second, what is the concentration? Is it single or double spin processing? For example, some names of single spin PRP systems in Canada include Eclipse, Regen, Selphyl. Some examples of double spin systems include Emcyte, Harvest, Magellan, Arthrex. Note, this is not a comprehensive list and there are new systems coming out all the time.
Injection Technique for PRP Treatment
Injection technique for PRP treatment is more difficult to describe as far as what to look for. It’s important to ask your provider about their experience and training in this regard. A note on auto injectors, sometimes known as injection guns or meso injectors: While these devices can be useful in terms of convenience, we do not currently recommend this method in general, especially when injecting PRP in the scalp for PRP hair treatments, as there is less control over depth of injection, and less feedback to know whether or not the injection is at the right level or intravascular. Also for scar treatments, injection technique should be manual with undermining at appropriate locations.
Activated vs Non-activated PRP, which is better?
The answer to this question is it depends, as there are both advantages and disadvantages to activating PRP. In general, it is desirable to activate PRP so that the platelets will release more growth factors. However, activated PRP will also tend to form a clot, sometimes known as platelet-rich fibrin matrix, or PRFM. PRFM does not spread out very well, which is good if you want the PRP to stay more in one area (eg for PRP under eye injections, joint injections, O-Shot or Priapus Shot), but in other situations it is actually better if the PRP spreads out a bit (eg, Vampire facial or PRP hair treatments).
While PRP treatment is still early in development, it offers promise as a new method to promote healing and regeneration by using the natural mechanism of growth factors contained within our own cells. PRP treatment has shown benefit in many aspects of medicine, including hair loss, skin rejuvenation, scar treatments, arthritis and joint inflammation.
In order to get the best PRP treatment, you should consider the type of preparation system, making sure that it is safe and effective. As well, you should ask about the experience and training of your provider and what areas of PRP treatment they specialize in.
Hopefully this information is helpful. If you have any questions about PRP treatment, please feel free to get in touch with us or book for a consultation online.
Ribatti D, Crivellato E. Giulio Bizzozero and the discovery of platelets. Leukemia Research. Published online October 2007:1339-1341. doi:10.1016/j.leukres.2007.02.008
KINGSLEY CS. Blood Coagulation: Evidence of an Antagonist to Factor VI in Platelet-Rich Human Plasma. Nature. Published online April 1954:723-724. doi:10.1038/173723a0
Ross R, Glomset J, Kariya B, Harker L. A Platelet-Dependent Serum Factor That Stimulates the Proliferation of Arterial Smooth Muscle Cells In Vitro. Proceedings of the National Academy of Sciences. Published online April 1, 1974:1207-1210. doi:10.1073/pnas.71.4.1207
KNIGHTON DR, CIRESI KF, FIEGEL VD, AUSTIN LL, BUTLER EL. Classification and Treatment of Chronic Nonhealing Wounds. Annals of Surgery. Published online September 1986:322-330. doi:10.1097/00000658-198609000-00011
Hesseler MJ, Shyam N. Platelet-rich plasma and its utility in medical dermatology: A systematic review. Journal of the American Academy of Dermatology. Published online September 2019:834-846. doi:10.1016/j.jaad.2019.04.037
Samadi P, Sheykhhasan M, Khoshinani HM. The Use of Platelet-Rich Plasma in Aesthetic and Regenerative Medicine: A Comprehensive Review. Aesth Plast Surg. Published online December 14, 2018:803-814. doi:10.1007/s00266-018-1293-9
Marx RE. Platelet-Rich Plasma (PRP): What Is PRP and What Is Not PRP? Implant Dentistry. Published online December 2001:225-228. doi:10.1097/00008505-200110000-00002
Giusti I, D’Ascenzo S, Mancò A, et al. Platelet Concentration in Platelet-Rich Plasma Affects Tenocyte BehaviorIn Vitro. BioMed Research International. Published online 2014:1-12. doi:10.1155/2014/630870
Yamaguchi R, Terashima H, Yoneyama S, Tadano S, Ohkohchi N. Effects of Platelet-Rich Plasma on Intestinal Anastomotic Healing in Rats: PRP Concentration is a Key Factor. Journal of Surgical Research. Published online April 2012:258-266. doi:10.1016/j.jss.2010.10.001
Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-Rich Plasma. Am J Sports Med. Published online October 28, 2009:2259-2272. doi:10.1177/0363546509349921
Chicharro-Alcántara D, Rubio-Zaragoza M, Damiá-Giménez E, et al. Platelet Rich Plasma: New Insights for Cutaneous Wound Healing Management. JFB. Published online January 18, 2018:10. doi:10.3390/jfb9010010
Fadadu PP, Mazzola AJ, Hunter CW, Davis TT. Review of concentration yields in commercially available platelet-rich plasma (PRP) systems: a call for PRP standardization. Reg Anesth Pain Med. Published online April 16, 2019:652-659. doi:10.1136/rapm-2018-100356