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What is PRP?
Platelet-Rich Plasma, better known as PRP, is described as a concentrate source of autologous conditioned platelets in a small blood volume.
Platelets are small disc-shaped fragments (2-4 μm) that originate from the bone marrow and have an average life of 8-12 days. Their main functions are haemostasis and tissue regeneration, thanks to the production of growth factors after tissue damage. The use of platelet concentrate for non-transfusional use, especially in the field of regenerative medicine has gained more and more importance on an international level and has witnessed an increase in the number of studies and applications in various medicine branches. The aim is to stimulate tissue growth and regeneration.

Legislation
License and eligibility. It is important to underline the fact that, in order to be able to perform this therapy, the clinic has to have the specific license to the use of haemoderivatives. Under current legislation, PRP can be prepared only for blood establishments. In Italy, the preparation and use of the products are regulated by Provision no.219//2005 on the quality and safety for the collection, testing, processing and storage of human blood and blood components and by Legislative Degree of 20th December 2007, no.261.
In Italy legislation about PRP is different in the different Regions and to date in most of them the presence of a transfusion doctor during the treatment is mandatory.

How do we obtain PRP?
It is very easy. It is necessary to draw a certain amount of peripheral venous blood (the quantity depends on the device you use). This blood is centrifuged in order to obtain its different components:

  • Plasma
  • Buffy Coat (Platelet-Rich Plasma and white blood cells)
  • Red blood cells

GROWTH FACTORS
Platelets contain alpha-granules, in which we find the main growth factors thanks to which platelets can regenerate tissues and foster cellular proliferation.
The main growth factors released by platelets (EGF, FGF, VEGF, TGF, PDGF, IGF) cause the following phenomena inside human tissues:

  • Cellular proliferation
  • Faster wound healing
  • Bio-stimulation of collagen
  • Stimulation of tissue revascularization
  • Stimulation of the production of fibroblasts

If we focus on hair, growth factors play a fundamental role in regulating the hair growth cycle by:

  • Prolonging the anagen phase
  • Stimulating the growth and thickening of the hair follicle
  • Inducing the proliferation and migration of dermal papilla cells.

Growth factors can also stimulate stem cells in the existing bulbs.

PRP ACTIVATION

The release of growth factors takes place thanks to the activation of platelets operated by stimulating substances, such as calcium chloride, autologous thrombin, batroxobin (a thrombin-like enzyme) and another substance we will talk about, developed by Dr. John Cole (Cole Hair Transplant Group, Atlanta USA) in a pioneering study.

ADVANTAGES OF PRP

  • Easy and fast to prepare
  • Autologous
  • Non-toxic
  • It stimulates angiogenesis and revascularization
  • Is stimulates cellular proliferation
  • It accelerates the healing process

The action of PRP leads to a safe and natural healing process, thanks to the fact that we use the patient’s blood.

PRP production method
To date we don’t have any qualitative/quantitative standardization for the preparation of this blood component.
It is possible to use several preparation methods.
The market currently offers a wide range of devices for the production of PRP. However not all of them produce the same type of Platelet-Rich Plasma, both from a qualitative and a quantitative point of view. The quality and quantity of platelets and growth factors changes according to the device you use.
Due to the great demand, more and more doctors are offering this treatment in several medicine fields.
However, unfortunately sometimes PRP doesn’t lead to anything.
The therapeutic efficacy depends on the devices and therefore on the method of production and dosing of the component.
The chosen method can influence the concentration of released growth factors in the interested area and the efficacy of the treatment.

The different devices used to produce PRP vary according to their ability to produce different concentrations of growth factors, ranging from low-level to high-level concentrations.

Research shows that inadequate devices produce PRP of poor quality.

Following are some questions about PRP, whose answers are still unclear:

What is the best method to produce PRP?

What is the best needle dimension for the infiltration?

What is the optimal platelet concentration?

What is the optimal haematocrit?

What is the best depth for the infiltration of PRP?

What is the best method of PRP activation?

NEW DEVELOPMENTS
Dr. John Cole and I decided to develop a protocol at the Cole Hair Transplant Group based in Atlanta (USA) in collaboration with the department of Plastic Surgery of the University of Rome Tor Vergata.

We studied the efficacy of several devices on the market and of several PRP activation forms and introduced a new method developed by Dr. John Cole: Ultrasound.

The market offers several techniques for PRP activation. In our study we compared two PRP activation methods: Calcium Gluconate vs. Sonication.

Sonication is a new method, tested for the first time in the field of hair restoration by Dr. John Cole, which consists of the “immersion” of PRP phials in an ultrasound bath with >20kHz frequency.

Our aim is to evaluate the best method for PRP activation in the increase of hair thickness and diameter.

STUDY:

  • 40 patients were selected
  • Norwood II-V or Ludwig I-III
  • 1 treatment/month for 3 months
  • Patients were evaluated 3 months, 6 months, 12 months after the treatment
  • One area of the scalp was treated with PRP activated through Calcium Gluconate, the other half with PRP activated with Sonication.
  • Both sides were marked with a tattoo for the Follow up

Two different machines offered by the market were used for the preparation of PRP:

ARTHREX ANGEL®

REGEN LAB®

Following are the parameters we focused on:

  1. Hair mass index
  2. Hair diameter
  3. Thickness

The evaluation of these parameters was possible thanks to the use of advanced devices.

Among these were:

  • Computerized Trichogram with the support of dermoscopy. It gives the opportunity to evaluate growth parameters in a fast and reliable way.
  • Cross-section Trichometry. A non-invasive exam used to measure hair mass.
  • Dermlite II Pro ®. A special portable polarized light dermatoscope. Dr. John Cole applied a 10 mm2 grid on its lens in order to calculate the number of FU/cm2 and Hair/cm2 in a manual, fast and reliable way.
  • Digital micrometer. It is used to measure the hair diameter in the interested areas.

Results:

Right after the treatment and during the following 2 months it was possible to observe a worsening in the analyzed parameters.

The reason for this is that the stimulus given by regenerative therapy brought most of the hair to a Telogen phase (resting phase).

Starting from 3 months after the treatment, it was possible to observe an increase in the parameters:

PRP + Sonification PRP + Calcium glutonate
HAIR MASS + 48% + 25%
HAIR THICKNESS + 57% + 33%
HAIR DIAMETER + 10% No Real Change

 

As you can see from the above-mentioned results, PRP activated using Sonication led to a higher increase in the parameters compared to the classic Calcium Gluconate activated PRP.

Second part of the study

IN THE SECOND PHASE OF THE STUDY WE COMPARED PRP GROWTH FACTORS OBTAINED USING TWO DIFFERENT DEVICES OFFERED BY THE MARKET:

  1. ARTHREX ANGEL®
    vs
  2. REGEN LAB®

The study on GROWTH FACTORS was carried out in the laboratory using ELISA TEST, a highly advanced and expensive test.

CONCLUSIONS

  • The study shows that PRP has positive effects on androgenic alopecia and has no side effects. More specifically, this studied tested the efficacy and safety in the use of the new method of SONIFICATION for the activation of PRP. Clinical and laboratory results proved this system is more effective than the traditional method of Calcium Gluconate.
  • The second part of the study shows that the production of PRP with the Arthex Angel® method leads to the release of a higher quantity of growth factors compared to the Regen® method.
  • This study demonstrates that the efficacy of PRP depends on several factors, such as the use of an adequate device, the choice of a safe activation method and the use of a precise protocol.