Everything You Need to Know About PRP

Part 1: What is PRP?

Welcome to my PRP blog post! I’m going to be diving into ALL things PRP. Even though it’s been around for a while, there’s still a LOT of people who have no clue about it or all the various things we can use it for. I’m here to change that!

I have personally performed, literally, thousands of PRP injections over the better part of a decade. Needless to say, I have a great deal of experience and expertise in this area, and often teach classes on it for other providers as well. I am now here to share expertise that with you, too. Let’s go:

So, what is PRP?

PRP stands for Platelet Rich Plasma and is a product we get from your own blood! It’s no more discomfort than a simple blood draw. An average volume taken is around 60cc. To put this in perspective, a blood donation is usually 500cc. Meaning, we take a nominal amount.

PRP itself is full of things called cytokines and growth factors. These are all the necessary ingredients for healing. For example, say I were to make a cut on your arm, the cytokines and growth factors in your own blood are what would rush to the area to heal it. Using PRP is just highly concentrating and multiplying those factors and putting them exactly where we want healing to occur. Pretty cool, right? We’ll touch more on these later.

Part 2: How does PRP get processed?

In order to process PRP you need a minimum of 3 things:
1) Blood from a consenting patient
2) Anticoagulant
3) Centrifuge

And between just those 3 things, holy cow, the options are seemingly endless! Let’s break them down and learn why:

Blood: QUALITY MATTERS! Plasma itself could be its own post, and perhaps I’ll save that for another time. What you need to know are things like age, diet, autoimmune disorders, overall health, and exercise habits are just SOME of the things that influence the quality of your PRP. A doctor who knows their stuff will talk to you about these variables to ensure you are as best prepared as possible. If you are preparing for a PRP injection, the best thing you can do is eat a healthy diet and limit inflammatory items such as sugar and alcohol.

Anticoagulant: this is what stops the blood from clotting before we use it. There are a few main options; heparin, sodium citrate, and citrate dextrose. While these won’t necessarily affect yield, what they do influence is the “ouch” factor with your injection and how much it will sting. Obviously the less sting, the better! Personally, I use heparin because it is the most friendly and pain free.

Centrifuge: there’s, like, a bajillion on the market. The most important things, at least to me clinically, are the ability for customizing centrifugal force, rotations per minute, and time. You see, these variables are what causes the platelet increase during processing, and you want to ensure the settings used allows for greatest platelet yield. This is where reading clinical studies is useful, so you can see what’s working. In addition to the centrifuge itself, a lot of companies sell “kits” that make processing a breeze and claim to have consistent yield. However this can increase the cost dramatically.

Part 3: How does PRP actually work?

PRP generally has two categories of components that do work:
1) Cellular – these are your platelets and peripheral blood mononuclear cells
2) Molecular – these are growth factors and immunomodulatory proteins

Let’s extrapolate an abridged list of what both of those components can do:

Cellular:
Detect and destroy microorganisms and tumor cells
Modulate immunity by producing antibodies
Secrete growth factors
Recruit stem cells
Maintain integrity of blood vessels

Molecular:
Growth factors (ex: platelet derived GF, transforming GF, vascular endothelial GF, epidermal GF, and more) – these, quite literally, cause growth
Cytokines (ex: interleukins, interferons, fibrin, fibronectin, vitronectin) – these work by autocrine, paracrine, and endocrine mechanisms to signal for healing

Simply, by introducing PRP into an area, you are leveraging ALL the healing components of plasma to exert their effects on the desired area. But note: ‘paracrine’ that I mentioned above means that healing signals can travel! I’ve frequently seen patients have benefits in areas where PRP wasn’t directly injected, but that’s a topic for another day 😊

Part 4: Is there anything else in plasma worth using?

Yes, there are other things we can get from plasma beyond just PRP:
PPP – you might have guessed, there is also such a thing as Platelet Poor Plasma. While it is low in platelets, it is rich in growth factors and can be very nourishing in certain situations or applications
Platelet lysate – this is achieved by taking PRP and purposefully breaking open the platelets (aka lysing them) with something like calcium or simply freezing and thawing. This makes all the growth factors in the platelets available immediately, instead of waiting for them to be released over days to weeks as in PRP
A2M – stands for alpha 2 macroglobulin, and this is a large molecule that can actually break down inflammatory proteins that are prominent in osteoarthritis. It is also very effective in neuropathic applications
VSELs – stands for very small embryonic like stem cells. These are a relatively recent discovery and I’m not going to pretend to know more about than a simple Google search, as I don’t use them in practice (yet)

Another thing that can sometimes show up in PRP? Red blood cells. This is usually due to a processing system or procedure that doesn’t do a fine enough job at separating the layers. While not harmful, RBCs can definitely add to the inflammatory discomfort from PRP in general. I personally prefer golden yellow PRP.

Are you fascinated by the potential already flowing through your blood vessels?! I know I am!

Part 5: Where can you put PRP?

The Musculoskeletal System:

This is by far the most commonly treated area with PRP. Everything from sprains and strains to ligament tears, to osteoarthritis, tendon issues, and more can be effectively treated with PRP.

Now, how this varies is usually on the number of treatments required (after, of course, the person is even deemed to be a good candidate in the first place). For something acute like an ankle sprain? One session. My “record” is a 2 day old anklesprain that completely healed (according to the patient) within 2 days of PRP being injected. Pretty darn incredible considering people usually suffer for 4-6 weeks!

For chronic issues and severe problems or things like tears that have been present a while and aren’t surgical candidates, you’re usually looking at minimum 2-3 treatments spaced about 4-6 weeks apart, sometimes as far as 12 weeks apart, but it is patient dependent.

When it comes to the number of areas I’ll treat in a session, I won’t do more than two (usually) as it is A LOT for the body to heal!

One time I had a colleague treat both my shoulders and both my knees. The data on my Oura Ring that night showed my body could not keep up with the demands the PRP put on it. My heart rate was elevated, my heart rate variability tanked, and my temperature and respiration even spiked. And I’m a relatively young and healthy person with a solid diet and supplement regimen. If my body couldn’t handle that much, I doubt my older or less healthy patients can.

Another amazing use for PRP is to enhance your natural beauty!

It has become increasingly popular over the last 10 years or so to utilize PRP with a microneedling pen to penetrate into the first few layers of the skin. The benefits include:
Increased collagen production
Reduction of fine lines and wrinkles
Clearing up acne and acne scarring
A tighter and more youthful appearance overall

Besides microneedling the PRP into the face, you can also inject it into the same areas you would put Botox and filler! While this doesn’t provide the immediate and temporary benefits that you’d get with those products, it does provide long term regeneration of the tissue that will make you actually look younger over time by increasing collagen.

Another beautifying application of PRP is for hair loss in both men and women! Now, this is generally something that needs to be addressed at the thinning stages where there is still a live and viable hair follicle. Unfortunately the cue ball type is not a candidate. But it is incredibly effective at regrowth and thickening!

Let’s talk about SEX! Yes, PRP can help with all things sexual.

Some examples include…

IN MEN:
– Erectile Dysfunction due to vascular issues (sorry, won’t fix the mental emotional stuff)
– Peyronie’s disease
– Increases sensitivity and intensity of orgasm
– Some men even report increased length and girth, and “towel holding” erections

In Women:
– Anorgasmia (the inability to have an orgasm)
– Incontinence
– Lichen Sclerosis
– Fissures or scarring
– Increases sensitivity and intensity of orgasm (have had women develop the ability to have vaginal only orgasms as well as ‘squirting’)
– Increases lubrication and overall hydration of tissues
– Vulvodynia / pain with intercourse
– Postpartum recovery

Obviously these are very sensitive injections, but there are steps we can take to make them as comfortable as possible, including applying numbing cream and doing strategic nerve blocks.
Overall, most of my patients report a sensation of pressure that is over pretty quickly!
Many even repeat the treatment on a 6-12 month basis because they love the results and want to keep compounding them! I mean, who doesn’t want dramatic improvements in their sex life using one of the most natural means possible?!

Let’s also list the UNIQUE uses:

Here I am going to summarize all the other “unique” things I’ve used PRP for that don’t neatly fit in the other categories:
As nasal spray for chronic sinusitis, a deteriorating septum, acute and chronic migraines, and seasonal allergies
As eye drops for corneal abrasion and dry eyes
As a retained enema for non healing anal #fissures
Nebulized for things like #COPD

Basically, my thought process is that literally almost anything that needs healing can be helped by PRP because it’s what does the natural signaling for healing in the body anyway. It certainly won’t hurt (minus a few situations where it is not indicated, but that’s a whole other post), is relatively inexpensive, so might as well try!

Part 6: Pre & Post Instructions

Alright, it’s important to prep for your treatment. My general guidelines include:
✴ No NSAIDs or alcohol for at least one week prior to treatment
✴ No steroids for at least 6 weeks prior to treatment
✴ No exercise 24hrs prior (it decreases certain growth factors)
✴ No bad attitudes!!!
✴ Do eat an excellent and healthy diet in the weeks leading up to it

After the treatment is when the healing actually starts to occur. The same pretreatment rules apply for after, plus I usually provide specific recommendations depending on the area treated.

Now, as far as healing goes, one can expect some soreness in the first 3-7 days due to the purposeful and controlled inflammation PRP causes as it starts a new healing cycle.

Next, we enter the proliferation phase where healing starts to get in motion and the proper growth factors and cytokines are engaged. This takes anywhere from 1-3 weeks. Pain relief often occurs in this phase.

Finally, we have the remodeling phase, where we begin to get the long term tissue changes we are seeking. This can last anywhere from 3 weeks up to 2 years. The human body is truly fascinating.

Part 7: Final Thoughts

I wanted to use this last part to summarize some thoughts that didn’t exactly fit perfectly in any of the other categories, so here we go:
⚜ PRP by itself should not cost thousands of dollars
⚜ PRP is not a stem cell product and should not be called a stem cell treatment
⚜ A good centrifuge is half the battle when making PRP
⚜ The act of needling itself is also therapeutic, which is why you want a skilled practitioner
⚜ While PRP can be used for dozens of things, it is not for everyone

Alright, I think that about sums it up. I hope this post was both informative and entertaining, and I look forward to helping you in the future!