Platelet-rich Plasma (PRP)
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets). The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors that are very important in the healing of injuries.
PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.
To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. These platelets are then injected into the injured site.
Hair loss: Doctors have injected PRP into the scalp to promote hair growth and prevent hair loss. According to researchTrusted Source from 2014, PRP injections are effective in treating androgenic alopecia, which is also known as male pattern baldness.
Tendon injuries: Tendons are tough, thick bands of tissue that connect muscle to bone. They are usually slow to heal after injury. Doctors have used PRP injections to treat chronic tendon problems, such as tennis elbow, Achilles tendonitis at the ankle, and jumper’s knee, or pain in the patellar tendon in the knee.
Acute injuries: Doctors have used PRP injections to treat acute sports injuries, such as pulled hamstring muscles or knee sprains.
Postsurgical repair: Sometimes doctors use PRP injections after surgery to repair a torn tendon (such as a rotator cuff tendon in the shoulder) or ligaments (such as the anterior cruciate ligament, or ACL).
Osteoarthritis: Doctors have injected PRP into the knees of people with osteoarthritis. A 2015 studyTrusted Source found that PRP injections were more effective than hyaluronic acid injections (a traditional therapy) for treating osteoarthritis. However, the trial was a small group of 160 people, so larger trials are needed for this to be conclusive.
How Does PRP Work?
Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.
To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:
- PRP can be carefully injected into the injured area. For example, in Achilles tendinitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first week or two, and it may be several weeks before the patient feels a beneficial effect.
- PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.
- A healthcare professional will draw a sample of your blood. The amount of the sample depends on where the PRP will be injected. For example, the amount of blood taken for injection into the scalp for one studyTrusted Source was 20 milliliters. This is slightly larger than one teaspoon.
- The blood is placed into a centrifuge. This is a machine that spins around very quickly, causing the blood components to separate. The separation process takes about 15 minutes.
- A technologist takes the separated plasma and prepares it for injection into the affected area.
- Doctors will often use imaging, such as ultrasound, to pinpoint specific areas for injection, such as the tendon. Your doctor will then inject the PRP into the affected area.
When PRP is injected following injury, your doctor may recommend that you rest the affected area. However, these recommendations are more related to the injury and less to the PRP injections. Most people can continue their daily activities following PRP injections.
Because PRP injections are intended to promote healing or growth, you may not notice an immediate difference after receiving the injections. However, in several weeks or months, you may observe that the area is healing faster or growing more hair than you would have expected if you hadn’t received PRP injections.
- avoiding unprotected and excessive sun exposure or tanning several weeks before your appointment
- drinking lots of water in the days before your appointment
- arranging a ride home from your appointment (which may not be entirely necessary depending on the office’s protocol)
- arriving with a bare face (you may cleanse that morning, but you should avoid wearing makeup or moisturizer)
The actual procedure involves two steps. The microneedling portion lasts about 30 minutes, depending on the areas treated. During this time your doctor will roll a professional-grade derma roller or FDA-approved device on the desired areas on your face.
A syringe of blood will be drawn, usually from your arm, while your face is numbing. The blood is then put into a centrifuge, which separates the PRP from other components of the blood.
The PRP solution is then massaged into the treatment area, usually after microneedling. The microneedling treatment creates small controlled micropunctures in the skin, allowing for penetration of the PRP.
In the past, PRP has been injected into the skin, but it’s becoming more of a common practice to use it along with microneedling.
Once the procedure is finished, your doctor may apply a serum or balm to help soothe any redness and irritation. You may also have the option to put on makeup to camouflage any temporary side effects.
Unless an adverse reaction occurs, you’re free to go home at this point. Although many people are comfortable enough to drive home, arranging a ride home in advance can help alleviate any uncertainty.
Using PRP alongside traditional microneedling treatments may improve the scars on your face, but the evidence is still inconclusive.
Although research is inconclusive about its effectiveness in facial rejuvenation, the downsides to adding PRP to microneedling appear to be minimal, aside from cost.
More studies need to be conducted on the utility of PRP and microneedling. It’ll likely take several treatments to see results.
After you finish your course of treatment, you may need to follow up with your doctor for potential maintenance, depending on the indication for your treatment.
If your doctor determines that you need a maintenance session, be prepared to spend the same amount per session as you did for your initial treatment.
Frequently Asked Questions
Is PRP New?
The technology has been used for years in surgical applications and wound care. The use of PRP for musculoskeletal injuries is fairly new and evolving into a promising treatment for both acute and chronic injuries. There are a number of medical studies supporting the use of PRP for tendon and ligament injuries.
Do I have to worry about the use of blood products?
The patient’s own blood is used for the procedure so there are no transfusion risks or blood borne infection from a donor.
How long does it take?
Generally a PRP injection requires an initial visit to see if the injury would benefit from such treatment, then a follow-up visit for the treatment itself is scheduled. The actual injection process takes about 45 minutes and a majority of that time involves drawing and processing the patient’s blood for the injection.
What conditions can be treated with PRP?
Many research studies have been performed, and many more are ongoing, which look at the effectiveness of PRP treatment. The most promising results to date have been with soft tissue injuries, including tendonitis, tendon tears, ligament sprains or tears, loose ligaments, and muscle tears. PRP has also been effective in treating cartilage degeneration such as arthritis. In some cases it can be used in conjunction with a surgical procedure.
What are some common diagnoses treated with PRP?
Shoulder: Rotator cuff tendinitis or tear, rotator cuff impingement syndrome or bursitis, bicipital tendinitis, labrum tear, arthritis, instability
Elbow/wrist/hand: Tennis elbow, golfer’s elbow, DeQuervain’s Tenosynovitis, trigger finger, arthritis, other wrist and finger tendinitis
Knee: Patellar tendinitis, partially torn or strained major ligaments of knee (ACL/LCL/MCL), meniscus tears, chondromalacia, arthritis, instability
Ankle: Achilles tendinitis, peroneal tendinitis, ankle sprain, instability, other foot or ankle tendinitis
How do I determine if I’m a good candidate?
Here are some general guidelines:
- Pain duration of 3-6 months or longer
- Persistent pain despite physical therapy, activity modification, NSAIDs
- Wishes to pursue alternative to surgical treatment
How long will the recovery take?
Post procedure pain and activity progression varies among patients. Regular range of motion at the site of injection is started immediately and patients typically progress to regular activities and light aerobic activity within the first few days to 2 weeks, depending on the site treated (see the General Instructions sheet). Rehabilitation is done under the supervision of physical therapy and specific home exercises are tailored for patient progress. It is common for the patient to feel increased pain immediately following the injection which resolves typically in one to two weeks.
Is PRP Painful?
Patients typically tolerate the procedure well, although post-injection soreness is expected given the PRP-induced inflammatory response, in some cases.
How many treatments do you need?
One to three treatments depending on the degree of injury and how long the injury has been there.
Are there any exclusion criteria that inhibit someone from getting PRP?
Severe anemia, low platelet count, abnormal platelet function, active systemic infection or active cancers are all contra-indications.
How long does it take to work?
Most patients notice some element of improvement by 2 to 6 weeks after the treatment.
Does insurance cover PRP?
No, PRP isn’t covered by insurance or Medicare/Medicaid and is considered an out of pocket expense.
Your PRP injection may be combined with a hyaluronic acid injection, if recommended by your physician.