PRP Training
2019
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WELCOME
• Firstly thank you for choosing our PRP platelet rich
plasma training for face and hair loss.
• Congratulations on taking your first steps to being one of
the best practitioners in the world!!!
• This course will enable you to deliver PRP treatment to
the highest standard
• This is done by ensuring all are the following paramount
in your practice:
• Anatomy and Physiology
• Knowledge of Products
• Injection Technique
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What we need to know?
What is PRP
What are its uses indications for treatment
Anatomy and physiology blood
Structural division of skin
PRP
Injecting techniques. (Papule, Nappage and point
by point Techniques).
• How PRP is applied to hair loss
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WHAT IS PRP?
• PLATELET RICH PLASMA (PRP)
• WORKS ON THE BASIS OF BODY’S NATURAL
HEALING PROCESS
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HOLISTIC REVOLUTIONARY REPAIR SYSTEM
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WHY IS IT HOLISTIC
• IT IS AUTOLOGOUS
• YOUR OWN BLOOD IS DOING THE HARD WORK
• NO SYNTHETIC MATERIAL
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PRP indications:
AESTHETIC:
CLINICAL:
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Sports medicine
Traumatology
Ophthalmic
Burn trauma
Wound healing –diabetic foot
Skin grafting
Dentistry‐ sinus lift
Tooth implants
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Skin rejuvenation
Under eye dark circles
Hair restoration
Fat grafting in combination PRP
Post laser
Cellulite combination
microneedling
Acne & Rosacea
Acne scars
Pigmentation
Tissue Volumisation – alternative
of HA fillers
Aesthetic gynecology /urology
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PRP indications:
Skin rejuvenation‐ facial resurfacing
Application‐ injection alone
Microneedling
Combination with HA, peeling or CO2 lasers
Hair restoration
Evidence for improvement of: Androgenic
alopecia ‐ male and females, “spot hair lost”
Improvement of age-related hair loss
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PRP- overview
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Platelet Rich Plasma (PRP) is derived from the patient’s own blood
serum.
10-20ml patients blood is taken
Drawn into a separating PRP tube and centrifuged.
Each part of the blood is separated
Plasma layer with all the nutrients, growth factors and platelets
is drawn up (the liquid gold)
This supercharged solution is injected
It recruits Stem Cells
Promotes healing
Increases blood supply
Regenerates new tissue
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REVISIT- BIOLOGY LESSON
ON BLOOD
Blood is a body fluid, considered a connective tissue.
• BLOOD HAS 3 MAIN FUNCTIONS: Transport, Protection
Regulation
• It delivers necessary substances such as nutrients and
oxygen to cells
• Transports metabolic waste away from those cells
• Protects at site of injury with platelet clotting
• Protects against infection and toxins
• Preserves the body's PH for physiological functions to
happen
• Regulates body temperature
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The Blood
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BLOOD
BLOOD IS MADE UP MOSTLY OF PLASMA
• 3 MAIN TYPES OF BLOOD CELLS CIRCULATE WITH PLASMA.
• PLATELETS - THROMBOCYTES Their role is to form a clot when
there has been vessels damage or tissue injury.
• RED CELLS - ERYTHROCYTES These keep tissues alive by
transporting oxygen to cells taking carbon dioxide away.
• WHITE BLOOD CELLS - LEUKOCYTES WARD OFF INFECTION. They
attack and destroy potential harmful foreign matter.
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HEMATOPOIESIS
• Bone marrow primary
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3 Stages of Haematopoiesis
• STEM CELL (IMMATURE PRECURSOR CELL)
• Progenitor
• Mature blood cell
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Blood cell formation
Average individual typical production:
• 200,000,000,000 red cells per day
• 10,000,000,000 white cells per day
• 400,000,000,000 platelets per day
• Trillions!!
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What's good FOR PRP- platelets
• Platelets contain a high content of “growth factors” –
proteins that help to heal injured tissue or damaged skin.
• The primary responsibility of the platelets is to stop the
bleeding where there is injury . When a blood vessel is
injured, platelets stick to the damaged area (this process
is called adhesion).
• Chemical signals are released from small sacks inside the
platelets called granules (this process is called
secretion).
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PLATELETS- PRP
• These chemicals attract other platelets to the site of
injury and make them clump together to form what is
called a platelet plug (this process is called
aggregation).
• If the wound is large, other proteins called clotting
factors are recruited to the site of injury. These clotting
factors work together on the surface of the platelets to
form and strengthen the blood clot.
• Platelets change from their resting form to active form by
growing and extending tenticles to make necessary
repairs.
• In short initiating the wound healing cascade
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Role of GF
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GROWTH FACTORS IN THE BLOOD
1. Epidermal Growth Factor - plays a significant role in the regulation
of cell growth,
*proliferation- INCREASE NUMBER OF CELLS
*differentiation – CHANGES FROM ONE CELL TO ANOTHER
*maturation phase( three stages of wound healing). CELLS
SPECIALIZING AND MATURING
EGF – ALSO Stimulates Keratocyte and fibroblast production
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Fibroblasts - are the main cells in the skin ,under the dermis. They
make up to 70% of dermal cells.
Responsible for producing collagen, elastin
Keratocyte Cells - are important component of wound healing
increasing fibroblast proliferation
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GROWTH FACTORS IN THE BLOOD
2. Transforming Growth Factor
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Controls cell growth
Cell proliferation
Cell differentiation
Cell shrinkage
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GROWTH FACTORS IN THE BLOOD
3. Vascular Endothelial Growth Factor - An important
signalling protein involved in both vasculogenisis,
angiogenesis and epithelialization for the intricate
process of the skin repairing itself after injury.
• Vasculogenesis- growth of new blood vessels
• Angiogenesis- is the process involving the growth of
these new blood vessels - expanding and
remodelling
• Epithelialization - provides protective cover
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GROWTH FACTORS IN THE BLOOD
Fibroblast Growth Factor – Promotes
• angiogenesis,
• granulation and
• epithelialization
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GROWTH FACTORS
Platelet Derived Growth Factor –
Attracts Macrophrages and fibroblasts to the zone of
injury, promotes collagen growth and proteoglycan,
Macrophrages – are very large and important cells of
our immune system that are formed when we have an
infection engulfing dead or damaged cells.
Proteoglycons – Proteoglycans are proteins found in
the space between our cells in the Extracellular Matrix.
The filler substance existing between cells in an
organism.
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GROWTH FACTORS
Connective tissue growth Factor
• Promotes angiogenesis
• Cartilage regeneration
• Platelet adhesion
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GROWTH FACTOR
Keratinocyte Growth Factor
• Keratinocyte (fibroblast cell that
specialises in wound healing)
migration directly enhance wound
healing and the generation of new
skin.
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Lets get started - THINK OF
CLINICAL SETTING - CONSENT
• MEDICAL HISTORY
• CONSENT FOR TREATMENT
• TREATMENT PROCESS EXPLAINED
• BEFORE PICTURES
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Who should AVOID PRP
• CANCER PATIENTS
• Septicemia
• CRITICAL THROMBOCYTOPENIA (LOW
PLATELETS IN BLOOD)
• Hemodynamic instability (unstable blood
pressure)
• PREGNANCY/BREAST FEEDING MOTHERS
• Active infection
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HOW TO GET STARTED - PRP
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PATIENT BLOOD DRAW/VIDEO
CENTRIFUGATION OF BLOOD PRODUCT
HARVEST THE PLATELET RICH PLASMA
INJECT INTO DESIRED AREA
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Process of PRP Therapy
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Preparing for PRP
• No NSAIDS BEFORE TREATMENT- APSPRIN,
IBUPROFEN, DICLOFENAC, CELECOXIB
• STERIOD MEDICATION STOP 2-3 WEEKS PRIOR
• Anticoagulant medication stop 5 days before.
• No Alcohol up to 72 hours before prp treatment
(alcohol effects the stem cells)
• Avoid vitamin e 1week
• Avoid herbal supplements 1 week
• Avoid fish oils 1week
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HERPES Simplex virus
• If you have a history of HSV (coldsores)
prophylactic ORAL antiviral medication
should be taken. ACICLOVIR 800MG 5 TIMES
PER DAY.
• 7 DAYS PRE-TREATMENT.
• 3 DAYS POST TREATMENT. THIS IS Prescription
only.
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Principles of extracting blood plasma from blood
• It is the process of separating the fluid and cellular
portions of the blood.
• This it possible by a process called (Centrifugation).
• Based on the gravity forces to separate the
components of blood (Takes long time if left
standing with natural forces)
• AMPLIFY this force by centrifugation.
• In differential centrifugation we separate specific
components of the blood. ( Differ speed and time)
• PRP – 3500 rpm 8min
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Blood draw yield
• BLOOD DRAW FOR PATIENT in specific PRP tube
(anticoagulated tube)- e.g. Cellenis
• 10-20ml (2 PRP tubes) WHOLE BLOOD WILL HARVEST
3-5ml PRP (small application)- facial cosmetic, hand
rejuvenation, neck, décolletage
• 30-60 ml 3-6 (PRP tubes) whole blood will harvest 710ml PRP (large application) –hair loss or
combination of all treatments
• ** anticoagulating tubes stops the blood from
clotting, component SODIUM CITRATE)
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CENTRIFUDGE
• Take the PRP blood draw tube to centrifuge
• Balance required if only odd number of tubes insitu
• Balance (placebo tube which replicates the blood
draw tube. It can contain any liquid to counter act
the blood draw tube weight)
• Scales may be required for accurate weight
balance (to weight tubes separately for accuracy
in spin)
• Centrifuge 3500 RPM 8min
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Commercially available PRPs
• Cellenis FDA approved CE certified
with health safety and environmental
protection standards certified
• Regeneris FDA approved CE certified
• Be cautious of centrifuge sold on eBay
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Principles of extracting blood plasma from
blood
PRP – High concentration of Platelets
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Draw Platelet Rich Plasma
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Your product has been spun
It should be definite ,the separation of blood composition. The yellow
straw like liquid at top.
The liquid gold is your elixir of youth
The PLATELET Rich is at the lowest part of the separation.
TAKE 1ml/ 2.5 ml syringe and attach 19G/21G 2-3” needle
THE needle G no smaller as you will denature the Isolated platelets)
Take off the rubber bung to prp tube
Insert 19g needle attached to syringe and withdraw, not to disturb
the separation gel from the rbc.
CONTINUE UNTIL YOU HAVE ROUGHLY THE LOWER HALF OF THE LIQUID
GOLD DRAWN UP. 3MLS
ASEPTIC NON TOUCH TECHNIQUE THROUGHOUT
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PRP DRAW AND TREAT
• CLEANSED THE AREA REQUIRED FOR TREATMENT
• YOU CAN USE ANESTHESIA CREAM IF PATIENT HAS NO
ALLERGIES/ SENSITIVITIES. 15MIN
** STUDIES SUGGEST IF YOU CAN TOLERATE WITHOUT
ANESTHETIC CREAMS YOUR TREATMENT COULD BE MORE
SUCESSFUL AS THE ANESTHESIA VASOCONSTRICTS THE
BLOOD VESSELS, WE NEED THE BLOOD VESSELS TO BE
FULLY READY TO PARTICPATE IN THE CASCADE OF
EVENTS TO COME FOR A GOOD RESULT.
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PRP treatment continued ...
Please place gown over patient incase plasma runs over.
GOWN AND GLOVES AT ALL TIMES AS BLOOD PRODUCTS.
HAVE BLOOD SPILLAGE PROTOCOL TO HAND.
Begin your injection technique depositing micro boluses
*** THIS TREATMENT IS SO FORGIVING, INJECT DEPOSIT PLASMA,
EXTRUDE PLASMA SERUM OVER - No Risk of over correction
*** MAKE THE MICRO- INJURY, DEPOSIT THE GROWTH FACTORS,
BRING ON THE HEALING CASCADE.
If plasma over spills when you are injecting that is quite normal for
this procedure- this is what you want after injecting
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Skin Revision – skin divisions
• Epidermis
• Dermis (GOOD RESULT PRP DEEP
DERMIS 3-4MM)
• Subcutaneous (hypodermis)
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Human Skin
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Histopathology of Aging Skin
• Flattening of the DEJ with loss of papillae
• Decrease in number of melanocytes
• Decrease in GAGs, proteoglycans, and ground
substance
• Decrease in elastic fibers
• Decrease in total collagen, especially type III
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Age related skin structure
deformation
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Patient selection
Treatment areas
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Mechanism of action
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Mechanism of action
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PRP- rejuvenates skin, aiding the
elasticity and texture. Aesthetically
pleasing refreshed appearance.
Which injection technique ?
• Nappage
• Papule
• Point by point
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Injecting Techniques
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Superficial
intradermal (Papule)
Injecting in the between the Epi.
And Der
Intradermal
(Nappage)
Injecting in the middle of the Der.
Deep intradermal
(Point by point)
Injecting in the between the Der.
And Subcutaneos
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Micro injuries produced by a needle
instigates platelet activation which
leads to the release of growth factors
and thus triggering the wound healing
cascade.
The practitioner
injects isolated active platelets from patients plasma in tandem.
This will promote tissue repair, blood vessel
formation and collagen synthesis
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PRP procedure
• You chose your technique
• You injected prp preferable 30 g 13mm needle or 33g
4mm needle
• Do Not wipe any plasma away with gauze
• Use the serum to clean face of any blood as patient
needs to be suitable to leave clinic.
• The serum is used as your aftercare serum. It will dry
rapidly and tighten skin
• The patient may find it difficult to speak due to tightness
in lower third of face
• Patient may encounter mild swelling (under eyes )
• Pinprick bruising is possible
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After care PRP
DONT’S:
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Do not wash face up to 8 hrs post treatment
Avoid makeup 8-12 hours post treatment
Avoid any exfoliants for up to 72hrs post treatment
Avoid sun exposure 72 hrs post treatment
Avoid rigorous exercise
Avoid saunas, sunbeds, steam rooms, swimming 48 hours
No alcohol at least 6hrs (alcohol effects the stem cells and compromises
healing)
No blood thinners at least 6hrs
Avoid smoking- the skin does not heal well.
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After care PRP
• Do wash face after 8-12hrs
• DO APPLY SPF 50 SUNCREAM
• Do use a hypoallergenic face cream 12hrs after/
hydrating face cream
• Retinol Cream commence 72 hrs post treatment
• DO HYDRATE WELL WITH WATER
• DO GET GOOD SLEEP FOR MAXIMUM HEALING
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Combine PRP
Combination PRP with Microneedling- using PRP as a topical
serum
Benefits:
• Reduces broken Capillaries and spider veins
• Reduces the appearance of large pores
• Reduces acne scarring
• Evens skin tone
• Improves the appearance of fine lines and wrinkles
• Gives a fresh glow- red carpet look
• Gives the skin a firmer and smoother texture
• Helps lighten the skin, sunspots - pigmentation
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Treat all skin layers
MICRONEEDLING
Epidermis
Superficial, mid, deep
MESOTHERAPY-PRP
Skin quality : radiance, elasticity,
hydration, even complexion,
healthy appearance
DERMAL ENHANSMENT/PRF
Wrinkles
Volume lost
Fat pat augmentation
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Recommended treatment process.
• 3 treatments 4-6weeks apart
• Repeat 6months
• Remember collagen synthesis takes up to 30 days
for new cells to be produced
• Alternate with other treatments over the 6month
period
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Recommended treatment process.
• 3 treatments 4-6weeks apart
• Repeat 6months
• Remember collagen synthesis takes up to 30 days
for new cells to be produced
• Alternate with other treatments over the 6month
period
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Recommended in your treatment process.
Gown on patient
Hair net
Inco sheet
***PERSONAL Protective
Equipment***
• Remember you are working
with blood products and
body fluid!
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Recommended in your treatment process.
Advisory to start from the midsagittal plane
(draw an imaginary line down the centre
of the face)
Work injections from the medial aspect of
face to lateral
This will aid the lymphatic drainage as you
are following the circulatory system to
clear toxins ready for fresh oxygen and
nutrients.
Giving a combined effort with PRP
enabling supreme result.
( FOLLLOW THE SAME INSTRUCTIONS WHEN
COMBINING WITH MICRONEEDLING)
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SKIN PRP PROTOCOL
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STEM CELLS SLOW & REVERSE
SKIN AGING
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EXELLENT NATURAL RESULTS
Skin quality improvement
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Eyes contour
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Volume enhancement
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EXELLENT NATURAL RESULTS
Acne scar
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EXELLENT NATURAL RESULTS
Skin after
1 PRP session
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Skin hydration, skin retexturising
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EXCELLENT NATURAL RESULTS
Crows feet skin rejuvenation and under eye dark circles
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EXCELLENT NATURAL RESULTS
Rosacea
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EXCELLENT NATURAL RESULTS
fine lines peri-oral lines, skin retexturizing , roseaca,
photoaging
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HAIR LOSS PRP
monotherapy or combination with
microneedling or hair transplant
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Some Indications
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Hair loss
Alopecia – may be reversible
Adrogenic alopecia- genetic irreversible
Chemotherapy
Post pregnancy in women
Oral meds available : minoxidil – primarily used to treat high
blood pressure
Finasteride – primarily to treat enlarged prostate (men)
Women can use Minoxidil
Over the counter remedies
Studies suggest PRP with oral minoxidil (OTC) results far more
superior than that of PRP with finasteride- POM for men
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Alopecia types
• Involutional Alopecia
• Shortened growth phase, thinning hair follicle, capillary collapse, insufficient nutrients
• Promotes anagen entry, follicle regrowth and neovascularization
• Androgenic Alopecia
• Reduction in follicle size, defect in conversion of hair follicle stem cells to progenitor cells
• Provides a suitable medium for conversion to progenitor cells and promotes neovascularization
• Alopecia Areata
• Immune system attacks hair follicles, presence of cytokines that inhibit hair growth
• Damage control, reduces frequency of attacks, and creates a medium with high
concentrations of cytokines that promote hair growth.
• Telogen Effluvium
• Premature termination of anagen phase, poor quality of hair follicles
• Neovascularisation, improve quality of hair follicles, promotes anagen entry
• Scarring Alopecia
• Scar tissue destroys hair follicles and ability to regenerate
• Efficacy depends on extent of disease, helps reduce rate of hair implant rejection
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Hair and Growth Cycle
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HAIR LOSS
Alopecia ‐ clinical & trichoscopic diagnosis : reduction or complete loss of hair
80% male,40% female
3 successive phases‐anagen, catagen, telogen
Current treatment options: minoxidil and finasteride
GF from PTL activate stem cells in the BULGE AREA OF follicles, stimulating
the development of new follicles and promoting neovascularization
Germinative phase of anagen requires :
GF and nutrition: iron, proteins, zink, minerals and vitamins.
BULGE AREA (4MM DEPTH)
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HAIR ANATOMY
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HAIR CYCLE
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CONTRA INDICATION
• Active inflammation process
• Low platelets number
• Coagulation factors deficiency
• Anti coagulation therapy
• Carcinomas ‐5 years diseases free
• Autoimmune diseases
• Pregnancy
• Hyper cholesterolemia
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80
4mm deep in to
hair bulb
33g 4mm meso
needle
or 13mm 30g
needle
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Hair Restoration
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HAIR INJECTION PRP
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HAIR RESTORATION
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Hair loss before and after PRP
Studies suggest PRP with oral minoxidil results far more superior than
that of PRP with finasteride.
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HAIR RESTORATION
• Hair loss before and after PRP vertex (crown)
• Studies suggest PRP with oral minoxidil results far more superior
than that of PRP with finasteride.
• HAIR REGROWTH
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Recommended treatment process
• Hair loss 6 treatments (once a
month 4 weeks apart) 6months
• Repeat in 6-12 months
• 6-18months regrowth, thickness
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HAIR and SKIN
After treatment care
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PREVENT CONTAMINATION
DO NOT USE PAIN KILLERS ‐ KEEP NATURAL HEALING CASCADE
REDUCE PHISICAL ACTIVITIES FOR 3‐4 DAYS NUTRITION
SUPPORT
Vit. A 25 000 IU/day – enhance early immune response, cells
differentiation
Vit. C 1‐2 g/day ‐ collagen synthesis , protect cells ‐ free
radicals
Protein ‐ 0,8g/kg BW – prevent prolongation of inflammatory
reaction
Zink ‐15‐30 mg/day ‐cells proliferation and protein synthesis
Glucosamine ‐1500mg/day –HA production
Biotin – Stimulates hair restoration
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…ready for
Practical Session?
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List of products – PRP packs
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Anaesthetic cream
Tourniquet
Antiseptic wipe
BD luer lock vacutainer blood collection pack
PPR tube
Centrifuge
1 m syringes / 2.5ml syringes
19g needles
13mm 30g needles
4mm 33g needles
(dermapen/ dermaneedle)
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Remember:
Remember PRP is very forgiving
Technique will come with experience
Be confident
There is so much more we can add to this
treatment....
• I look forward to seeing you in the practical
to explore other avenues of this
revolutionary treatment process....
• See you in class soon...
•
•
•
•
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