PRP: is it worth all the hype?

Celebreties are raving about it, doctors are promoting it for many things, but is it really worth the hype?

In short, PRP is not FDA approved for anu Dermatologic or Cosmetic indication. There are several small studies that concluded that there is benefit when treating androgenic alopecia. That being said, larger, well-designed studies are needed. For other indications, such as photo-rejuvenation, studies are even more poorly designed.

There is a good scientific basis for why PRP may help a variety of conditions. Unfortunately, due to a lack of good clinical studies further research is needed. So the answer to the question of whether is is worth the hype is maybe. 

Often, PRP is combined with another procedure–laser resurfacing+PRP, or Restylane+PRP. When doing so, it is difficult to know if the PRP is adding any benefit.

Scar Treatments using “Lasers”

It’s funny today. No matter what the condition, everyone thinks that a “laser” is available and is best. In most cases, this is not so, but in many cases, laser treatments are available.

There are many different types and causes of scars: traumatic, post-surgical, and acne scars to name a few. Well, there is not one treatment that is best for all types of scars. So, when it comes to scars, you need to have a lot of tools at your disposal in order to get the best result. For example, here is a list of treatments that I perform regularly for scars:

  • CO2 laser ablation
  • Dermabrasion (not to be confused with microdermabrasion)
  • TCA peels
  • IPL (intensed pulsed light)
  • Topical treatments (i.e. silicone gel sheets, 5-FU), which can be combined with other treatment modalities
  • Surgical scar revision
  • Electrodesiccation
  • Dermal and/or subdermal fillers
  • Subcision

What is not on the list:

  • Microdermabrasion – studies have shown that there is virtually no benefit unless one reaches the dermis( pinpoint bleeding), at which point it is a dermabrasion and not microdermabrasion. This modality can be combined with chemical peels, which does offer benefit.
  • Microneedling – although there may be some benefit, the cost-benefit ratio is poor (high cost for minimal, if any, benefit). This is frequently recommended as there is minimal risk.

In short, the treatment of scars requires experience and skill. More and more frequently, I perform post-operative treatments to reduce the appearance of scars before they fully form (i.e. 10-14 days after facial surgery). But, most scars that are treated are from acne and/or trauma.

Hair loss treatments – for men and women

According to a recent article, all treatments that were evaluated were effective in treating hair loss.

For men, 2% minoxidil, 5% minoxidil, low light therapy, and finasteride were all effective.

For women, 2% minoxidil was effective. Unfortunately, other treatments were not evaluated for women.

Recommendations from Dr. Bader: In my experience finasteride is most effective in men with a high compliance rate.  The original 1mg dose was actually pulled out of thin air–no studies to find the most effective dose with the least amount of side effects was used to come up with this dose. I have found that 1mg may not be enough for some patients. 1.25mg (a quarter of a 5mg tablet) works well and some require a 2.5mg dose once or twice a week. I have found that this higher dosing has a greater effect on those who do not get the desired result with a minimal increase in side effects.

For women, I recommend that 5% minoxidil used once daily. This dosing schedule was recently FDA approved, not that this matters. One can buy the 5% minoxidil for men or women, whichever is cheaper. The product is the same. The only difference is the instructions that come with the product. Men are instructed to use the product twice daily. Studies have shown that 5% minoxidil twice a day is no more effective than 2% minoxidil twice a day. For this reason, once a day dosing is recommended for women, not that there is substantially greater risk of using the product twice a day. Side effects from this product include low blood pressure and increased facial hair growth in some. I recommend using the product at night, when one is less affected by lower blood pressure. One should get out of bed slowly to ensure they do not get lightheaded.

New scar treatment for thick scars

Tranilast 8% liposomal gel was shown to be effective in treating scars from cesarean sections. Patients were asked to treat half of their scars with this gel and the other half with placebo. Patients were much more satisfied with the Tranilast side.

Unfortunately, this treatment has not been compared to other treatments, including steroid injections and silicone gel sheets, but at least gives another option for patients with thick scars

Devices that help retain hair when undergoing chemotherpy for breast cancer

The DigniCap Cooling System was FDA approved in 2015 to prevent hair loss, which may be of benefit to those undergoing chemotherapy. The FDA has just approved a second system, the Paxman Scalp Cooling System, for reducing hair loss in breast cancer patients undergoing chemotherapy.

Rare cancer linked to breast implants

The Food and Drug Administration has identified 359 women with “breast implant-associated anaplastic large cell lymphoma (ALCL), a type of non-Hodgkin’s lymphoma,” since a link was discovered between breast implants and the rare form of cancer in 2011. Nine of the women identified have died and that most of the cases have involved “textured breast implants” rather than “smooth” implants.

Fat transfers take over 2 years to see final result

Moving fat from one area of the body to another has been used for decades with much success, but often great variability is seen from one surgeon to another. Various techniques have been used (i.e. fresh fat technique versus frozen), both with good results. With the recent addition of good sub-dermal fillers, fat transfers are less commonly used.

In a recent study, the final result took an average of 2.2 years after treatment. That is surprisingly long time.