Dr Feller is treating patients from his office in New York now and the first few have gone really well. All cases will be well documented. We will be offering PRP here in the UK in the not too distant future also - Feel free to contact me if you would like to be put on the list for treatment. -
[email protected]
He treated the first guy the other day - here is a write up along with some info from the doc from another forum - There are several "youtube" videos on other topics will attempt to addthem here also to help. Quotes from Dr Feller - :
I am proud to announce that we performed New Yorks first PRP treatment in Great Neck today.
The patient had visited us twice for HT surgery consultations but was turned down on both occassions. When he asked if there was anything new available to patients in his situation, we told him about PRP and he decided to give it a try.
His entire procedure took about 25 minutes. We drew some blood from his arm and then processed it to obtain concentrated plateles. Then I numbed his scalp with a local anesthetic and injected the PRP into the dermis where the follicles live. Then I used a tiny needle and made 200 punctures in the skin to activate the platelets. I let him sit for 5 minutes during which his skin healed, washed his scalp with some clean water, and sent him home. That was it. Very undramatic. I will post photos when I get the chance.
--
Yes, I will be documenting ALL of them.
No, not a single injection. I inject PRP every CM or so to "seed" the dermis as evenly as I can. Then I poke the area that has been seeded about 200 times to ACTIVATE the platelets.
I guess I haven't made the mechanism of action of PRP clear, so let me summerize here:
Platelets in and of themselves are inactive and dormant. If they weren't, you're blood stream would be just one massive clot. Platelets only become active when triggered by disruption of tissue. So when you cut yourself, the platelets passing by in the blood stream at that time become ACTIVATED by the injury and start to do their magic- which is to clot blood and exude growth factors of different kinds to regenerate the skin and surrounding structures in an effort to heal them.
The blood has a relatively low concentration of platelets, so in PRP procedures we strive to concentrate the platelets 5-7 TIMES normal. Then we inject it into the dermal layer where the follicles live.
At this point the PRP concentrated platelets are in the dermis, but are inactive, so when I poke the area a few hundred times the trauma causes the platelets to activate. That's the general mechanism of action of PRP as I understand it. Perhaps Dr. Joe Greco can come on here and elobarate if need be, but I thing that pretty much says it.
The reason I turned that patient down twice was simply because he had too much hair for surgery at this time. That's what made him an excellent PRP candiate.
This patient is not on any meds and does not want to be- yet another criteria that made him an excellent PRP candidate.
While PRP is "experimental", I am not trying to experiment on patients. That is, I will not preclude patients who are already on finsateride, dutasteride, minoxidil, or anything else in the name of doing a study. Instead, I will treat all patients I feel are candidates for PRP and simply follow their progress in photos. Then I will do a retrospective study to see what the effects of PRP truly were.
PRP seems to play two major roles:
The first is to aid in reducing, arresting, or reversing miniturization. In this case the best patient is someone with ALOT of thin hair like diffuse alopecia. Another ideal patient is the one who is losing their hairline due to traction alopecia secondary to pulling the hair back into a ponytail.Yet another is the young person who sees areas of their scalp noticably thinning. Most of these type patients should NOT be candidates for HT in the areas that PRP treatment is recommended.
The second is the hair transplant patient. I now tell all my patients that they have the OPTION to get a PRP treatment 2 weeks to a month BEFORE their scheduled HT procedure to help prepare the donor area and recipient area for the surgery. Since PRP exudes EGF (Endothelial Growth Factor) it means new capallaries will be formed within the skin which can only help the donor area heal better and the recipient area recover faster after surgery. And before anyone worries about the area bleeding MORE during surgery due to the PRP treatment, it won't because the new vessels are capallaries and are therefore too small to make a difference in the volume of blood lost during surgery.
If PRP is performed in an area where grafts are already grown out it will not harm them. Think about it, even a massive surgery in and around prior transplants very rarely harms the original transplants. The amount of trauma from a PRP treatment is FAR less than that.
I suppose there is ALWAYS a risk of shockloss as some peoples physiology are more sensitive than others, but I have to state that I HIGHLY doubt shockloss can occur as the result of a PRP procedure. The wounds are just too small.
According to the scant data we have for the efficacy of PRP on follicles, it seems that a return visit would be called for every 6 to 8 months. If PRP is effective in your case, I suspect that you would return EVERY month for several hundred needle pricks without hesitation. Fortunately you don't feel the sticks because I numb the scalp with local anesthetic prior to the procedure.
Needle-less injectors may or may not work. My concern is whether the high pressure will rupture the platelets. I will order such an injector and shoot it though pig skin. Then I will examine under the microscope. If the platelets are intact then I will consider needle-less injectors.
I have no idea how many terminal hairs it will produce. Dr. Greco showed a cosmetically signficant amount during the Fox newscast he was on, I'd be happy if most people achieved that level of growth.
I have not heard nor read one word about PRP enhancing any kind of untoward growth like tumors, and it is unlikely that it is capable of doing so. I had a conversaton with the rep of the most successful PRP company in the world and he never heard of it either.
If the patient has extensive baldness in an area without ANY miniaturized hairs and no chance for a hair transplant, then there is no point in offering PRP at all.
To me, any person with a thinning area of scalp extensive enough to worry them, but not enough to justify a hair transplant, is an instant candidate. This goes double for women in particular who can't use finasteride.
Like Propecia, Minoxidil, and Dutasteride PRP is NOT a magic bullet.At least not yet. But the only way to find out its potential is to simply do them and report on the results. Perhaps PRP is where crude HTs were 40 years ago and it will just take some clever hard working doctors to maximize its potential. One thing is for sure, it's potential extends far beyond other junk therapies like lasers, steroid injections, magic shampoos, etc...
Growth factors are the stuff of life. They are real, tangible, well understood, and proven. Stands to reason that they would have a beneficial effect on any tissue they came into direct contact with...hair follicles and surrounding skin included.
-Dr. F