attention dr. feller , your prp treatments

[joe from staten island]

hi dr. feller i have a great deal of respect for you, and i know that you are an outstanding physcian in the field of hair restoration. i have had several unfortunate hair transplants over 25 years ago. my hair grafts only grow to a certain length and then stay stagnant. i also have many minitaurized hairs that have stayed the same length for over 25 years. i have been told by other physcians that i have no donor area left. my question to you is that does the possibility of prp therapy exist, that it can increase circulation in my scalp possibly helping some of my grafts to grow longer. these other physcians have told me that my previous surgeries have created a problem with circulation in my scalp. any improvement would be a miracle to me. also the cost is obviously minimal and i would be willing to go for several sesions.in addition will you be incorporating the extra celluar matrix in your practice.any assistance you could give me would be greatly appreciated, thank you for your time dr. feller, sincerely joe from staten island.

[joe from staten island]

attention dr. feller prp therapy

hi dr. feller i greatly appreciate your rapid response to my question on the potential of prp therapy in my situation. i definetely will be contacting your office in the near future. hopefully you may be able to get some donor hair from the back and sides of my scalp, this hair is curly and grows at a tremendous rate. one doctor suggested i use some hair from my virgin temporal region. any further insight that you may have to offer would be greatly appreciated. i realize that there are no guarantees of sucess, but in my situation i really have nothing to lose. my expectations are realistic , any improvement would be a significant milestone in my life. dr. feller thank for your time and consideration , i am looking forward to meeting you , i know that you are truly a great and wonderful physcian in the area of hair restoration. sincerely joe from staten island

[Dr Joseph F. Greco]

Multiple HT's of the old variety can certainly decrease vascularity to a significant degree. A lessor known consequence is that the skin of the scalp may also become chronically irritated from all the excess tissue -which can also limit hair growth.

PRP does increase vascularity and also decreases inflammation, so I would think that PRP would be a very appropriate therapy for someone in your situation.

I honestly don't see how the extracellular matrix can make any signficant difference because. like LLLT, I don't see how it will get past the epidermis and shallow dermis to get to the follicle in any signficant concentration. While it may be effective in the body, I think it is at a signficant disadvantage outside of the body. Also, ECM is Platlett Poor Plasma which makes it less potent to begin with. I doubt it would make much of a difference even if it were injected.

Perhaps Dr. Joe Greco has some more insight on the matter, but for now I see no point in using ECM for treating hair or dermis.

I think these are great questions and Dr Feller is correct in how we feel PRP works on hair. Both PRP and GF/ECM complexes work on increasing hair shaft and follicle density via vascularization of the follicle. We offer both to patients.

Other than our study, two individual studies by (Yano, 2001) and (Rinaldi, 2007) demonstrate growth factors, namely VEGF, increase vascularity to the follicle leading to increase in follicle and hair shaft size. “Feed it and it will grow”!

So I feel both PRP and GF/ECM complexes will have a positive influence on hair, but to answer the direct questions Dr Feller posed:

1- “I don't see how it will get past the epidermis and shallow dermis to get to the follicle in any significant concentration”. It is quite easy to infuse the GF/ ECM complex into the dermis via creating thousands of micro channels through the epidermis into the dermis with a micro needling roller. Additionally, injecting the complex either in a retrograde fashion deep to superficial will infuse the complex through all layers of the scalp including the dermis or it can be injected into the dermis. A layer of activated GF’S are left on the scalp over night and when the epidermal channels close the GF/ECM complex is entrapped in the dermis.

2- While it may be effective in the body, I think it is at a significant disadvantage outside of the body. Independent studies conclude that, “GF–ECM complexes may well be the most effective and efficient method to stimulate cell proliferation, as well as tissue healing or regeneration”. Clark, R et al. Synergistic Signaling from Extra cellular Matrix–Growth Factor Complexes. Journal of Investigative Dermatology (2008) 128, 1354–1355. doi:10.1038/jid.2008.75.

3- Also, ECM is Platlett Poor Plasma which makes it less potent to begin with. I doubt it would make much of a difference even if it were injected.

This is true if you dilute PRP with only PPP, but our GF/ECM is achieved by a second concentrating processing of PPP and when mixed in a specific ratio with PRP and “activated” creates a natural protein matrix entrapping the GF’s inside the protein matrix. Because it takes the body longer to break down the protein the GF’s remain in the treatment area longer to create more angiogenesis and mitogenesis.

The protein matrix allows new cells to attach to the cross linked protein fibers and independent studies indicate that less GF’s are needed to achieve the same result as GF/ECM complexes. Upton et al. (2008)

Platelet Poor Plasma (PPP) is a disconcerting term because it has a negative connotation “Poor”. It should be called Protein Rich Plasma because it has tremendous advantages as demonstrated in our 072 patent because of the level of fibrin, fibrinonectin and vitronectin. (Upton et al. (2008) demonstrate that vitronectin (VN) complexes with insulin-like growth factor (IGF) and IGF-binding proteins (IGFBPs) could enhance migration of human keratinocytes in vitro and possibly in vivo.

So if you think of what hair is made of (protein), introducing a Platelet Rich concentration entrapped in a cross linked protein matrix is only beneficial to hair.

I hope this clarifies my position and any misconceptions regarding PRP and GF/ECM complexes. Both PRP and GF/ECM complexes are positive for hair and I applaud Dr Feller for his use of PRP and support his continued use of this therapy. This type discourse is great for both clinicians and patients and I look forward to working with Dr Feller and others in investigating and understanding newer technologies.

Finally, our experience in literally thousands of wound and soft tissue cases since 1998 utilizing PRP and GF/ ECM complex demonstrate that the GF/ECM complex are clinically superior. This is just the next step in the evolution of PRP as we will be adding peptides, stem cells and cultured cells to this GF/ECM complex.

[Jeffrey Epstein, MD]

Joe- Great summary of the ongoing therapies.
I want to thank you for being so willing to share your knowledge with surgeons like Glenn Charles and myself- we are very excited to offer this therapy. My first case several weeks ago utilized both the PRP and the PPP (or we really need to come up with another abbreviation for Protein Rich Plasma to distinguish it- perhaps PCP - protein concentrated plasma)

Jeff Epstein, MD, FACS

[Dr Joseph F. Greco]

Joe- Great summary of the ongoing therapies.
I want to thank you for being so willing to share your knowledge with surgeons like Glenn Charles and myself- we are very excited to offer this therapy. My first case several weeks ago utilized both the PRP and the PPP (or we really need to come up with another abbreviation for Protein Rich Plasma to distinguish it- perhaps PCP - protein concentrated plasma)

Jeff Epstein, MD, FACS

Hi Jeff, thanks and great to hear from you. Yes, good suggestion regarding the concentrated PPP. In patent applications it is referred to as PPPc so there is a definite distinction between PPP and PPPc. Again, we need to get rid of the negative "poor" connotation because it is very valuable for hemostasis and matrix backbone. While many just throw this away we use many ways. Lets discuss this in Amsterdam over dinner. Joe

[Dr Joseph F. Greco]

Dr. Greco,
How many cc does your second stage concentration of PPPc produce assuming an orignal blood draw volume of 60cc?

Thanks.

Hi Alan, I would be happy to discuss this with you off line or in Amsterdam. Regarding your previous question injecting PPP.. we have done this in HTP surgery for hemostasis in the graft site area rather than epi and have not had any problems; however, I would be concerned about seroma formation with just larger amounts of non concentrated PPP. Best, Joe

[Dr. Glenn Charles]

Joe, I want to thank you again for your generosity. The new machines were delivered today and we did a hair transplant procedure with PRP. Everything went very smooth. I agree with you that the PRP and PPP may significantly reduce the amount of epinephrine used during hair restoration surgery. A big bonus for patients with a cardiac history. I was also thinking how we need to establish new terminology for platelet poor plasma (PPP). How about PlRP for Platelet Rich Plasma and PrRP for Protein Rich Plasma. I am sure over time as more data is collected we will see additional benefits that come from the use of these substances.