SLIDE 1

Platelet-rich plasma (PRP) is defined as a portion

of the plasma fraction of autologous blood having
a platelet concentration above baseline. PRP is
becoming a very popular therapy for a variety of
conditions including aesthetics, rejuvenation,
degenerative and musculoskeletal conditions. The
balance between degeneration and regeneration is
restored in favour of regeneration with the help of
PRP.

The initial popularity of PRP grew from its

promise as a safe and natural alternative to
surgery. PRP advocates promoted the procedure as
an organically based therapy that enabled healing
through the use of one's own natural growth
factors. With more than 10,000 article base and
hundreds of critical reviews one can very easily
conclude arrival of the ultimate medicine for
rejuvenation. But is the hype thus created justified
to use PRP therapy in all situations or one needs to
judiciously decide on the indications?
SLIDE 2
There is great variation in reported results with
spectrum of no results, through minimal effect to
complete rejuvenation with few sittings.
Though PRP is being used over a long time, there
is still confusion over proper terminology to
define, classify and describe the different
variations of platelet concentrates. There is also a
wide variation in the reported protocols for
standardization and preparation of PRP, in
addition to lack of accurate characterization of the
tested products in most articles on the topic.
Additionally, the high cost of commercially
available PRP kits, precludes its use over a larger
population.
SLIDE 3
As we all know body regenerates itself and no
medicines or surgery can be effective if the body
cells and tissues do not respond to medicines. The
potential of body to regenerate and repair itself is
very unique and depends on cell to cell stimuli
comprising of chemical stimuli, hormones,
neurotransmitters, nutrients and medicinal
chemicals. With aging and disease conditions cells
loose potential to respond to these stimuli and
repair and rejuvenation gets delayed. This is seen
in most of the chronic inflammatory diseases as
well as diabetes. If we can restore cells’ potential
to react to these stimuli, repair and regeneration
can be hastened and can achieve full physiological
potential in any tissues and organs of the body.
Platelet derived growth factors have such magical
properties which have been recently recognized.
Methods of harvesting and using platelet rich
plasma are now becoming widely practiced in the
fields of sports medicine, orthopedics,
traumatology, general surgery, dentistry,
dermatology and cosmetology.
SLIDE 4
WHAT IS PRP?
Human blood contains 55% plasma and 45%
RBCs with very minor volume occupied by
platelets and WBCs. Normal blood has 150,000 to
450,000 platelets per microliter (μL).
PRP preparation involves concentration of these
platelets into small volume of plasma enhancing
concentration of platelets in that volume of plasma.
Efficacy depends on the ability of properly
concentrating platelets and using appropriate
volume for the purpose it is used.
SLIDE
Platelets are the smallest fragments of blood cells
derived from fragmentation of precursor
megakaryocytes in bone marrow. 2-3 microns in
size platelets are devoid of nucleus or DNA and life
span is also short 3-5 days. Platelets attract media
attention mostly during Dengue epidemic when
people realize their importance, as life threatening
platelet reduction is common in severe infections
and it then becomes critically deficient resource.
Though media does not realize but we know
platelets are very important source for therapy in
wide variety of diseases requiring repair and tissue
healing.
SLIDE
On a stained blood smear, platelets appear as dark
purple spots, about 20% the diameter of red blood
cells. The ratio of platelets to red blood cells in a
healthy adult is 1:10 to 1:20.
SLIDE
The main function of platelets is hemostasis by
attaching to any breach in vessel where platelets
aggregate, activate and release granules. The
platelet’s organelle zone is rich in platelet granules.
Alpha granules contain clotting mediators such as
factor V, factor VIII, fibrinogen, fibronectin,
platelet-derived growth factors, and chemotactic
agents. Delta granules, or dense bodies, contain
ADP, calcium, serotonin, which are platelet-
activating mediators
SLIDE
Activated platelets release granules by exocytosis
which contain not only clotting factors but more
than sixty different biologically active substances
that are involved in processes of tissue regeneration,
angiogenesis, epithelialization, proliferation and
differentiation of osteoblasts, and in synthesis of
collagen
SLIDE
The important growth factors in PRP are

1. Epidermal growth factor - stimulates

endothelial chemotaxis or angiogenesis,
regulates collagenase secretion, stimulates
epithelial, or mesenchymal mitogenesis
2. Platelet-derived growth factors (PDGF-AB and
PDGF-BB) - mitogenetic for mesenchymal
cells and osteoblasts, stimulates chemotaxis
and mitogenesis in fibroblast, glial, or smooth
muscle cells, regulates collagenase secretion
and collagen synthesis, stimulates macrophage
and neutrophil chemotaxis.
3. Insulin-like growth factor (IGF) improves the
early healing of tendon defects by over-
expression of IGF-1,[43] chemotactic for
fibroblasts and stimulates protein synthesis,
enhances bone formation
4. Vascular endothelial growth factors -
stimulating new blood vessel formation to bring
nutrients and progenitor cells to the injury site,
stimulates mitogenesis for endothelial cells
5. Transforming growth factor-B - stimulates
undifferentiated mesenchymal cell
proliferation, endothelial chemotaxis, and
angiogenesis, inhibits macrophage and
lymphocyte proliferation, regulates endothelial,
fibroblastic, and osteoblastic mitogenesis,
mitogenic effects of other growth factors,
collagen synthesis, and collagenase secretion
 SLIDE
6. Keratinocyte growth factor - promote
endothelial cell growth, migration, adhesion
and survival, angiogenesis.
7. Fibroblast growth factor-2 - stimulating new
blood vessel formation to bring nutrients and
progenitor cells to the injury site
8. Platelet factor 4 - stimulate the initial influx of
neutrophils into wounds, chemoattractant for
fibroblasts
9. Interleukin 8 - pro-inflammatory mediator,
recruitment of inflammatory cells
SLIDE
PDGF
2 polypeptide chains
AB, BB and AA types (AB in human platelets)
Stored in alpha granules in platelets
TGF beta
Also polypeptide, multiple chains, TGF beta-1 most
studied form
Found in platelets and bone, cartilage
SLIDE
Effects of PGDF on tissues are
Immediate (within 5 minutes)
Second messenger stimulation
Inflammatory response
Early (30min to 4 hours)
M-RNA stimulation, protein synthesis
Chemotaxis (draws cells to the area)
Late (4-24 hours)
Fibroblast mitosis
SLIDE
It appears that through a complex series of
biochemical and cellular events, these growth
factors cause a rapid and sustained increase in the
number of fibroblasts in an area and then through a
poorly understood interaction among factors
modulates cellular activity to cause stem cell
maturation.
SLIDE
The PRP treatment using extract of platelet derived
growth factors is an attempt to mimic the natural
response of living organism to tissue damage.
Release of platelet granule derived growth factors
initiates a chain reaction of chemotaxis,
proliferation, cell differentiation and synthesis of
extracellular matrix. Thus PRP therapy can be
directed to not only to repair damage but also to
create a biological model encouraging tissue
regeneration. The most ideal therapy for tissue
regeneration is using stem cells. PRP can do the
same regeneration to almost 90% extent at minimal
costs and minimal setup.
Natural ageing process of tissues weakens the
regeneration potential, which can be effectively
bypassed by using PRP, directed to enhance
regeneration.
SLIDE
PRP is prepared by a process known as differential
centrifugation. In differential centrifugation,
acceleration force is adjusted to sediment certain
cellular constituents based on different specific
gravity.
SLIDE
There are many ways of preparing PRP.
It can be prepared by the PRP method or by the
buffy-coat method.
SLIDE
Gel tubes used for collection
SLIDE
Specialized devices used for PRP preparation
There are many PRP systems commercially
marketed, which facilitate the preparation of ready
to apply platelet-rich suspensions in a reproducible
manner. All operate on a small volume of drawn
blood (20-60 mL) and on the principle of
centrifugation. These systems differ widely in their
ability to collect and concentrate platelets depending
on the method and time of its centrifugation. As a
result, suspensions of different concentration of
platelets and leucocytes are obtained. Differences in
the concentrations in platelets and WBCs influence
the diversity of growth factors concentration. It is
difficult to assess which kit for PRP preparation is
better and which is worse.
SLIDE
Diponed kits
SLIDE
In the PRP method, an initial centrifugation to
separate red blood cells (RBC) is followed by a
second centrifugation to concentrate platelets,
which are suspended in the smallest final plasma
volume.
WB (whole blood) is initially collected in tubes
that contain anticoagulants. The first spin step is
performed at constant acceleration to separate
RBCs from the remaining WB volume. After the
first spin step, the WB separates into three layers:
an upper layer that contains mostly platelets and
WBC, an intermediate thin layer that is known as
the buffy coat and that is rich in WBCs, and a
bottom layer that consists mostly of RBCs. For the
production of pure PRP (P-PRP), upper layer and
superficial buffy coat are transferred to an empty
sterile tube. For the production of leucocyte rich
PRP (L-PRP), the entire layer of buffy coat and
few RBCs are transferred. The second spin step is
then performed. The upper portion of the volume
that is composed mostly of PPP (platelet-poor
plasma) is removed. Pellets are homogenized in
10% of original volume of blood to create the PRP
(Platelet-Rich Plasma).
In the buffy coat method, whole blood (WB) is
centrifuged at a ‘high speed’ with subsequent
collection of the buffy coat. A buffy coat contains
high concentration of leucocytes.
From small volume of WB (10 mL), a very thin
layer of a buffy coat can be produced. The
difficulty lies in separating this thin buffy coat
layer that contains mainly white blood cells
(WBCs) and platelets, from the underlying RBC
layer.
SLIDE
Each method can be evaluated on these criteria.
Yield: Yield is efficiency of process. It’s the
ability of method to extract all the platelets in
collected volume of blood into final concentrate.
Concentration: concentration is enhancement of
platelet count in the final prepared volume. Lower
the concentration compared to native blood
platelet count lower will be effect of PRP
injection. It is desirable to achieve concentration 7
10 10X compared to native blood to get proper
effect.
Dose: Dose is amount of PRP concentrate of
appropriate 7x-10x concentration used per unit of
tissue. For examples use of 0.1 ml of PRP
concentrate per square cm of skin surface area for
skin rejuvenation. Similarly using specific
volumes to be injected in the joints.
Activation: Activation is required for release of
growth factors. Various methods can be used for
activation leading to different profile of growth
factors released in the tissues over the time period.
Activation can be achieved using Calcium ions,
Thrombin, Various platelet activating factors or
simply by mechanical disruption of platelets.
Chemical stimulation with Calcium ions or
thrombin takes few minutes to few hours to
completely express the growth factors. Mechanical
disruption will be very effective in certain
situations where we need instant growth factors
release.
Each method of preparation and indication for
PRP therapy should be evaluated against these
parameters to standardize method and usage.
SLIDE

There is no consensus on whether or not platelets

must be previously activated before their
application and with which agonist. Some authors
activate platelets with thrombin or calcium,
whereas others apply platelets without being
previously activated, arguing that better results are
obtained. PRP activation prior to injection is
another parameter that requires further discussion.
PRP can be activated exogenously by thrombin,
calcium chloride or mechanical trauma. Collagen
is a natural activator of PRP, thus when PRP is
used in soft tissue, it does not need to be
exogenously activated. Once PRP is activated,
(fibrinogen-fibrin) a fibrin network begins to form,
solidifying the plasma and creating a fibrin clot or
membrane.
SLIDE

ANTICOAGULANTS

The importance lies in choosing an anticoagulant

capable of preserving the platelets’ best possible
functionality, integrity, and morphology.
With regard to the type of anticoagulant for use,
most authors agree on not using EDTA because it
could damage the platelet membrane. Therefore,
anticoagulants with sodium citrate or dextrose with
sodium citrate are recommended.
The anticoagulant ACD-A is the choice for
collection of platelets by apheresis, whereas
trisodium citrate (3.2% or 3.8%) is the
anticoagulant most commonly used for diagnostic
evaluations of platelets. Trisodium citrate and
ACD-A solutions differ markedly in pH, with
ACD-A having a pH of 4.9 and 3.8% sodium
citrate having a pH of 7.8. In addition, the citrate
ion concentration in ACD-A is 15.6 mg/mL,
whereas 3.8% sodium citrate contains 24.4 mg of
citrate ion/mL.
Alternatively citrate phosphate dextrose-adenine)
can be used.
By far it is conclusively demonstrated that sodium
citrate is the best anticoagulant for PRP
preparation.
SLIDE
PRP VARIANTS
⚫ PLATELET CONCENTRATION
⚫ FIBRIN CONCENTRATION
⚫ LEUCOCYTES PRESENCE
⚫ ACTIVATION STATUS
SLIDE
Nomenclature of PRP is varying depending on
methods used in preparation. There is lot of
confusion about nomenclature and use of specific
product in literature.
The current consensus classification of PRP
preparations is based on a simple classification
system dividing so many types of products in 4
main families, based on their fibrin architecture and
cell content: Pure Platelet-Rich Plasma (P-PRP),
Leukocyte- and Platelet-Rich Plasma (LPRP), Pure
Platelet-Rich Fibrin (P-PRF), Leukocyte- and
Platelet-Rich Fibrin (L-PRF). The 4 main families
of products present different biological signatures
and mechanisms, and obvious differences for
clinical applications. This classification serves as a
basis for further investigations of the effects of these
products.
If required PRP can be activated using calcium ions
which makes it to a-PRP. There is a chance of
strong clotting which may make it unsuitable for
injection through insulin syringe.
a-PRP can be further incubated at 37C to prepare
expressed serum containing all the growth factors,
which can be used devoid of the clot.
Another important preparation is Platelet rich fibrin,
in which fibrin clot is prepared which is rich in
platelets. The clot then is compressed to make a
membrane which can be used in dental
reconstruction or bone reconstruction. Fibrin
provides good scaffolding matrix for growth of
regenerating cells.
According to the classification proposed by
Ehrenfest et al. (2009), four main families of
preparations can be defined, depending on their cell
content and fibrin architecture.[11]
1. Pure Platelet-Rich Plasma (P-PRP) or
leucocyte-poor PRP products are preparations
without leucocytes and with a low-density fibrin
network after activation.
2. Leucocyte- and PRP (L-PRP) products are
preparations with leucocytes and with a low-
density fibrin network after activation. It is in
this family that the largest number of
commercial or experimental systems exist.
Particularly, many automated protocols have
 been developed in the last years, requiring the
use of specific kits that allow minimum
handling of the blood samples and maximum
standardization of the preparations.
3. Pure platelet-rich fibrin (P-PRF) or leucocyte-
poor platelet-rich fibrin preparations are without
leucocytes and with a high-density fibrin
network. These products only exist in a strongly
activated gel form, and cannot be injected or
used like traditional fibrin glues.
4. Leucocyte- and platelet-rich fibrin (L-PRF) or
second-generation PRP products are
preparations with leucocytes and with a high-
density fibrin network.
This classification system was largely cited,
advocated, and validated by a multi-disciplinary
consensus conference published in 2012.
SLIDE
PRP being almost an all round therapy it can be
used in almost all the disciplines of medicine. Every
faculty of medicine can be benefitted use of PRP for
treatment of specific conditions requiring repair,
regeneration and regeneration.
Healing of musculoskeletal diseases
Repair of nerve damage/injuries
Repair of muscle damage/inluries
Bone repair
Plastic/cosmetic surgery
SLIDE
Oral surgery/dental implants
Wound care
Hair regrowth
Facial Rejuvenation
Dry eye treatment
Thin endometrium
.
SLIDE
Ovarian regeneration and premature menopause
O-shots
P-shots
Vampire breast lift
SLIDE
PRP therapy finds usage in most of the medical
disciplines and scientists have used PRP in treating
varied diseases requiring rapid repair and
restoration.
SLIDE
You must be wondering why am I mentioning
Dentistry first while taking about PRP uses. But it is
must to give the credit to Dentistry for using PRP
therapy on larger scale for guided regeneration of
bone tissue. Utilizing the methods of enhancement
of bone and soft tissues regeneration using PRP are
being used in periodontics, oral implantology and
oral and maxilla-facial surgery.
New bone formation is a prerequisite for
regeneration of tissues lost through periodontal
diseases and for osseo-integration of implants used
in restorative dentistry.
In implant surgery most frequent hindrances at the
implantation site are lack of adequate bone
availability, proximity of maxillary sinus and
inferior alveolar nerve canal. Advanced procedures
like sinus grafting and guided bone regeneration are
necessary is many cases before implants can be
securely placed. Use of PRP enhances the results of
procedures like sinus lifts, ridge augmentations
multifold at the same time enhancing potential of
osseo-integration of implants. All cases where
hydroxyapatite bone graft powder material is used,
combination with PRP enhances the bone formation
many folds due to growth factors supplied by PRP.
In most of the maxillofacial surgery procedures use
of PRP results in increase in healing speed, two to
three folds thus reduces the healing time and offers
hastened restoration of function.
SLIDE
Orthopedics had direct advantage of PRP use based
on the experience gained by dentistry.
Uses in Orthopedics are varied. Roughly can be
divided into bone regeneration uses and soft tissue
function restoration uses.
SLIDE
There is conclusive proof that PRP helps in non
union fracture treatment. When surgical procedures
are performed along with use of PRP the healing is
early and sure. In practical studies It was found that
platelet derived growth factors were deficient in all
non-union cases and when restored with PRP the
healing happened in average 8 weeks.
Autologous bone grafts are used for spinal fusion
surgeries. When used in combination with PRP it
resulted in goon union in all the cases.
Use of PRP as adjunct in joint replacement surgeries
is very interesting study. In a recent review in
literature where PRP was used in 98 cases of
various joint replacement surgeries, PRP was
applied intraoperatively to exposed tissues,
synovium and lining of wound at the closure. The
patients had less postoperative blood loss, fewer
pain reducing medications, greater range of
movements at the discharge and shorter hospital
stay compared to those who did not have PRP
applications. This study directly concludes that
direct application of PRP to operative site after TKR
seals the tissues and enhances integration of the
implant material. With newer press fit type implants
which avoid use of bone cement use of PRP
promotes earlier and more complete osseo-
integration of implants into host bone.
SLIDE
PRP should be used in combination with autograft,
allograft, demineralized bone matrix, hyxroxyapatite
powder or any other graft material used to fill bone
defects. If the graft material is used in form of tiny
chips or powder it is best to use PRP to mix the graft
material along with activator so that graft material
and PRP can form a firm gel which can be filled in
the defect in form of putty which will provide three
dimentional matrix as well as all necessary growth
factor for enhanced healing and repair.
SLIDE
Injuries in various sports are very common and
become a media news. The treatment and
rehabilitation has to be quick, and prompt and
effective therapy is expected and all these things get
discussed in media regularly. In sports medicine
PRP therapy must be enhancing the economic
potential of sportspersons by billions of rupees.
PRP became a big news when high profile sports
persons were treated with.
SLIDE
⚫ Many athletes use PRP Therapy
– Rafael Nadal
– Tiger Woods
– Hines Ward
– Kobe Bryant
– Brandon Roy
-Sachin Tendulkar
-Saina Nehwal
SLIDE
Usage of platelet rich plasma (PRP) in aesthetic
medicine is a new concept. In dermatology and
cosmetic medicine, PRP has been used to treat acne,
scarring, and alopecia (especially in women). It is
also effective for skin rejuvenation and tightening
around the eyes. Before injecting PRP to treat hair
loss, a tiny scalp roller with spikes is used to
stimulate the thinning areas. The rationale is that
this sends a message to the hair follicles to start the
healing process. Then, PRP is injected over the
affected area to further stimulate stem cells in the
follicle. Platelet-rich plasma is injected by multiple
tiny punctures under the dermis, with or without
topical local anesthesia. The process is painless if
sufficient topical anesthesia is applied. When PRP is
injected into the damaged area, it stimulates the
tissue, causing mild inflammation that triggers the
healing cascade. As a result, new collagen begins to
develop. As this collagen matures, it begins to
shrink and tightens and strengthens the skin.
Improvement in skin texture and tone is noticeable
within 3 weeks. Full collagen regeneration requires
3 months. The PRP treatments can be used on all
skin types and tones. Minimal swelling, bruising,
and redness for the initial 12 to 24 hours are
expected. A bruise at the needlestick site may be
visible for 2 to 3 days. Swelling from the fluid is
what the patient will notice first. During several
weeks, the platelets stimulate growth factors, which
assists in more collagen stimulation. Treatment
results vary but last up to 18 months in most
patients.
SLIDE
Skin ageing is an unpreventable, irreversible process
that is influenced by both intrinsic and extrinsic
factors. The intrinsic factors like the reactive oxygen
species along with matrix metalloproteinases
(MMP) reflect different physiological and
pathological processes involved in skin ageing.
There is accumulation of fragmented collagen fibrils
that prevents neo-collagenesis and causes further
degradation of the extracellular matrix (ECM).
Conventional anti-aging strategies, including lasers
and topical treatments, increases ECM synthesis
through the activation of fibroblasts.
Usage of PRP in aesthetic medicine is a new
concept. Advantages of using PRP in aesthetic
medicine include, tissue regeneration and
rejuvenation, induction of cell differentiation,
extracellular matrix formation, recruitment of other
cells to the site of injury and an increase in collagen
production. This can increase skin thickness and
overall skin health.
Platelets release growth factors and cytokines
locally which facilitates cell stimulation,
proliferation, differentiation and extracellular matrix
accumulation. This reverses Ageing process which
is due to reduction and degradation of ECM and
reduction of collagen.
When PRP is injected in dermis of damaged area, it
stimulates the tissue, causing mild inflammation that
triggers the healing cascade. As a result new
collagen begins to develop. As the collagen matures,
it begins to shrink and tightens and strengthens the
skin, as well as the tendons and ligaments of the
damaged area when injected at that level.
Improvements in skin texture and tone are
noticeable within 3 weeks. Full collagen
regeneration requires 3 months.
Advanced wrinkling cannot be reversed also severe
scarring does not respond to treatment which needs
to be resected.
SLIDE
Androgenetic alopecia (AGA) is the most common
form of hair loss but current treatment options are
limited and moderately effective. Efforts are on to
understand cellular pathways and molecular
mechanisms involved in the pathophysiology of
alopecia, so as to target potential treatment that not
only stimulates hair growth, but induces formation
of new hair follicles.
Current strategies for treatment of pattern hair loss
mainly focus on promoting cellular proliferation and
differentiation during hair growth cycle. Minoxidil
is such agent which promotes survival of dermal
papilla cells. Finesteride reduces apoptosis of hair
follicle cells. Both the medicines work on very
limited basis. PRP which provides a battery of
growth factors can do this job more efficiently. If
use properly in early stage of hair-fall, it can work
wonders and can reverse the process of hair loss
completely.
EGF & FGF activates the proliferation & causes
trans-differentiation of hair stem cells & produce
new follicular units. bFGF & beta-catenin, promotes
the anagen phase of papilla cells & thereby plays a
key role in elongating hair shaft. The antiapoptotic
regulators, Bcl-2 protein & Akt signaling, that are
activated by these GFs, prolongs the survival of
dermal papilla cells during the hair cycle. Thus, the
mitogenic & antiapoptotic effects, of PRP prolong
survival of dermal papillae. PRP modulates
angiogenesis and enhance blood flow around hair
follicles, thus improving cutaneous ischemic
conditions.
The use of PRP mesotherapy either alone or as an
adjunct to surgical procedures in the patients of
androgenic alopecia thus holds promising results.
PRP can be injected as inter-follicular injection as
0.1 ml/cm2, in a retrograde fashion from deep to
superficial, at every centimeter, throughout the
treated site while in
mesotherapy the microneedle roller of 1-mm fine
needles is rolled over scalp followed by
interfollicular injection of PRP over the treated area.
It is also used as an adjunct to hair transplantation to
increase the survival rate after implantation. The
pretreatment of follicular units with PRP before
transplantation has resulted in improved hair growth
and density. The hair follicle is dipped into PRP for
15 minutes, before implantation and after transplant
PRP is injected into both the donor and recipient
area of scalp to minimize bleeding, stimulate wound
healing & to reduce scarring .
Though, PRP is a promising newer technique in a
dermatosurgeon's armamentarium but it is yet to
show consistency in results.
SLIDE
A healthy sex life is thought to have significant
benefits to both the mind and body. Sexual
dysfunction such as anorgasma, dysparenuria,
decreased libido and vaginal dryness, along with
urinary stress incontinence (USI), can occur after
childbirth or during menopause. Sexual dysfunction
in both men and women can result in a reduction in
sexual intimacy in a relationship, which may then
negatively affect family life and self-esteem.2 While
there are many treatments available for erectile
dysfunction in men, there are currently no Food and
Drugs Administration (FDA) approved treatments
for sexual dysfunction in women.
As per American statistics, about 40% women have
sexual dysfunction leading to psychological distress
but only 14% during lifetime seek medical help.
Main reason is lack of communication between
doctor and patient and doctor, with very few options
to treat anyway. The situation must be very grim in
country like India where discussion about sex is a
taboo, and in male dominated society female sexual
dysfunction is thought to be non existent.
There is no specific treatment available, no
medicine for FSD except for primitive counselling
and psychological support from treating doctors.
SLIDE
Similarly urinary incontinence in females also is an
under reported condition.
Involuntary loss of urine or Urinary Incontinence
is a very common condition and affects millions of
women of all ages. Urinary Incontinence is twice as
common in women as men.
Pregnancy and vaginal birth, menopause, and the
structure of the female urinary tract account for the
increase in incidence of Urinary Incontinence in
women.
Urinary Incontinence can interfere with self esteem
and social life. Involuntary urine loss during
intercourse can lead to significant emotional distress
and sexual dysfunction including loss of libido and
anorgasmia.
Types of Urinary Incontinence
There are several types of Urinary Incontinence and
each type can be managed with a combination of
treatments:
Stress Incontinence: Involuntary leakage of small
amounts of urine with any activity that increases
pressure on bladder e.g coughing, sneezing, jumping
etc.
Urge Incontinence: Involuntary leakage of large
amounts of urine at rest with no precipitating
activity e.g while resting comfortably or even during
sleep.
Mixed Incontinence: This usually includes
symptoms of stress and urge incontinence together.
Overflow Incontinence: Inability to hold urine in a
full bladder leading to involuntary leakage of small
amounts of urine
Overactive Bladder: Frequent and urgent desire to
urinate, may be associated with urge incontinence.
Functional Incontinence: Urinary leakage and
inability to hold urine due to physical disability or
communication difficulty that prevents reaching the
toilet.
Transient Incontinence: Temporary involuntary
urinary leakage due to any concurrent illness such as
coughing, bladder infection, side effects of a new
medication etc.
SLIDE
The results of various studies suggest that some
cases of female sexual dysfunction may be treated
with specifically prepared injections of autologous
Platelet Rich Plasma (PRP) in the area of the
Skene’s glands and the clitoris. Studies have
demonstrated that PRP induces regrowth of new
tissue by of the activation of pluripotent stem cells
that are indigenous to most parts of the body. These
cells are capable of differentiating into several tissue
types, when stimulated by growth factors produced
by activated platelets. It is postulated that when PRP
is activated and injected into the anatomic areas
involved in sexual responsiveness, growth factors
and cytokines may cause differentiation of
pluripotent stem cells resulting in neo-angiogenesis,
fibroblast growth, glandular proliferation (Skene’s
glands), and new neuronal growth—resulting in
improved physiologic responsiveness. Improved
vascularity and neuronal regrowth in the vagina and
in the clitoral area could restore or possibly enhance
sexual responsiveness and sensitivity by increasing
blood flow to the area, especially in cases where
hormonally independent vaginal atrophy contributes
to FSD. In addition to increased blood flow,
collagen and sensory nerve regrowth might relieve
coital discomfort as well as enhance vaginal
sensitivity. Also, increased blood flow in the
clitoris, if induced by PRP injections, could also
lead to improved arousal and orgasm.
Anecdotal evidence from patients suggest this
procedure can be helpful for:
Reduced sensations
Decreased arousal
Anorgasmia
Vaginal Dryness
Redeuced sexual desire
Dyspareunia
The O-Shot May Help with:
Greater arousal from clitoral stimulation
Increase sexual desire, arousal and libido
Tighten the introitus (vaginal opening)
Stronger and more frequent orgasms
Increased ability for vaginal orgasms
Increased vaginal lubrication
Improved urinary control
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PRP- Platelet Rich Plasma For Urinary
Incontinence
PRP can be very effective in improving Urinary
Incontinence via regeneration of your own healthy
tissue to reverse some of the changes that lead to
urinary incontinence. PRP treatment is a simple,
relatively painless procedure
Platelet growth factors are released upon activation
of platelets and lead to rejuvenation of the muscles,
nerves, blood vessels in the distal female
genitourinary tract; the clitoral- urethral- bladder-
vaginal interface.
The patients treated with PRP and vaginal muscle
training exercises experience reduction in Urinary
Incontinence, improvement and strengthening of
orgasmic activity, improvement in sensation of
clitoris and reduction of pain during intercourse.
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Here are two ways PRP is used for breast
procedures.
1. Fat Transfer & Platelet Rich Plasma For Breast
Lift
Fat transfer is the process of taking unwanted body
fat (liposuction procedure) from other parts of the
body and processing it before injecting it to
upper part of the breast and in the cleavage area.
This is immediate enhancement. And since it’s
immediate, the sudden expansion of the breast
can cause blood vessels to be blocked causing some
parts of the breasts or the nipples to lose sensitivity.
Sometimes it can even cause the skin at
those areas to go haywire.
So the best way to avoid that is to make sure enough
collagen and growth factors are supplied, well in
excess of the area’s needs. That’s why it
makes sense to combine the Fat Transfer procedure
with Platelet-Rich Plasma. In this combination, PRP
(Platelet Rich Plasma) is added to the fat when
processing the fat, which includes many blood-
derived growth factors and tissues containing
collagen for skin rejuvenation. The end-product is
then injected like a typical PRP Injection. The result
is firmer breasts with not just a change in
size, but also changes in skin texture and shape of
the breast. And there’s no worry of losing
sensitivity. Some call the entire procedure as
Platelet-Rich Plasma Facelift. Results generally last
from 9-18 months.
This great procedure has boosted the confidence
levels of thousands of women who wanted to
overcome their unnatural shaping and aging of
breasts. However, even though it works for all kind
of breast sizes, it’s not recommended for women
with:
• Extreme Loss of Volume
• Excessive Sagging
• Previous Breast Implants
2. Only Platelet Rich Plasma For Breast
Rejuvenation
This second procedure is purely PRP for
rejuvenation purposes. It’s for women who’re happy
with their breast size but would love to rejuvenate
the skin for youthful looks, restore fullness for
healthy breasts and regain sensitivity in areas where
it’s diminished. The procedure is same as any
other Platelet-Rich Plasma procedures. PRP
injection not only enhances the looks, it actually
produces new tissues in the area because of all that
growth
factors resulting in better cleavage and fullness.
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⚫ Inability to achieve or maintain erection is a
major male sexual dysfunction
⚫ Leads to major psychological disturbances and
marital discord
⚫ “Small” penis is another major problem faced
by Indian Male population
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Priapus Shots can benefit
⚫ Improved firmness of erection
⚫ Enhanced blood flow and circulation in Penis
⚫ Greater sensation in Penis Head
⚫ Elevated sexual pleasure and stamina
⚫ Increase in girth and length of Penis over time
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Any wound goes through stages of acute
inflammation, increased mitotic activity and finally
orderly repair. Chronic wounds can be those
wounds failing to proceed through an orderly and
timely process to produce anatomic and functional
integrity. Practically, a chronic wound is the one
which has failed to heal within 3 months.
Repeated trauma, foreign bodies, pressure necrosis,
infection, ischemia and tissue hypoxia are few of the
reasons of non healing. Growth factors are crucial
for timely wound healing. Platelets can fill the gap
by supplying growth factors. It is desirable to supply
growth factors over extended time and this can be
achieved by delivering platelets in fibrin matrix.
Fibrin membranes are very useful for treating
chronic diabetic non healing ulcers, and pressure
sores. Use of fibrin membranes in such cases can
prepare the wound for skin grafting earlier, reducing
the time for total healing. This results in improved
quality of life and lower cost of care over other
conventional therapies.
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Advantages of PRP rejuvenation are
Uses body’s own natural platelets so there is no risk
of allergic reaction
Natural collagen formation in response to presence
of activated platelets
PRP is ideal for patients who do not want any
synthetic fillers
There is very little swelling, bruising, lumping as
fluid assimilates in natural skin environment
PRP can be used to enhance laser procedures for
faster and improved healing.
PRP therapy is equally effective in men and women.
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PRP can be practically used in any case of delayed
healing or where healing process gets hindered due
to any reason. There are suggested many uses of
PRP in literature. Few such conditions are like sinus
and fistula surgery…
I have tried to cover as much as possible literature
review to bring this small presentation and
interesting possibilities of participation of laboratory
in actual treatment of patient. With your cooperation
many such possibilities can be explored to enhance
the cure for patients which will directly give
benefits to hospitals instituting such therapies.
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Relative contraindications:
Consistent use of nonsteroidal anti-inflammatory
drugs within 48 h of procedure
Corticosteroid injection at treatment site within 1
month
Systemic use of corticosteroids within 2 weeks
Tobacco use
Recent fever or illness
Cancer-especially hematopoietic or of bone
Hemoglobin (HGB) <10 g/dl
Platelet count <105/ul.
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We do not know:
What is the ideal concentration of PRP
Which technique is better as several techniques and
commercial products are used for PRP preparation
Which PRP is better as each commercial technique
leads to formation of different product. Each has
different biology and efficacy.
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PRP is very promising futuristic therapy. It is a
vehicle to deliver large amount of important growth
factors, which are biologically active, to the injury
site. Its use has increased extensively over the last
decade due to advanced technology, availability of
newer commercial PRP equipment, manufacturing
various PRP products in the market. It is very
simple and easy to use, easily available, uses patient
own blood (autologous), potential cost-effective,
and considered very safe therapy. There are many
case series showing positive outcomes. But despite
the promising results of several animal studies, well-
controlled human studies are lacking. The research
is still in its infancy. There is no consensus or
protocol for the use of PRP. Even with all the
limited evidence available, today PRP is becoming a
very popular therapy in various fields of medicine.
More research in future will clear the clouds over
many questions being raised about the efficacy and
evidence for PRP. To conclude, we may say that
there are reasonable amount of data which warrant
continued research in PRP but currently its role in
clinical practice is not completely defined.