Taking Charge of Your Health

Thank you for your question. You’re asking fillers or PRP, which to inject
first. And you’ve gone to ask about questions about
the possible controversies associated with PRP and which centrifuge to use. And I think what you’re looking for basically
is some guidance as to what roles PRP and fillers have in the facial enhancement. So I can certainly give you some guidance
as to how I educate my patients. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long
Island for over 20 years. Helping people look their best through non-surgical
facial rejuvenation is something we do every day and we use a lot of PRP in our practice. So we’ll begin first by understanding some
basic principles of what fillers do, what PRP does and where there may be some potential
opportunity for synergy. So to begin with, we’ll address what PRP
is and what it can do. PRP is platelet-rich plasma. Platelet-rich plasma (PRP) is derived from
your own blood. It is a concentration of the wound healing
factors that help improve collagen, blood supply and a variety of other things that
also improve fat cells under the skin. It’s been well established in the medical
literature to have value in a variety of situations. In fact, it has been significantly well established
in oral surgery as well as orthopedic surgery. And in aesthetics, it has become more and
more recognized and certainly, it has been proven through very good scientific data,
from a microscopical level, the effects of PRP. I think that one of the challenges is that
many doctors are not educated and choose not to pursue any knowledge about PRP and are
quick to dismiss it. This is not an unusual thing when it comes
to the medical world of people who don’t know something about an area will often dismiss
it because they think that if it was significant, they would know it. But the reality is, the medical education
is often dictated by the messaging of very well-funded large scale pharmaceutical companies
and device companies. So when it comes to platelet-rich plasma (PRP),
there is no multimillion company. It’s basically a very basic simple technology
that actually uses your own blood and therefore the knowledge is actually gained through education
that the doctor has to pursue and experience that the doctor has to pursue. So it’s understandable why the confusion
in terms of validity. In terms of equipment, I think it’s kind
of interesting. It’s comparable to the way the laser companies
try to prove to the practitioner that one laser is better than the other or market to
the consumer that one laser is better than the other. Once again, it’s about the knowledge of
the doctor and the way the doctor applies the technology for the benefit of the patient. A lot of times, doctors like to advertise
or promote and distinguish themselves from the others by saying that they have a piece
of equipment that other people don’t. Since most doctors who practice aesthetics
can essentially afford any piece of equipment they need, centrifuge is kind of pretty much
on the cheaper end so it’s not exactly expensive, for people who own lasers which are worth
hundreds of thousands of dollars. It’s not a big stretch to go buy a centrifuge. So I can tell you that from an equipment point
of view, you should take that with a grain of salt. I can tell you that, from my personal knowledge
and experience of the evolution of PRP for aesthetics, essentially before it became even
somewhat brought awareness in the United States or doctors in the United States became aware
of it, PRP was used frequently for years in South American countries like Columbia. And I can tell you by looking at the clinical
experience of colleagues from these countries, in South America, the equipment was very basic
and very straightforward. It’s basically the early articles about
PRP was actually in the oral surgery literature where dental implants were able to heal better
within the mouth when PRP was used and this was in the late 90s where the centrifuges
were, even less complicated. So basically, if you understand the principle
and you have a doctor who has experience with PRP then certainly there’s no reason to
get hung up on a particular single piece of equipment. I’ve used a lot of different kits, I’ve
used many different centrifuges and I have my own personal biases on how I do PRP and
how I prepare PRP and those are the things that work for me and are effective for my
patients. Now PRP is not a substitute for fillers. PRP can stimulate collagen, can stimulate
the fat cells, improve vascularity. So there can be somewhat of a volumizing effect
but it varies and it cannot be a substitute when you want a more robust volume correction
and that’s where fillers play a role. And fillers, we use at multiple levels in
the face starting at the deepest which we call structural volumizing. This is where we are using a long lasting
filler like Juvederm Ultra Plus, Juvederm Voluma and we’re placing it at the deeper
levels under the muscles on top of the bone to give you more cheek structure and definition,
jawline structure, chin projection. If you’re going to ask, which should you
do first, fillers or PRP? Certainly, it depends on what you need but
I would suspect, if you are dealing with volume loss issues, fillers are your foundation. So you can think of it that way: fillers,
foundation, something to restore volume or if volume is needed. PRP is a way to restore skin healthiness,
quality, glow. In many ways, it’s counteracting the natural
deterioration of the skin and the soft tissue below the skin. Essentially by stimulation, the body generates
increased volume and fat, increased collagen, increased vascularity. You’re getting something for the superficial
levels. And with the fillers, you’re getting something
at the deeper levels. Now where does the synergy opportunity come
in? Well, I will give you a couple of examples. One is when I treat acne scars. Acne scars are routinely combined with hyaluronic
acid filler as well as PRP to basically restore volume and in a way synergize to get a more
permanent correction with this combination. This has already been established in wound
healing literature where the combination of PRP and hyaluronic acid actually improve wound
healing in exposed bone in one particular study I’m thinking of. There’s another opportunity for example
in the under eye hollow area where the tear trough, I’ll place a filler like Restylane
into the tear trough and then PRP at just under the skin level. Synergy, you’re getting volume, you’re
getting healthier skin, you’re getting a more global, youthful appearance. So I think you need to find a doctor that
you feel really understands your needs before you just commit to a particular pursuit of
one type of solution. A physician’s role is to guide you as to
first identifying what are the issues that are most significant for you as well as guide
you as to the optimal strategies and usually, there are many choices. I routinely will ask the patient what their
main concern is and usually, their main concern is to look younger, to look more healthy and
then they focus in on a few things that bother them like certain lines, or jowls or marionette
lines. Things like that. But what I’ll do is I’ll take their picture
and I’ll put them up on the screen and then we’ll decide together what makes sense with
them and then we work on a process that fits their timeframe and their budget. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

10 thoughts on “How Fillers and Platelet-Rich Plasma (PRP) Play Different Roles in Facial Rejuvenation

  1. I am African American and I have severe acne scars (ice pick & boxcar) on my face. I was told years ago nothing could be done which was quite devastating however, lately I've researched different procedures for those scars such as TCA Cross and Punch excisions. Today, I ran across the Vampire Facelift/Facial which claims that it helps with acne scars. I watched your previous videos regarding the difference between Vampire Facelift/Facial and which would be beneficial for pigmented skin (very informative BTW). My question is more specific to my acne scars. What would you suggest (if anything) that could at least reduce the amount of scarring on my face? Thank you in advance for your insight

  2. I would love to learn to do this, can a physician assistant be trained , or is this MD only? I want to transition from to FP aesthetic med

  3. Sorry but I respectfully disagree with you on which machine or system is better. I would want a double spin Centrifuge with proven higher concentrations of platelets and growth factors if I'm spending hundreds or sometimes thousands on series of procedures. Although I do agree Dr's technique and knowledge is the most important thing on getting good results.

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