First PRP treatment in New York-Dr. Alan Feller

[Dr. Alan 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.

 

Dr. Feller

Great Neck, NY

[thanatopsis_awry]

Wow. Exciting news, particularly since I'm pretty interested myself. Are you going to be documenting any of these cases/

[miked]

Excellent news Dr. Feller. When you say "injected the PRP into the dermis" do you mean this was accomplished via a single injection?

 

What do "200 punctures" exactly accomplish? were you just trying to have blood exit through this many places to assist the circulation of the PRP?

 

Could you please explain the reason for turning him down twice previously for an HT? was it poor credit? (half joking since i suspect the profession would hardly blink if I offered to pay them to do an HT on my cat given this economy)

 

Was or is the patient on minox or fin or any other compound that could later be misconstrued as growth as a result of the PRP treatment?

 

Also was this a localized experiment (eg the crown area) just to see effectiveness, or was the patient treated with the intent to achieve growth throughout the scalp?

[Mr. GQ]

i hope and wish that his result turn up to his expectations when it's all said and done.

 

kudos to you Dr.F for taking on the challenge.

[Dr. Alan Feller]

Thana,

Yes, I will be documenting ALL of them.

 

Mike,

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.

 

Thanks GQ.

 

-Dr. F

[Ceasar08]

Hey Dr. Feller --

 

Like everyone else, I've been following this thread closely. I'm curious as to who would make a suitable candidate.

Are the best candidates people with a lot of hair in the area of treatment, or might it work on a more barren area of scalp?

 

If PRP is done in an area where grafts already have grown out, do you think it can harm the grafts?

 

In general, do you think there could be any risk of shockloss from wounding the area?

 

 

Thanks!

[Dr. Alan Feller]

Ceasar,

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.

 

Thanks for your participation Ceasar. You have been hailed.

 

Dr. F

[miked]

Thanks for the explanation Dr. Feller. I know I drilled with a lot of questions at once.

 

I recall reading somewhere on this forum that PRP would need to be repeated periodically to maintain its effectiveness against MPB. Is that recollection accurate? if so I would be (hypothetically speaking) a little hesitant to make a visit every, say- three months, to get several hundred needle pricks in my scalp.

 

My question then is would this treatment benefit from one of the various needle-less injection systems that have recently been made available (using high pressure vs needles)???

[Curious]

I hope this pans out. How much terminal hair do you hope to produce with this treatment? Is there any risk of a tumor developing, as another poster suggested.

[Cant decide]

Dr. Feller - You explained which patients are ideal for PRP. In what situations would you simply turn someone away from doing PRP because they simply are not a good candidate?

 

Thanks

[Dr. Alan Feller]

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.

 

Curious,

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.

 

Can't decide,

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

[Uk_lad]

Hi Dr Feller, hope all is well. Why would people on proprecia not be suitable candidates? (May have miss read, but its been a long day! lol)

[Dr. Alan Feller]

You must have mis-read UK_lad, people on propecia are just as suitable as those who aren't.

 

By the way, if you are interested in seeking PRP in the UK, we will be offering it there shortly. Contact Spex for more info.

 

-Dr. F

[Lastchance]

Hi Dr Feller, congratulations on your first procedure. I hope the results are a great sucess. I have a question on the need for return visits. If a patient was to gain some regrowth and they were a good responder to propecia, is there a possibilty that this alone could maintain the benefit without the need for indefinite follow ups? I realise you're still at the early stages in the procedure, but in theory anyway, is there a possibility that the rewakened follicles could survive in this case as they would not be under threat from DHT second time round?

[why oh why]

so does this new procedure produce new follicles? if so, then how come people with no miniaturized hairs in their balding areas are not candidates?

 

if this is because the true result is not known yet then that is understandable

[cactus]

Dr Feller,

 

Does bathing the grafts in PRP after harvesting reduce transection rates?

[azn_guy]

I'm guilty of not reading in detail about this, but I simply noticed the acronym "PRP"

 

Is this the same thing that Dr. Cooley does? Or is Dr. Feller doing something different?

[FollicularlyChallengedScar]

Dr. Feller,

 

A few of questions:

 

(1) Are you using the extracellular matrix with your PRP treatments?

 

(2) Do patients have to suspend the use of Minoxidil 5% prior to and post-PRP procedure? If so, for how long?

 

(3) In the past, I believe you mentioned that you may tweak the PRP Procedure to incorporate a missing feature. Have you made any additional contributions or changes to the PRP Procedure yet? If not, are you still working on refinements?

 

FCSM

[Dr. Alan Feller]

LC,

Thank you for your good wishes.I don't see any cross over between the use of PRP and Propecia, so I wouldn't substitute one for the other. If a propecia regimine is working, then the patient should stick with it and add PRP as an option. As far as I know, PRP does not have an effect on DHT receptors or the propensity of a follicular cell to express them when the time comes,or if already doing so.

 

Why,

No, all the PRP in the world will not produce new follicles. It's purpose is to get the most out of the ones that are left, which is what makes patients of both sexes great candidates when they are suffering from miniturization, or if the skin is suffering from a chronic dermatitis causeing localized hairloss. Slick bald people are not candidates for PRP unless they are scheduled for HT surgery within 2-4 weeks.

 

Cactus,

Bathing grafts in PRP after harvesting has no effect on transection- which can only be caused by poor handeling and dissection of the grafts. Minimizing transection is a function of the clinic's ability to train their technicians and perform regular quality control checks.

 

Azn,

It is the same thing, however, Dr. Cooley uses it to augment his HT surgery, I use it much the same way that Propecia and Minoxidil are offered.

 

FCSM,

1. No, I do not use the ECM at this time, but I may do so in the future.

2. Patients do not have to change their normal hair regimines prior to PRP.

3. I am now working with the company that produces the equipment and the procedure kits to institute the new technologies that I feel would be beneficial for PRP application to hair. Before I institute them I will be corresponding with Dr. Joe Greco to get his take on the refinements as he seems to be the fields leader in PRP application to hair and is way ahead of me.

 

This is a new field called "regenerative medicine" and it will take time for it to blossom. I want to thank all the posters for not hypeing this procedure and for "keeping it real". To date I have performed exactly FIVE of these procedures, so I can hardly call myself an enlightened "expert", however, it does bring me back to the days when follicular units, megasessions, and FUE were in their infancy and had to prove themselves. A few years later, here we are. Let's hope the same goes for PRP. Of all the non-FDA approved medications for hairloss PRP is the ONLY one that actually has a scientific and clinically proven basis for efficacy.

[cactus]

Dr F,

 

sorry what i meant to say was that if bathing grafts in PRP will improve there survival. since i saw one of dr cooleys patients who had there grafts bathed in prp after removal.

[lost my swagger]

dr feller, i appreciate you taking the time to address all these questions.. 600 bucks is quite 'do-able' IMO, i believe thats the cheepest ive seen this treatment offered... meaning you are taking the OPPOSITE approach to that of your FUE cost thank you.

[Petchski]

I'm watching this PRP treatment with interest. I would be interested, but would like to see some documented evidence before going ahead with it.

 

Aside from androgens, I think inflammation is a big part of the MPB process, so it sounds good and I may take you up on PRP treatment in the future, and look forward to your documenting of PRP as a possible worthy development in the fight against MPB.

[greenmud]

Dr. Feller,

 

Will this work for the front of the head as well, of course assuming the individual has hair or are you looking at this from the crown perspective?

[Dr. Alan Feller]

Cacti,

I know Dr. Cooley uses PRP for his actual surgeries, but I've always felt that transplants grow so well on their own that the benefits of doing PRP during surgery were marginal. I chose to offer PRP to surgery patients 2 weeks to 1 month BEFORE surgery to begin the process of neovascularization.

 

Lost,

I realize that my PRP prices are pretty low, but some of that is due to the temporary discount I am getting from my supplier. When his generosity runs out, the price will go up by about $150 to $200, but that's it. I have no interst in making PRP a major aspect of my practice, surgery is rewarding enough. My goal is to keep the price low enough to attract as many people as I can afford to do for the low price. This way I can collect as many data points as possible to find out how effective PRP truly is for various types of thinning.

My FUE prices are actually quite reasonable. Charging much less than $10 per FUE graft is simply untenable from a business perspective and something must be sacraficed for it-usually it's the benefit of a trained staff and/or lack of microscopic inspection and preperation of FUE grafts before re-implantation.

 

Petchski,

I will document the results of my PRP patients on the forums. Dr. Greco has some very impressive results, but they're not MY results so I don't rely on them. It will be a great day indeed when I can show off the results of a few of my own PRP patients. If the results are poor or cosmetically insignificant, you can be sure I'll blast PRP right on this forum, but I STRONGLY believe PRP is going to come through. Laser treatments don't pass the "laugh test", but PRP comes from a real sound and solid scientific basis and is in so many ways...eligant. Best of all, it's safe.

 

Greenmud,

I don't discern one area of scalp from another. All share the same physiology and therefore I expect the same results from all areas assuming, of course, the physilogy of that patient is ameniable to PRP in the first place.

 

Dr. F

[wtb_hair]

Any pics from the procedure yet? I know no results yet, but just some post-op pics?