How and why to incorporate PRP into your practice
I NEVER WANTED TO DRAW BLOOD IN MY office; I was happy doing my thing without blood draws for platelet rich plasma (PRP). And then, I went to a lecture by Dr. Jeffrey Rapaport at the American Academy of Dermatology Annual meeting and saw 1st hand how PRP grew hair and could improve patient’s lives (patients should expect anywhere between 30-40% improvement when following protocols). Since that Rapaport lecture, I have trained staff to draw blood and have had my own scalp injected with PRP 4 times- spaced 1 month apart, and am due for my 6 month maintenance treatment this month. It used to be that we only had finasteride and minoxidil to treat hair loss (these remain the only 2 FDA approved medicines for hair loss), however with the addition of PRP, hair helmets, supplements and shampoos, the hair loss world has changed dramatically in the past few years.
PRP is the latest innovation in Las Vegas Dermatology’s armamentarium and there is a lot going into the business behind PRP. For starters, you can’t just use any off the shelf blood draw tube for PRP- we have chosen the Eclipse system for PRP because the system is pyrogen free and FDA cleared for PRP with a proprietary blood draw tube and gel separator maximizing the amount of platelets while minimizing the amount of red and white blood cells in the tube. Additionally, when starting any technology, the need to market that technology to your patients is massive and challenging. Eclipse allowed us to use their marketing materials and Dr. Rapaport’s photos for our customizable brochures and media. Having the proper consent forms, suggested lab work, marketing materials and warnings from Rapaport and Eclipse was useful. Writing down and following a process and procedure for everything PRP is key because a proper system will avoid the tragedy of injecting or applying another patient’s blood product into the wrong patient.
Utilizing the same apparatus for hair loss to draw PRP for microneedling is an added bonus that was easily incorporated therapy in our practice. PRP with microneedling speeds wound healing and improves clinical outcomes. The basics of the PRP business are as follows: The Eclipse 11ml Tube costs $90 for Microneedling and the 22ml Tube costs $160 for Alopecia. We charge $800 for PRP + microneedling and $800 for alopecia injections. For patients who want both microneedling and alopecia treatments in the same visit, we offer a discount as the Platelet Poor Plasma (PPP) is used instead of the small tube for PRP. A Medical Assistant spends 20 minutes of time with the patient: Drawing blood, labeling syringes and blood draw tube as well as spinning blood (10minutes at 3,500 rpm’s), drawing off PPP and PRP. The Room is skunked for 1 hour with blood draw, spinning, injection and helmet time (all of our PRP patients are given the Theradome helmet to wear post treatment as an adjunctive therapy).
One of the things that we have recently added to our options for PRP treatment is the ProNox, Nitrous Oxide analgesia device ($6,000 cost of ProNox, $13 cost/patient for tubing and $3/patient gas charge). ProNox utilizes a 50:50 combination of Nitrous Oxide and Oxygen to provide patient administered on demand analgesia. The effects of N2O gas wear off 10 minutes post inhalation- we have found patients tolerate the PRP or microneedling injections much better with ProNox than when using a cooling fan or topical numbing alone. We charge an additional $75 for the procedure when ProNox is used, as we have to cover the costs of individualized on demand tubing and gas. With a cost of entry around $7,500 (centrifuge, tubes, marketing materials, photos and consents), PRP is easily one of our best investments this year.
H.L. Greenberg, M.D., F.A.A.D. is the Founder of Las Vegas Dermatology. He will present his session on the incorporation of PRP into his practice on Saturday 9 June, at 3:00pm