Topics Discussed Include the Following…

*PRP vs. Minoxidil for Alopecia
*The common location for the very rare cases of blindness after the injection of PRP

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Outline of This Page
1. Transcript
2. Relevant Links
3. Relevant Research

1. Transcript

Charles Runels, MD

Welcome to The Journal Club. Tonight I’d like to cover a paper that came out that proved me wrong about something, and I think it’s important when we get the word out. Something very rare regarding blindness and an easy way to avoid it, secondary to PRP.

Before we get to that, by the way, I put all the papers we’re talking about. They’re in the handout so that you can grab them. They go away after the webinar is over.

PRP vs. Minoxidil for Hair Growth

In the first one, they compared PRP for androgenic alopecia versus minoxidil. They found they were the same in efficacy.

Most of us are doing both.

PRP is effective, and so is minoxidil. But they decide the side effects are more frequent with PRP.

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They leave out the fact that some people actually develop atrial fibrillation from Minoxidil. It’s rare, but it happens. I never documented it, but when I use Minoxidil, I get palpitations, so I decided not to use it. It’s a known side effect that can cause intermittent atrial fibrillation. Anyway, it’s not completely benign.

Most of us combine PRP with Minoxidil. It’s useful to know, though, that at least I’ve never seen a head-to-head study, and in this one, it looks like they come out about the same when used alone. I think most of us see a synergy between the two. But there you go.

The Most Likely Unlikely Place to Cause Blindness with the Injection of PRP

The main thing I think worth thinking about tonight, or the one that I wanted to really bring to your attention, was something that proved me wrong. Let me just pull this up; we can talk about it. We’ve talked a couple of times in the past about vision loss after platelet-rich plasma injections.

It’s very rare.

There’s a handful of cases, less than a dozen cases. As you guys know, several companies produce more than a million PRP kits per year. So this would be very rare. But if you’re the one, if you’re the provider, or you’re the patient, it doesn’t matter. We need to know what are the commonalities.

In the previous two papers where I looked, the confusion to me was in all of these papers; there was a question about who was doing it and what else might have been mixed with the PRP. Oftentimes, it was an even unknown license provider. It was a hotel room somewhere. So unknown whether soft tissue fillers were mixed with the PRP. But even with that unknown, if you look at where the locations are, it’s mostly in the glabella with a one-off where it occurred injecting TMJ.

But this odd thing, someone got blindness from TMJ and one forehead treatment with dizziness, tinnitus, vomiting, and some loss of vision.

Again, I passed it off, “Well, if we don’t even know who is doing it and what they mix with it, maybe we’re okay.” Most likely, we are.

The same thing was in this case study where, if you look at the case report, there was a question about modifications. See, they even mention it. Some practitioners deliberately modify these products, and the patient declined even to tell. They were protecting the person who did the procedure. They were worried about the person going to jail. So not even a properly licensed person did the procedure.

But today, this paper is out now. You can see it came out just this month, and there’s no such mention that the PRP was mixed with anything. They don’t make a point to say that it was not, but they mentioned that most of the reports of blindness are with HA fillers, although there are some occlusions related to PRP but rarely reported.

And I just gave you those rare reports.

But in this case, there’s no mention of anything being mixed with it.

The authors document the blindness that occurred, and they postulate that possibly it’s from… You can see the literature about visual complications is limited, more intensive synergy. But the bottom line is they postulate that maybe it’s not even an occlusion; maybe it’s from the expansion of the tissue with some sort of blockage secondary to that.

But the reassuring thing is that once again, it was injecting the glabella region.

The bottom line, I think, to avoid this complication is that for the glabella, we’re best off using Botox and microneedling and not injecting subdermal PRP.

If that would’ve been done, there would essentially be no cases in the literature except for these two one-offs where the forehead was injected in TMJ. Again, in these, there was even a question about things being mixed with it. And obviously, if you put HA in the forehead, well, yep, you’re asking for trouble.

I’m not sure what to make of these, but this one I have to pay attention to because there’s no mention of HA fillers, straight-up PRP.

But once again, it’s the glabella, so I think the take-home message is that we should all be using microneedling and Botox or whatever your neuromodulator of choice is and not injecting subdermal PRP in the glabellar region.

This was what they call the lateral glabella, so someone was trying to inject number 11s or the area of the corrugators and got into trouble.

As you guys know, if you remember from the model skull that you studied, there’s an osmium there, and blood vessels exit the skull in that region, and nerves. I’ve only had two people pass out, just instantly pass out from doing Botox after doing it for more than a decade. In both cases, they were extremely tough women. One used to be a professional water skier turned triathlete and attorney, and the other was like the lady in Flash Dance, only she supervised men as a welder at the shipyard. So these were tough women and impressive women and smart women. Both of them immediately became unconscious when I injected their right corrugator. It was like the Spock thing; a light switch went out.

So there’s something interesting about that area, and I think we should be avoiding it for subdermal injections of PRP. Stick to your radio frequency, microneedling, your creams, and all the other things you know to treat those number 11s.

All the papers are there that we’ve talked about.

Let’s see if anybody has questions. If not, that’s all I’ve got. I just think it’s important enough to feature it and let that be it for the night because it’s pretty important. Now, let’s see if I see any questions. Otherwise, let’s call it a night.

I didn’t see anything else that stood out as something we’ve not talked about already.

Update: our Botox procedures are going crazy and still going viral, and our group is growing. We had another double-blind placebo prospective study demonstrating the effectiveness from PRP for erectile dysfunction.

We’ve got some more studies that are coming down the pike. Always honored to have the attention of you guys, and I am on standby, my staff and I. Have a great night. Bye-bye.

Relevant Links

–>Next class to learn to inject the major joints (knees, elbows, shoulders, Achilles) with PRP<–

–>Apply for Further Online Training for O-Shot®, P-Shot®, Vampire Facelift®, Vampire Breast Lift®, Vampire Wing Lift®, or Vampire Facial®<–

–>Next Hands-on Workshops with Live Models, worldwide <–

—>Dr. Runels Botox Blastoff Class<—

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Relevant Research

The research discussed in this Journal Club (in the above video)

Regarding Ill Effects of Minoxidil 

Regarding PRP for Alopecia

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