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What is PRP?

Platelet rich plasma

What is so important about PRP?

PRP contains all the regenerative healing growth factors in our bodies. By using concentrated platelets and plasma, we have a dense component of healing regenerative growth factors to place in the areas of need. The platelets and plasma then grow (proliferate) and remodel into the tissue that is needed for the specific locations in the body. PRP will never be degenerative to you. It will never harm you.

(This is in contrast to steroids which are degenerative. Too many steroids over time contributes to brittle bone disease [osteoporosis], hypothyroidism [poorly functioning thyroid], diabetes, tearing of the tendons and ligaments etc.)

Does this PRP procedure really hurt?

No. Dr. Bethea walks you through the whole process so that there are not any surprises. She will tell you if you will feel some pressure or if you will feel some burning. The temporary burning sensation, which goes away in less than 60 seconds, is related to the property of lidocaine. Dr. Bethea decreases this sensation of burning by combining sodium bicarbonate with lidocaine. Sodium bicarbonate is really just sterilized baking soda. This is a base so it neutralizes the acidity of lidocaine.

Where does platelets and plasma come from?

Platelets and plasma are found in YOUR whole blood.

Can I use another patient’s platelets and plasma?

No. This is not like blood transfusions done in the hospital. We use your whole blood to obtain your platelets and plasma

If I am sick, can I still do my PRP procedure?


How much blood do you draw?

This depends on the total number of areas we have to treat. A minimum of 20 mL is drawn up.

Is my blood drawn on the same day that the procedure is done?


Do I need to drink a lot of water before getting my blood drawn?

Yes. This helps the clinical team to have an easier time with obtaining your blood.

How do you get the platelets and plasma out of my blood?

We use a special machine called a centrifuge. The centrifuge spins your whole blood. The whole blood settles to the bottom of the tube. Your plasma and platelets rise to the top of the tube. There is a distinct color difference when they separate.

How long does it take to centrifuge my blood?

It takes nine minutes.

How long overall does the PRP procedure take?

It depends on the number of areas which have to be treated. It is normally not more than 60 minutes for a few joints compared to 60-90 minutes if the spine is included. For sexual wellness, the longest part of the visit is the numbing part. The actual PRP sexual wellness procedure takes less than 10 minutes to perform. PRP hair restoration and skin rejuvenation take the longest. They’re much more involved.

Once my platelets and plasma are separated from my blood, then what happens next?

The clinical team will show you exactly how the platelets and plasma are separated from your whole blood. This is pretty neat. Once it is separated, we divide it into respective syringes. This is based on the number of locations we need to treat.

Do you mix anything else with my platelets and plasma?

Yes. For pain management treatment, we add 2% lidocaine. This is an anesthetic. We also add calcium chloride. Calcium chloride is an activator. It keeps the plasma and platelets together wherever they are placed

Do you add anything else for other PRP treatments?

When we are treating patients with PRP for hair loss, we add niacin and dexpanthenol. Niacin and dexpanthenol are B vitamins. Niacin nourishes the scalp. Dexpanthenaol allows the hair follicles to open wider in order to accommodate more PRP.

Do I need to bring anything for PRP pain management?

Yes. We prefer to have imaging studies (x-rays, CAT scans, MRIs, or ultrasound) of the respective joints and of the spine before injections can take place. If you do not have any of these studies, these can be ordered at your consultation visit.

Is the PRP consultation separate from the PRP actual treatment?

Some patients prefer to do the consultation first and then return on another day for their PRP procedure. You would have to return on another day if specific products were not stopped for three days. Some patients are already prepared to undergo their PRP procedure. They have their imaging studies together and they have stopped the respective products.

What is the PRP consultation fee?


How do I schedule a PRP consultation?

You can email us through the following account: or you can call us at

336-501-3796 between the hours of 7:30 AM-4:00 PM Monday through Wednesday and 7:30 AM-7:00 PM on Thursday Eastern Standard Time. We are closed daily from noon to 12:30 PM for lunch. Phones are not answered during that 30 minute period of time. We are closed on Fridays but you can still email your request for a PRP consultation appointment with Dr. Bethea. Dr. Bethea will get your email over the weekend and will respond to you over the weekend. She is normally pretty prompt with her response time to email.

Do I need to stop any medications or foods before or after PRP treatment?

Yes. In order for you to have the best outcome, you need to stop the following for three days before and stay off of these three days after PRP treatment:

ALL NSAIDs, which includes prescription as well as over-the-counter topical and oral forms, must be stopped. This also includes natural based NSAIDs such as turmeric, OPC-3, etc.. It is best to stop anything that is stated to be an anti-inflammatory.

ALL vitamins, minerals, and other supplements must be stopped. This even includes your multivitamin.

Any aspirin containing products or blood thinners must be stopped (examples: Coumadin, Xarelto, Brilinta, Effient, Plavix, etc.). Some vitamins and supplements have blood thinning properties to them. These must be stopped. If you’re taking any blood thinner greater than 325 mg of aspirin, then we will need written medical clearance from whoever prescribes your blood thinner. We have a special form that we send to your prescribing provider. All they do is sign it and circle yes or no regarding your approval to stop your blood thinner for the respective time frame. If they do NOT approve you, then you will not be able to undergo your PRP procedure. IF you come off of your respective blood thinner without your prescribing provider’s permission, you will be doing so at your own risk.

It is recommended that you stay away from green tea, wine, and other type of fluids that are known to have antioxidant properties to them. Any agent that contains antioxidant properties needs to be stopped.

Steroids must be out of your system for two weeks before and two weeks after treatment.

Can I drive to my PRP pain procedure or do I need to have a driver?

You can drive to the procedure as long as you have not taken any type of pre-medication sedation agents. That’s things such as Valium, Ativan, or Xanax. Valium is called in for some patients who undergo PRP spine treatment. This is not called in for peripheral joints, such as the knees or the shoulders.

What things would decrease my chances of the best outcome?

Not stopping the medications, vitamins, minerals, and supplements stated above.

Smoking, drinking, and doing drugs are all bad.

If you cannot come off of steroids because of a medical condition, then PRP will not work for you

If you are taking immunosuppressants (neutralizes the hyperactivity of your immune system), you must be off of these for seven days before and seven days after your PRP procedure.

What can I do then if my doctor tells me I cannot stop my steroids, blood thinners, or immunosuppressive? If you cannot stop any of these mentioned, then you are not a candidate for PRP. Yes. There is hope for you. That is with stem cell treatment.

Will I have restrictions after my PRP pain management treatment?

Yes. Reduce intensity of exercise activities by 40% for the first four weeks. Increase to 50% by week five and full intensity of activities by week six.

You will receive a detailed discharge instructions sheet which will spell out more specifics tailored to your joints or/and spine.

Can I go back to work the same day following my PRP pain management procedure?

If you have not taken any pre-procedure sedation, you can return to work the same day.

When should I notice a difference in my pain reduction and improvement in my quality of life?

The first three days is the inflammatory phase. During this phase, you may experience increased pressure and throbbing as a result of the initial tissue growth. More regenerative mediators go directly to the site of treatment. After these three days, is the proliferative phase. This is where the growth starts and goes up to six weeks. After six weeks is the remodeling phase. That’s when the tissue becomes more and more native to its location. By six weeks, patients start noticing improvements in their quality of life and in pain control. For some patients, all symptoms resolve by that time. It is an individualized tissue growth process. It may take others longer than six weeks. New healthy tissue does not grow overnight. You must be patient. If you are one who tends to be inpatient, you will need to ask yourself whether or not this treatment is for you. New healthy tissue does not grow overnight!

Will I need more than one PRP injection?

Some patients may need more than one treatment depending on the severity of their pathology.

Are PRP treatments covered by insurance?

No. Treatment is still affordable. We have a Care Credit, which provides an 18 months interest-free program for repayment. Some patient’s HSA and FSA accounts cover their treatment costs.

Am I responsible for giving my payment up front?

Yes. Patient payment is due on the date of service for PRP. If stem cells are going to be used, those must be paid for in advance.

Does PRP work for hereditary pattern baldness?


Is anything required before I undergo PRP treatments for hair loss?

Ideally, we prefer to draw blood in order to determine whether or not the hair loss is related to a suboptimal functioning thyroid, hormone imbalance, or other metabolic disturbances. We have had some patients, who were adamant, about going straight to PRP without blood work. They stated that they would still proceed regardless of the blood work results.

Does it work for thyroid induced, hormone induced, or auto immune induced hair loss?

We make sure that the thyroid metabolism is optimal as well as the hormones are balanced before patients pursue PRP treatment. If the thyroid and the hormones are not addressed, the outcome for PRP is not so good. If your hair loss is related to an autoimmune disease, then you most likely will need to go the stem cell route.

How many PRP treatments are required for hair loss?

The recommended number of treatments in which success has been noted, is 3. If the area of loss is small enough, less than three treatments could do the job.

Is PRP hair restoration painful?

No. We do a good job with making sure that the scalp is numb first with the topical. That is a combination of benzocaine, lidocaine, and tetracaine. That is allowed to marinate in the scalp for 45-60 minutes. We then use injectable anesthesia. Once that sets in, which usually takes place in 5-10 minutes, then we start the PRP procedure.

Does PRP hair restoration involve a lot of injections?

It can. It depends on the surface area of loss. We want to make sure that all areas are completely covered.

PRP is injected underneath the scalp but is also placed in the scalp from the top through a microneedle.

When can I wash my hair after PRP treatment?

Eight hours

Don’t wait any later than that; otherwise, the residual topical anesthesia will be more difficult to remove off of your scalp.

Do I need to bring anything to the hair PRP procedure?

Yes. You need to bring either a scarf or a hat. Your head needs to be protected for eight hours following the procedure if you are going to be outdoors.

Can PRP reduce the size and/color of my scars?


Can PRP reduce the size and/or color of my stretch marks?


What is involved with treating scars or stretch marks with PRP?

These areas are numbed up with topical benzocaine, lidocaine, and tetracaine. This sits for about 30 to 45 minutes before actual PRP treatment begins.

Using a sterile cosmetic paintbrush, your PRP is painted on the scars or stretch marks. If the scars are on your face, neck, or the back of the hands, a micro(nanopen) needle is used to penetrate the PRP directly into the scars or stretch marks. If the scars or stretch marks are on other parts of the body such as the chest, arms, legs, or torso, then a roller is used in place of the microneedle. The roller has more points of contact and can penetrate deeper into the respective scars or stretch marks. No PRP is injected underneath. It is all injected on top of the scar or stretch mark.

Anything special I should do following scar and stretch mark PRP treatment?

You will want to have these areas covered. These areas cannot be washed for eight hours.

If the scars are on your face, you will need to wear a hat with a large brim, to keep the direct sun away from your skin.

Can PRP help frown lines, smile lines, crow’s feet, and marionette lines?

Yes. Your PRP has the capability of smoothing out these lines. The skin over these locations are numbed with the topical benzocaine, lidocaine, and tetracaine. PRP is not injected into these areas. PRP is injected underneath the skin directly along the respective trouble lines. PRP allows normal fatty tissue to grow in these areas so that these areas are smooth and don’t wrinkle up.

Will PRP help if I have tissue loss?

Yes. PRP is commonly used in the face, neck, upper chest, and back of the hands. These are areas where we lose a lot of our fatty cells. PRP can help restore that volume back to these locations. The skin over these areas are numbed just like above. No PRP is injected into the skin. PRP is injected under the skin. A large amount is injected underneath the skin because we want the proper volume to return to the respective areas.

Anything special I should do following PRP treatment for wrinkles or tissue loss?

Make sure you bring your wide brim hat especially if the wrinkles and tissue loss is in-your-face. You need to make sure that your face is protected from the sun. You cannot wash these areas until eight hours has passed.

When should I notice a difference with PRP treatment for hair loss?

You must give each treatment up to six months to notice the benefit. Again most undergo 2-3 treatments. The six-month marker follows the last treatment. Remember that hair does not grow overnight.

When should I notice a difference with PRP treatment for scars, stretch marks, and volume loss?

You should start seeing a difference around six weeks for scars and stretch marks. They will continue to shrink and lighten over time.

Restoring volume loss can take longer than six weeks. This depends on the volume of the surface area of loss.

Does PRP treat sexual problems like erectile dysfunction and dyspareunia (female painful sex-intercourse)?

Yes. It treats both.

Do I need to do anything differently before PRP sexual wellness procedures?
Yes. Please make sure ALL devices, jewelry etc. are removed from your penile shaft, glans penis, vagina, clitoris, and labia. We do not have the tools to be removing these appendages in the office. We cannot perform the procedure if these are in place. That would be a waste of everyone’s time.

What happens with a PRP erectile dysfunction procedure?

The shaft of the penis and the corona of the glans penis is numbed with benzocaine, lidocaine, and tetracaine (BLT) topical solution. You will be wearing gloves. You will clean your shaft and corona with alcohol and then you will apply BLT solution to these areas liberally! Believe it or not, BLT numbs the shaft and the corona quickly. It typically takes about 15 minutes tops. PRP is then injected on each sides of the shaft at the base. It is injected on each side at the midshaft. It is then injected into the corona of the glans penis. It is a very comfortable procedure. Patients do not feel a thing.

If you are not familiar with vacuum pumps, you will get familiar with it. Using a vacuum pump helps move your PRP around in the tissue of your penile shaft. Your vacuum pump must be used for 10 minutes twice a day. Pump it up to 25 mmHg . You don’t need to go any higher than that. Do not want you experiencing pain by trying to achieve higher mmHg. Those two 10 minute intervals, have to be separated by 30 minutes. This process must be done for six weeks. The outcomes with PRP erectile dysfunction are much better when the vacuum pump is used for the six weeks following treatment. Please keep in mind that using this device is NOT advocating or precipitating masturbation. Using this device is ONLY about moving your PRP around in the cavernosa tissue of the shaft of the penis so that the tissue has the highest chance of equally growing in all compartments.

What happens with PRP for dyspareunia (female painful sex- intercourse)?

BLT is used just like all other PRP procedures. This is applied liberally to the anterior portion of the vagina, clitoris, and labia after these areas have been cleaned. The BLT is allowed to marinate for at least 30 minutes. Once these areas are confirmed to be completely numb, then PRP is injected into the anterior vagina and clitoris. If any PRP product is left over  (which should be the case) following injecting these the anterior vagina and clitoris, then it is typically placed in the labia on both sides.

When should I notice a difference with my erectile dysfunction?

It usually takes about four weeks. It can take longer, depending on the source of the erectile dysfunction. Example is following prostatectomy. We found that this takes the longest and usually requires additional treatment.

Does this treat curved or bent penis (Peyronie’s disease)?


Does the PRP procedure protocol vary because of the curve or bent nature?

Yes. PRP is injected directly into the curve or bend on both sides in addition to the other locations.

Frequency of the vacuum pump use is the same following treatment. Really want to get the PRP flowing through the curved or bent locations of the penis. That’s going to involve consistent 25 mmHg vacuum pump treatments.

When should I notice a difference with my dyspareunia (painful female intercourse)?

Some women will notice a difference on the exact same day that the treatment takes place since the tissue is engorged. We still state to give the treatment up to the whole six weeks to work.

Can I go back to work the same day following PRP sexual wellness procedure?


Will PRP sexual wellness work if I have had external reproductive organ reconstructions?

This is not within the scope of Dr. Bethea’s training. Dr. Sandhya Montilus-Thomas, who is the owner of Serenity Integrated Medical Spa in Fayetteville, NC, is who Dr. Bethea recommends to address this question.