Were You Told PRP Didn't Work, or That All PRP is the Same? It Isn't.
Platelet-rich plasma therapy has become one of the most sought-after treatments in orthopedic medicine — and one of the most misunderstood. Patients who had disappointing results with PRP elsewhere are often surprised to learn that the quality, concentration, and composition of PRP varies enormously from one physician's office to another. The system used, the volume of blood drawn, the method of processing, and the ability to customize the final product all determine whether PRP will be effective for your specific condition.
At Dr. Mirzayan's practice, PRP is not a commodity procedure. It is a precision treatment — prepared with the most advanced technology available and administered with the same level of care and expertise that defines every procedure he performs.
What Is PRP and How Does It Work?
Your blood contains plasma, red blood cells, white blood cells, and platelets. Platelets are small cells best known for their role in clotting, but they are also rich in growth factors — proteins that signal the body to initiate and accelerate tissue repair. When platelets are concentrated and delivered directly to a site of injury or degeneration, they can stimulate healing in tissue that has limited natural blood supply and poor healing capacity on its own, such as tendons, ligaments, and cartilage.
Platelet-rich plasma is created by drawing your blood, spinning it to concentrate the platelets, and injecting that concentrated product back into the treatment site. The critical variable — the one that most patients and even many physicians overlook — is what happens between the blood draw and the injection.
Not All PRP Is the Same — And the Difference Matters
PRP is not regulated by the FDA as a standardized product. There is no requirement that a physician use any particular system, draw any minimum volume of blood, or achieve any specific platelet concentration or count. This means the PRP being administered in one office may be dramatically different — in platelet count, concentration, volume, and composition — from what is being administered in another. Two blood draws from the same patient on the same day can even yield different results!
When evaluating PRP, these are the questions every patient should ask:
- Which system does the physician use, and how does it process the blood?
- How many cc's of blood are drawn?
- What platelet concentration and total platelet count does the system achieve?
- Can the system produce both leukocyte-rich and leukocyte-poor formulations?
- If multiple sites need to be treated, is there a separate fee for each one?
These questions matter because the answers determine whether your PRP treatment has any meaningful chance of working and makes a difference in the pricing.
The Arthrex Angel System: The Most Advanced PRP Technology Available
Dr. Mirzayan uses the Arthrex Angel system — widely regarded as the most sophisticated PRP platform on the market. Most PRP systems draw 20–30 cc of blood and rely on a single centrifuge spin to separate blood components. The Angel system works differently, and the difference is significant.
The Angel system begins with a centrifuge separation, then passes the separated blood through a flow cytometer — an optical sensor system that uses specific wavelengths of light to detect in real time when plasma, platelets and white blood cells, and red blood cells are passing through. The machine automatically and precisely diverts each layer into the correct compartment, producing a PRP product that is both highly concentrated and fully customizable.
The Angel system can achieve concentrations as high as 18 times the patient's baseline platelet count. More importantly, it gives Dr. Mirzayan precise control over the final composition of the PRP — including the ability to produce both leukocyte-rich and leukocyte-poor formulations depending on what your condition requires.
This distinction matters clinically. For certain conditions such as tendinopathy, leukocyte-rich PRP — which includes white blood cells — may enhance the healing response. For joint conditions such as knee arthritis, leukocyte-poor PRP is generally preferred, as white blood cells can provoke an inflammatory response inside the joint. A PRP system that cannot produce both formulations cannot be optimized for every patient and every condition. The Angel system can.
The Angel system costs more to operate than standard PRP platforms. Dr. Mirzayan uses it because it produces a superior, reproducible, and customizable product — and because his patients deserve nothing less.
Why Platelet Count Matters More Than Concentration
When PRP first gained popularity, marketing from device companies focused heavily on concentration — how many times above baseline the platelets were. A decade of research has clarified that this framing was misleading. What actually determines clinical effectiveness is the total number of platelets delivered to the treatment site, not just how concentrated they are relative to baseline.
For knee arthritis specifically, research has shown that a minimum of 10 billion platelets is needed to achieve a meaningful therapeutic effect. Reaching that threshold typically requires drawing approximately 120 cc of blood — a volume that most standard PRP systems are not designed to handle.
Dr. Mirzayan draws the volume of blood necessary to achieve a clinically effective platelet count for your specific condition. This is not the approach taken at most PRP clinics.
How to Prepare for Your PRP Treatment
How you prepare your body before the blood draw directly affects the quality of your PRP. Dr. Mirzayan recommends the following in the days leading up to your procedure:
- Eat well. Good nutrition in the days before your draw supports optimal platelet production. Do not fast before your appointment.
- Stay hydrated. Arrive well hydrated. Dehydration affects blood volume and platelet yield.
- Avoid alcohol and tobacco for at least several days before your procedure, as both impair platelet function.
- Stop anti-inflammatory medications (NSAIDs such as ibuprofen and naproxen) for at least one week before your appointment, as these interfere with platelet activity.
- Exercise vigorously for 10–15 minutes immediately before your blood draw. Research has shown that short-duration vigorous exercise measurably increases circulating platelet counts. If possible, arrive a few minutes early and take a brisk walk or do jumping jacks before coming in.
These steps are not optional extras — they are part of optimizing your treatment. Have questions about what to expect before your procedure? Call our office at (310) 746-5918 — we will walk you through everything.
Conditions Treated with PRP
Dr. Mirzayan uses PRP to treat a range of orthopedic conditions where biologic stimulation of healing is appropriate:
- Knee osteoarthritis — one of the most well-studied applications for PRP, with strong evidence supporting pain reduction and functional improvement
- Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) — chronic tendinopathies that respond well to leukocyte-rich PRP
- Partial rotator cuff tears — where stimulating healing of a partial-thickness tear may avoid the need for surgery
- Biceps tendonitis — inflammation or partial tearing of the biceps tendon at the shoulder
- Shoulder impingement syndrome
- Partial UCL tears — partial ulnar collateral ligament injuries in throwing athletes who are trying to avoid Tommy John surgery
- Patellar tendonitis - or Jumper's knee which is pain below the knee cap oftentimes seen in basketball and volleyball players
PRP is not appropriate for every patient or every condition. Dr. Mirzayan will evaluate your imaging, your symptoms, and your treatment history before recommending PRP, and will be straightforward with you if he does not believe it is your best option. If you are not sure whether PRP is right for your condition, call (310) 746-5918) and our team will help guide you. Dr. Mirzayan will only recommend PRP when he genuinely believes it is your best option.
One Fee. Up to Four Injection Sites.
Most physicians charge a separate fee for each site injected during a PRP session. At Dr. Mirzayan's practice, a single procedure fee covers treatment of up to four sites in the same visit. If you have knee arthritis and tennis elbow, or multiple tendon issues that can be addressed simultaneously, you will not be charged per injection. To learn more about our PRP pricing or to schedule a consultation, call (310) 746-5918 today.
The Procedure
PRP is performed in the office without general anesthesia. After your blood is drawn and processed — a process that takes approximately 20 minutes with the Angel system — the PRP is injected into the treatment site. Ultrasound guidance is used when clinically appropriate to ensure precise delivery to the target tissue.
Most patients experience some soreness at the injection site for a few days following the procedure, which is a normal part of the biologic response. You will be advised to avoid anti-inflammatory medications after the injection, as these can blunt the platelet response. Activity guidelines will be discussed with you based on the site treated and your specific condition.
PRP is not covered by insurance, including Medicare. It is a cash-pay procedure. Call (310) 746-5918) and our team will help guide you on pricing and an appointment.
Frequently Asked Questions
Why didn't PRP work for me when I had it done elsewhere?
The most common reason PRP fails to deliver results is inadequate platelet count, suboptimal system technology, or a mismatch between the PRP formulation and the condition being treated. A leukocyte-rich product injected into an arthritic joint, for example, can actually worsen inflammation. If your previous PRP was prepared with a basic system drawing 20–30 cc of blood, you may not have received a therapeutically meaningful dose. Dr Mirzayan will customize and cater the correct PRP formulation for your specific needs.
How many treatments will I need?
This depends on the condition being treated. Some patients respond to a single injection. Others benefit from a series of two or three treatments spaced several weeks apart. Dr. Mirzayan will discuss realistic expectations with you at your consultation.
How long until I feel results?
PRP stimulates a biologic healing process, which takes time. Most patients begin to notice improvement between four and eight weeks following the injection. Full benefit may take three to six months to be realized.
Is PRP covered by insurance?
No. PRP is not covered by any insurance plan, including Medicare and Medicaid. It is a self-pay procedure. Call (310) 746-5918 for pricing information.
Do I need imaging before my PRP appointment?
In most cases, yes. Recent X-rays or MRI help confirm the diagnosis and ensure PRP is an appropriate treatment for your specific condition. If you do not have recent imaging, Dr. Mirzayan's team can help arrange it.
Dr. Raffy Mirzayan is a double-board certified orthopedic sports medicine surgeon at DOCS Health, 8436 W 3rd St #800, Los Angeles, CA 90048. To schedule a PRP consultation, call (310) 746-5918 or visit raffymirzayan.com.
