We Applied PRP Injection for Empty Nose Syndrome!

PRP Injection To Turbinates For Nasal Hyperventilation

Patient 1

Some of our patients may request a very large amount of PRP injection at one time. In the procedures we perform here, it is usually a PRP infection obtained by taking 5 or 10 millilitres of blood. Some patients want a blood sample of 40 millilitres at one time and approximately 20 millilitres of PRP content obtained from this subject to be injected into the turbinate remnanti. It is not possible to inject such a large amount of fluid into the turbinate at one time. Divided doses and repeated applications will be much healthier. I usually prefer to use a cannula during PRp injection, I do not use a needle. It is not always easy to inject fluid into these fibrous tissues that have previously undergone radiofrequency or other procedures.

Empty Nose Syndrome (ENS) is a rare but serious disorder in which patients feel that their nose is blocked despite having sufficient airflow in the nose (even more airflow than normal). It usually develops after surgical interventions on the turbinates (nasal flesh) located in the nose. Problems such as loss of sensation in the nasal tissues, airflow disorders and mucosal dryness are observed in ENS patients. Air hunger and painful areas in the nose may occur, and a feeling of cold air contact in the nose may occur. This condition causes patients to experience serious discomfort both physically and psychologically. In addition to procedures such as cartilage implantation, filler injection, and modified Young operation for the purpose of narrowing the abnormally widened airway in the nose; PRP (Platelet-rich plasma) and stem cell injections have recently begun to be performed for the purpose of improving mucosal health. In addition to these, fat injections are also performed together with stem cells for the purpose of narrowing the nasal air passage. We performed PRP injection on the patient who came today and had nasal hyperventilation symptoms after previous concha radiofrequency application. The right nasal passage was larger than the left. The patient stated in the cotton test that there was a decrease in complaints, especially when the nasal airway was narrowed on the right. The patient was planned to receive treatment for repeated PRP applications as a priority.

PRP injections have attracted attention as one of the innovative methods in ENS treatment in recent years!

PRP is a plasma obtained from the person's own blood and rich in growth factors. When applied into the nose, it aims to regenerate damaged mucosal tissue and increase blood circulation. In this way, partial recovery of intranasal sensation, improvement of mucosal moisture balance and general reduction of symptoms can be achieved in ENS patients. In office conditions, 10 ml of the patient's blood is taken and the plasma injected for PRP is obtained after centrifugation.

PRP injection is usually applied under local anesthesia, in several sessions at certain intervals. The fact that the application is non-invasive and contains the patient's own biological material makes the
risk of side effects quite low. However, since each patient's clinical condition is different, PRP treatment should be evaluated and planned by an experienced otolaryngologist. Although PRP does not provide a definitive treatment for ENS, it stands out as a promising option in relieving symptoms.

Patient 2 - We Injected 6 + 12 ml of PRP into the Turbinates of a Patient with Empty Nose Syndrome Symptoms

A patient who had undergone bilateral turbinate reduction during a rhinoplasty performed at a different clinic one year prior and was experiencing symptoms of empty nose syndrome was examined. The anterior and caudal portions of the left inferior turbinate were quite small. The distance between the septum and the left inferior turbinate was greater than normal, and the sensation of cold air and nasal dryness were particularly pronounced on this side. A leftward septal deviation was observed, which narrowed the left airway. Therefore, it was thought that the symptoms were not exacerbated in the left nasal cavity. The right inferior turbinate was very close to normal size. Because the patient also had minor symptoms on the right side, we planned to inject 6 ml of PRP into the anterior portion of the right inferior turbinate, 12 ml into the anterior portion of the left inferior turbinate, and posteriorly into the middle and posterior portion. I have included pre- and post-procedure images below.

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection. 

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection. The volume increase in the left inferior turbinate is easily visible.

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection.

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection.

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Patient 3 - We Injected 6 + of PRP into the Right Turbinate of a Patient with Empty Nose Syndrome Symptoms

The patient had previously undergone a turbinate resection at a different clinic. Symptoms of empty nose syndrome subsequently developed. The patient underwent a right lateral submucosal nasal implant at a different clinic. The patient received a 6 ml PRP injection in the office. Pre-procedure and pre-procedure photos are included below.

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Right Inferior Turbinate, Before and After 6 ml PRP Injection

How is PRP Obtained?

PRP (Platelet-Rich Plasma) is obtained by centrifuging venous blood drawn from the patient. After being collected into special tubes, the blood is subjected to a two-stage centrifugation process. In the first stage, erythrocytes are separated, while in the second stage, platelet-rich plasma is collected from the top. This method allows for the intensive use of cellular growth factors.

Which Part of PRP is Most Beneficial?

The plasma obtained after centrifugation has different layers:

• PPP (Platelet-Poor Plasma): The upper, platelet-poor layer
• PRP (Platelet-Rich Plasma): The middle, most commonly used layer
• Buffy Coat PRP: Leukocyte-rich layer

From a therapeutic perspective, the platelet-rich layer (PRP layer) is the most beneficial due to its high concentration of growth factors.

How Much Blood Can Be Obtained as PRP?

Approximately 1–2 ml of PRP can generally be obtained from 10 ml of blood. This means that approximately 10–20% of the total blood can be used as PRP. If Platelet Poor Plasma, Platelet Rich Plasma and Buffy Coat sections are also taken after centrifugation, almost half of the total blood taken can be used as PRP.

Benefits of PRP Injection in Empty Nose Syndrome

• Regeneration and tissue healing in the turbinate mucosa
• Increased hydration and moisture balance of the mucosal surface
• Partial restoration of sensitivity in nerve endings
• Improvement of the subjective perception of airflow
• Long-term symptom reduction and improved quality of life

How is PRP Injected into the Turbinate?

I usually just spray lidocaine spray into the nose and follow these steps:

PRP is generally administered as follows:

• A locking syringe is used to prevent fluid reflux.
• A blunt-tip cannula is preferred for administration.
• Small volumes of PRP are slowly injected into the submucosal layer of the turbinate mucosa.
• Injections are usually administered into the inferior turbinate region.

How Much PRP Should Be Injected into the Turbinates? How Is It Determined?

An average of 6–12 ml of PRP can be administered, depending on the turbinate volume and the patient's symptoms.

When making the decision:

• Symptom severity (difficulty breathing, nasal dryness)
• Endoscopic examination findings
• Previous surgeries and extent of resection are taken into consideration.

Comparison of Turbinate Gel Filler Injection and PRP Injection

Gel filler injection and PRP (Platelet Rich Plasma) injection, two methods used in the treatment of empty nose syndrome, differ significantly in terms of their mechanism of action, durability, cost, and side effect profile. Gel filler injection is a mechanical filling procedure that primarily aims to improve airflow by adding volume to the turbinate. This method provides rapid effects immediately upon application and can quickly alleviate nasal congestion symptoms. However, while this effect lasts longer than the volumizing effect of PRP, it is generally temporary, lasting an average of 6–12 months depending on the filler material used, requiring repeated applications. Fillers containing hyaluronic acid, in particular, can increase natural water molecule retention and edema within the turbinate. In contrast, PRP injection involves injecting plasma, derived from the patient's own blood and rich in growth factors and regenerative cellular components, into the turbinate tissue. This procedure not only creates a mechanical volume effect but also enhances mucosal regeneration, functional activation of nerve endings, and tissue nutrition, resulting in biological healing. Therefore, the healing effect of PRP is based on a longer, natural healing process. Its volumizing effect, however, is shorter than that of filler injections. From a cost perspective, PRP is generally considered more economical because it uses the patient's own blood, while gel fillers, being ready-made medical products, are more expensive. Regarding the side effect profile, PRP, being an autogenous material, carries a very low risk of immune reactions or allergic side effects. However, complications such as foreign body reactions, granulomas, or infections can rarely occur with gel fillers. Therefore, in clinical practice, PRP is the preferred choice if long-term functional recovery and natural tissue repair are the goal. Gel filler injections may be preferred for patients who desire rapid results and require a short-term solution.

Left Inferior Turbinate, Before - After 16 ml PRP Injection

Left Inferior Turbinate, Before - After 16 ml PRP Injection

Left Inferior Turbinate and Nasal Floor, Before - After 6 ml PRP Injection

Left Inferior Turbinate and Nasal Floor, Before - After 6 ml PRP Injection

Frequently Asked Questions and Answers About PRP (Platelet-Rich Plasma)

What is PRP?

PRP is an abbreviation for "Platelet-Rich Plasma," which in Turkish means platelet-rich plasma. It is the plasma portion obtained from a person's own blood and contains a higher concentration of platelets than normal blood. Since platelets contain various growth factors and biologically active substances that play a role in wound healing and tissue repair, PRP can be used in various medical and aesthetic applications.

How is PRP Obtained?

To prepare PRP, a certain amount of venous blood is first taken from the patient. The blood is transferred to tubes containing appropriate anticoagulants and then centrifuged. As a result of centrifugation, the components of the blood are separated according to their concentrations. The platelet-rich plasma portion is appropriately collected and can be used for treatment purposes. The properties of the obtained PRP may vary depending on the tube, centrifuge system, centrifugation time, and method used.

How Many Components Does PRP Consist Of?

When preparing PRP, blood is primarily separated into its cellular components such as plasma, platelets, erythrocytes, and leukocytes. While the number of layers obtained after centrifugation can vary depending on the method used, in classic blood separation, the lower section where erythrocytes are concentrated, the intermediate section where platelets and leukocytes are located, and the upper section where plasma is located can be distinguished. The content of PRP may vary depending on the preparation protocol used.

What Does PRP Contain?

The main component of PRP is plasma, which contains concentrated platelets. Platelets may contain and surround growth factors associated with tissue healing, such as PDGF, TGF-β, VEGF, EGF, and IGF, as well as various biological molecules. Whether PRP contains leukocytes and the platelet concentration may vary depending on the preparation method used.

Why is Platelet-Rich Plasma (PRP) Important?

Platelets are not only cells involved in blood clotting. They also release growth factors and other mediators that play a role in various stages of the healing process after tissue damage. Therefore, theoretically, preparing platelets at a specific concentration and applying them to the target tissue can support tissue healing and regeneration processes.

How is PRP Applied?

PRP can be applied in different ways depending on the purpose of use and the area being treated. Prepared PRP can be injected directly into the target tissue under appropriate sterilization conditions, or it can be applied to or into the tissue in some surgical procedures. The application method varies according to the purpose of the treatment and the protocol preferred by the physician.

In Which Diseases and Conditions is PRP Used?

PRP has been researched and used for various purposes in orthopedics, sports medicine, dermatology, plastic surgery, dentistry, and some other medical fields. Tendon and ligament injuries, some joint problems, hair loss, and skin applications are examples of these. However, the effectiveness of PRP varies depending on the disease, the application method, the properties of the preparation used, and the patient's condition; the level of scientific evidence is not the same in every field of use.

Is PRP Used in Hair Loss?

PRP can be applied to the scalp, particularly in some types of hair loss such as androgenetic alopecia. The aim is for growth factors released from platelets to support the biological processes surrounding the hair follicles. While some studies have reported improvements in hair density and thickness in some patients, results may vary depending on the PRP protocol used and the patient's characteristics.

Is PRP Used in Skin Rejuvenation?

PRP is used in some aesthetic applications to improve skin quality. It is thought that various growth factors released from platelets can affect processes related to collagen production and tissue regeneration. Therefore, PRP can be considered in conjunction with other applications for conditions such as fine lines, skin tissue quality, and some scars.

Is PRP Used in Ear, Nose, and Throat Diseases?

The uses of PRP have been researched in various medical fields in recent years. In the field of ear, nose, and throat, research is ongoing, particularly regarding tissue healing, wound healing, and certain regenerative applications. However, not all uses of PRP in ENT are considered standard treatments, and when it should be applied should be determined by evaluating scientific evidence together with the patient's clinical characteristics.

Is PRP Used After Nose Surgery?

PRP has been researched to support tissue healing in some surgical procedures. Studies exist on the potential effects of PRP on edema, bruising, wound healing, and tissue regeneration in rhinoplasty and other nasal surgeries. However, there is no definitive and standard protocol indicating that PRP should be routinely used in every nose surgery.

Is PRP Made from the Patient's Own Blood?

Yes. PRP is autologous, meaning it is prepared from the patient's own blood. Therefore, blood or plasma taken from another person is not used. Blood taken from the patient undergoes a special process to separate the platelet-rich plasma fraction, which is then used for treatment in the same person.

Is the Entire Blood Used in PRP Preparation?

The entire blood taken from the patient is not injected for treatment during PRP preparation. After centrifugation and separation processes, the different components of the blood are separated, and the targeted platelet-rich plasma fraction is used for treatment. Which fraction is used may vary depending on the PRP preparation system and treatment protocol.

Are PRP and Serum the Same Thing?

Serum is the liquid portion of blood remaining after clotting and normally contains little to no platelets. PRP, as the name suggests, is platelet-enriched plasma. Therefore, the biological properties of PRP differ from those of serum.

What is the Difference Between PRP and PRF?

PRP and PRF are platelet-based biological products prepared from the patient's own blood, but their preparation methods and contents differ. During the preparation of PRF (Platelet-Rich Fibrin), a distinct fibrin network is formed, and the product's structure differs from PRP. PRF generally forms a structure containing a denser fibrin matrix, while PRP is a more liquid preparation.

Why is Centrifugation Used in PRP Preparation?

Centrifugation allows the components of blood to separate from each other by taking advantage of differences in their concentrations. This makes it possible to collect erythrocytes, leukocytes, platelets, and plasma in different fractions. The single or double centrifugation protocol used can affect the platelet and leukocyte content of the resulting PRP.

What Should the Platelet Count Be in PRP?

There is no single ideal platelet concentration applicable to all PRP applications. The platelet concentration of the prepared product can vary depending on the initial blood values, the tube used, the centrifugation method, and the preparation system. Furthermore, not only the platelet count but also factors such as leukocyte content, erythrocyte contamination, activation method, and applied volume can affect the biological effects of PRP.

What is the Difference Between PRP Containing Leukocytes and PRP Poor in Leukocytes?

PRP preparations can generally be classified according to their leukocyte content as leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP). The choice of preparation depends on the tissue being treated and the clinical goal. Due to the effects of leukocytes on the inflammatory response, different PRP properties may be preferred for different diseases.

When Does the Effect of PRP Begin?

The time it takes for the effect of PRP to appear varies depending on the tissue being treated, the disease, and the properties of the preparation used. In most cases, the aim of PRP is not to create a direct and immediate effect, but rather to influence the tissue's healing and biological response processes. Therefore, in some applications, it may take weeks or months to evaluate the results.

How Many PRP Sessions Are Needed?

There is no standard number of PRP sessions for everyone. While a single application is considered sufficient in some treatment protocols, several sessions may be planned in others. The interval and total number of sessions should be determined according to the disease being treated, the PRP method used, and the patient's response to treatment.

What are the Side Effects of PRP?

Because PRP is prepared from the patient's own blood, the risk of allergic reactions is lower compared to injections containing many foreign substances. However, temporary pain, tenderness, swelling, redness, or bruising may occur at the injection site. Rare complications such as infection, bleeding, or damage to surrounding tissues can also occur with injection applications.

Is PRP Suitable for Everyone?

Before PRP application, the patient's general health status, blood values, medications used, and the disease to be treated should be evaluated. Significant platelet disorders, certain blood diseases, active infections, or certain problems at the application site may require evaluation for suitability for PRP.

Is PRP Safe?

PRP is generally a biocompatible treatment approach because it is prepared from the patient's own blood. However, being "natural" does not mean it is completely risk-free. Sterile preparation and application conditions, correct patient selection, and appropriate technique are important in reducing the risk of complications.

Is the Scientific Evidence Strong for PRP?

The effectiveness of PRP is not proven to the same degree for all diseases and application areas. While studies reporting positive results exist in certain areas such as some musculoskeletal problems and androgenetic alopecia, evidence is more limited or heterogeneous in many other areas of use. Therefore, PRP should not be considered a "regenerative method that cures every disease"; the existing scientific evidence for the condition in which it will be used should be taken into account.

Will the Disease Treated with PRP Be Completely Cured?

It is not possible to guarantee the outcome of PRP. PRP may contribute to the reduction of symptoms or the support of tissue healing in some patients; however, the cause of the disease being treated, the patient's age, general health status, the severity of the disease, and the application protocol affect the results. Therefore, PRP should generally be considered as part of a patient-specific treatment plan.

What Should Be Considered Before PRP Application?

Before the application, the patient's medications, bleeding and clotting status, existing diseases, and the condition of the application area should be evaluated. It is important to inform your doctor before the procedure, especially if you are taking blood thinners or medications that may affect platelet function. Medications should not be discontinued without your doctor's recommendation.

What Should Be Considered After PRP Application?

Post-procedure precautions vary depending on the area where PRP is applied and the treatment purpose. Mild pain or swelling may occur at the injection site. Unless otherwise advised by your doctor, it is important to avoid excessive manipulation of the area and to follow the recommended care guidelines. Post-operative recommendations are particularly important if PRP has been used after surgical procedures.

Are PRP and Stem Cell Therapy the Same Thing?

PRP and stem cell therapy are different biological approaches. PRP is essentially a preparation related to platelets and the growth factors they contain. Stem cell therapies, on the other hand, may involve cellular materials with different properties. Therefore, it is not accurate to directly define PRP as "stem cell therapy."

Why Doesn't PRP Yield the Same Results in Every Patient?

The composition of PRP can vary from person to person. Many factors can affect the properties of the resulting product, including the initial platelet count, blood cell characteristics, age, general health status, application area, kit used, and centrifugation protocol. Furthermore, using different PRP preparation and application protocols for the same disease can make direct comparisons of study results difficult.

What is the Most Important Feature of PRP?

One of the most important features of PRP is that it is a biological preparation obtained from the patient's own blood, containing concentrated platelets. Due to the growth factors and other biologically active substances contained in platelets, PRP is used in various medical fields to support tissue healing and regenerative processes. However, the most appropriate application area and protocol should be determined in accordance with existing scientific evidence.

What is PRP Injection in Patients with Empty Nose Syndrome?

Empty nose syndrome is a complex condition that can occur especially after excessive reduction or dysfunction of the nasal turbinates; it manifests with symptoms such as lack of airflow in the nose, nasal congestion, excessive dryness, crusting, and difficulty breathing. PRP injection is based on the principle of applying platelet-rich plasma, prepared from the patient's own blood, to appropriate areas inside the nose. The aim is to support tissue healing and regenerative processes.

Does PRP Treat Empty Nose Syndrome?

PRP injection should not be considered a definitive and guaranteed treatment for empty nose syndrome. However, it can be considered a supportive treatment option, especially in some patients with dryness, sensitivity, crusting, and impaired tissue quality in the nasal mucosa. The aim of PRP is not to recreate the reduced turbinates, but to support the healing capacity of the existing tissue and mucosal functions.

How is PRP Applied Inside the Nose in Empty Nose Syndrome?

PRP is prepared by centrifuging blood taken from the patient using an appropriate system and separating the platelet-rich plasma portion. The prepared PRP can be applied to target areas inside the nose with small injections. The areas to be treated and the amount of treatment may vary depending on the patient's nasal anatomy, existing turbinate tissue, mucosal condition, and complaints.

Does PRP Enlarge Turbinates in Empty Nose Syndrome?

The aim of PRP is not to mechanically enlarge the turbinates. In empty nose syndrome, a significant portion of the symptoms may be related to turbinate volume loss and changes in nasal airflow. PRP can support healing and regeneration processes in existing tissues, but it is not expected to replace large amounts of lost turbinate tissue. In patients with significant tissue deficiency, different surgical or volume-enhancing methods may be considered.

Can PRP Reduce Nasal Dryness and Crusting?

In some patients, it is thought that PRP may contribute to the healing and moisturizing function of the nasal mucosa. Therefore, it can be considered as an auxiliary treatment, especially in ENS patients with complaints of mucosal dryness, sensitivity, and crusting. However, these effects may not be seen at the same level in every patient, and it cannot be said that PRP completely eliminates dryness.

Can PRP Improve Breathing Sensation in Empty Nose Syndrome?

In empty nose syndrome, the inability to feel adequate airflow even though sufficient air passes through the nose can be a significant complaint. Changes in sensory receptors, mucosal structure, and airflow distribution within the nose may play a role in the development of this sensation. The effect of PRP on these mechanisms has not been definitively established; however, in some patients, subjective improvement in the sensation of breathing through the nose may be observed as a result of supporting the mucosal tissue.

Does PRP Regenerate Nerves in Empty Nose Syndrome?

It is thought that various growth factors in PRP may have biological effects on tissue healing and some neurovascular processes. However, there is insufficient evidence to definitively say that PRP regenerates nerve structures in the nose or restores normal sensory function in ENS patients. Therefore, PRP should not be considered a definitive nerve-regenerating treatment.

How Many PRP Sessions Are Applied in Empty Nose Syndrome?

There is no standard number of PRP sessions that can be applied to all patients with ENS. A single or multiple applications may be planned based on the patient's complaints, intranasal examination findings, the amount of existing turbinate tissue, and the characteristics of previous surgeries. Session intervals are also determined according to the protocol used and the patient's response to treatment.

Which Patients Can Benefit More from PRP in Empty Nose Syndrome?

PRP may be particularly helpful in patients where mucosal damage, dryness, crusting, and deterioration in tissue quality are prominent findings. Conversely, in patients with very advanced turbinate loss or significant anatomical volume deficiency, PRP application alone may not be sufficient. Therefore, the diagnosis and treatment plan for ENS should be based not only on symptoms but also on a detailed nasal examination and the patient's past surgical history.

Can PRP Be an Alternative to Surgery in Empty Nose Syndrome?

In some patients, PRP can be considered as a non-surgical or minimally invasive supportive treatment; however, it is not a direct alternative to methods that surgically reconstruct significant anatomical tissue loss. Especially in patients with severe turbinate loss, if the goal is to restore the lost volume within the nose, tissue or implant-based volume-enhancing methods can be considered. PRP can be considered as an additional or, in selected patients, independent supportive method to these approaches.

Are PRP and Concha Augmentation the Same Thing?

PRP and graft or implant applications used to increase concha volume are different. PRP is primarily used to support biological healing and tissue regeneration, while concha volume augmentation aims to physically increase the volume of missing tissue inside the nose. In some patients, these methods can be considered complementary.

Does PRP Provide a Permanent Solution for Empty Nose Syndrome?

It is not possible to say that PRP provides a permanent and definitive solution for ENS. The effect of the treatment depends on the patient's anatomical condition, the degree of mucosal damage, previous surgeries, and the underlying mechanisms of ENS. Therefore, patients who will undergo PRP should be informed that the treatment aims to reduce symptoms and support the function of the existing tissue.

What Should Be Evaluated Before PRP in Empty Nose Syndrome?

In ENS patients planning PRP, it should first be evaluated whether empty nose syndrome is actually present and whether the symptoms are caused by another reason. Nasal endoscopy allows examination of the current condition of the turbinates, the appearance of the mucosa, crusting, dryness, septum, and nasal valves. Imaging and assessments such as the Cotton test can also aid in treatment planning in necessary patients. This helps determine whether PRP should be applied alone or in combination with another treatment method.

How is PRP Part of the Treatment Approach for Empty Nose Syndrome?

ENS treatment is often a personalized and phased approach tailored to the patient's needs rather than a single method. Moisturizing and mucosal-protective treatments, behavioral and environmental adjustments, biological applications such as PRP in suitable patients, and reconstructive surgical methods in cases of significant anatomical tissue loss can be considered. The role of PRP should be determined by considering the patient's intranasal anatomy and the mechanism of their symptoms.

Similar links related to empty nose syndrome >> Empty Nose Syndrome

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:

Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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