Platelet rich plasma (PRP) has been used extensively in Orthopedics and spine disorders for many years to treat a number of musculoskeletal ailments. In recent years, many hair restoration practices have added this treatment for both men and women who suffer from hair loss due to a number of causes. Let’s review what is PRP, does it work, and is it right for your hair loss?
Platelet rich plasma (PRP) is collected from your own blood sample which is collected the same way as your blood is drawn in the lab for testing. The blood sample is collected in a sterile tube which is then placed into a centrifuge which spins it at a high speed for several minutes. This process called centrifugation separates the blood into the red blood cells and the plasma or clear portion of your blood. It is this clear portion of blood which contains platelets as well as many factors thought to help in the healing or inflammation process. These factors include cytokines and chemokines, such as vascular endothelial cell growth factor (VEGF), platelet derived growth factor (PDGF), epidermal growth factor (EFG), fibroblast growth factor (FGF), transforming growth factor-beta (TGF-B), insulin growth factor (IGF), Interleukin-8 (IL-8), macrophage inflammatory protein-1α (MIP-1α), and platelet factor-4 (PF-4) among others. Specific to hair restoration surgery, it has been demonstrated that the application of active platelet gel to surgical sites reduces erythema, crusting, and swelling. Furthermore, the VEGF8 and PDGF4 found in PRP are known to facilitate angiogenesis (growth of new blood vessels) around the hair follicle, and this may be one mechanism underlying observations that PRP can foster robust hair growth.
PRP has been evaluated as a treatment to both speed wound healing and improve hair growth. PRP increases the delivery of growth factor, cytokine, and chemokine activities and this is based upon available past and present data. A recent scholarly review article used the Pubmed and Google Scholar databases to search the world literature on the results of all studies which examined the value of PRP for hair loss due to androgenic alopecia or male pattern baldness. Out of the 32 publications retrieved, 14 publications were determined to be valid, of which 3 randomized, 4 prospective controlled, 4 prospective uncontrolled and 3 retrospective studies. Seven out of 9 studies reported a significant increase of hair density ranging between 12.3 and 45.9 hairs/cm2, (i.e. 19–31% hairs/cm2). Four studies assessed hair loss with the traction test and found a negative result after treatment in more than 95% of patients. Regarding hair thickness, 1 study reported an increase in hair diameter of 46.4% and 1 reported an increase of 106.4% of the “Hair mass index”. Overall, the use of PRP injections in patients with androgenic alopecia seems effective with respect to promoting lost hair regrowth, decreasing hair loss and increasing hair thickness. The effects appear to be progressive from the first injection session, to peak after 3 to 5 sessions and to be reduced in the absence of further injections. No major adverse effect was reported in the 14 clinical studies.
Several studies have been undertaken to evaluate the effectiveness of PRP in the treatment of female pattern hair loss (FPHL). Most of these studies have concluded that PRP is an effective tool in most women who suffer from hair loss. Increases in hair density hair caliber or thickness were seen in most subjects. The hair pull test, which measures the fragility of the hair shaft, was improved in most cases as well. The best results are obtained when the hair loss is first noted and PRP treatments are continued long term.
There are no standard protocols for PRP injection in terms of the ideal number of treatment sessions or the timing of such sessions. However, the above studies seem to indicate several sessions provide the best outcome for patients, from 3-5 sessions. Most hair restoration practices perform these initial sessions 4-6 weeks apart. PRP injections are then continued every 6 months to maintain the regrowth of hair as maintenance therapy.
In addition, most hair restoration practices also encourage patients who are undergoing hair restoration procedures to add PRP treatments. It has been our experience that PRP treatments performed at the time of hair restoration and continued afterward enhance the growth of the hair transplants and surrounding hair. We have also seen less “shock loss” called telogen effluvium in the regions where hair is transplanted when PRP is added to hair transplant patients. Shock loss is a temporary loss of the patients non-transplanted hair which occurs following hair restoration. It generally occurs within the areas that hair transplants are inserted, namely the frontal and crown regions. PRP injections at the time of hair replacement seem to reduce shock loss both in terms of amount and duration. Also, the hair transplant grafts are bathed in PRP which may promote survival and growth of the transplants.
PRP treatments simply involve obtaining a sample of venous blood in the same manner the lab draws your blood for routine testing. After the blood sample is collected and spun in a centrifuge the clear or plasma portion of the blood is collected and injected into the scalp with a tiny needle into the areas of hair loss. There is no significant bruising nor bleeding from PRP treatments. Patients generally return to work or school immediately following a PRP session. Patients may wash their hair normally the day following the procedure and no further precautions are required.
In conclusion, PRP treatments have been well established within the Orthopedic and Spine specialties. They are now gaining widespread approval and acceptance within hair restoration practices who treat both men and women for alopecia. Numerous studies have documented the effectiveness and safety of PRP when used as a standalone procedure for hair loss and in combination with hair transplant procedures. Our practice has been very encouraged by the results for our hair loss patients whom have been treated with PRP injections. We have seen similar results as those reported in the literature for improvement in hair caliber, hair density, and improved hair strength. Our hair transplant patients who undergo simultaneous PRP injections demonstrate improved graft survival, reduced shock loss, and improved growth of non-transplanted hair in both the frontal and crown regions.
If you’d like to learn more about PRP for hair restoration, contact our San Diego area practice to schedule a consultation!