Men and women of all ages suffering from hair loss understand the physical and emotional stress that accompanies this condition. Over the past half decade, the use of Platelet-Rich Plasma (PRP) for treating hair loss has been one of the most promising success stories that has emerged in regenerative medicine. However, many patients (and physicians) are still not aware of this this breakthrough therapy despite its potential to prevent and even reverse hair loss.
Why and how hair loss occurs
Androgenic Alopecia (I.e. pattern baldness) is hereditary and the most common hair loss disorder - characterized by progressive and accelerating hair loss. For many individuals with a family history of hair loss, this is the most likely reason. However, other conditions such as Alopecia Areata (auto-immune disease), medications, and lifestyle choices may also be contributing factors and it is always recommended to see your primary care physician for an accurate diagnosis. While the exact mechanism by which each of these conditions contribute to hair loss may vary slightly, the primary symptom of hair loss is caused by low hair density around hair follicles - the little bulbs in your scalp that produce hair. On average, two or three strands of hair grow from a single follicle. Over time, individuals predisposed to hair loss will see their hair follicles naturally slow production and result in only one or no remaining strands of hair as the follicles reach a state of dormancy. Current treatment options for hair loss include prescription drugs such as minoxidil (rogaine) and finasteride, as well as hair transplant surgery and/or laser therapy. However, each of these treatment options have a variable track record of success (to put it lightly) and may come with side effects such as headache and increase in other body hairs for minoxidil whereas loss of libido has been reported with oral finasteride (1).
Does PRP for hair loss work?
After becoming a staple in the treatment plan of soft tissue and joint injuries, PRP is now being used in cosmetic and aesthetic medicine. PRP is a biological solution derived from a patients blood that is specially processed in a centrifuge to increase the concentration of platelets to supra-physiological levels before being injected back into the patient. Platelets contain numerous growth factors that help stimulate and accelerate tissue healing. It is a relatively low cost treatment option that is well tolerated with minimal side effects, as it is produced entirely from cells within you own body. In hair loss treatment, growth factors are released from the platelets in PRP and act on stem cells in the bulge area of hair follicles, promoting a transition from a dormant to growth phase. This stimulates the development of new follicles and promotes neovascularization (increased blood flow). In layman terms, PRP flips the switch on hair loss by helping create a healthy environment that can increase hair density and distribution throughout the scalp area. Clinical Evidence Strong clinical evidence for this treatment option began to emerge in the early 2010's, when Dr. Khatu et al. used PRP to treat 11 male patients suffering from androgenic alopecia that had failed minoxidil and/or finasteride treatment. Over the course of 4 injections, the authors found a significant reduction in hair loss. Hair count increased from average number of 71 hair follicular units to 93 hair follicular units. Therefore, average mean gain was 22.09 follicular units per cm2 (2). In 2015, authors expanded on the aforementioned pilot study in a randomized, placebo-controlled clinical trial that involved 33 patients and 3 injections of PRP during the course of therapy. Their findings were equally as promising: "at the end of the 3 treatment cycles, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 33.6 hairs in the target area and a mean increase in total hair density of 45.9 hairs per cm2 compared with baseline values." (3) Androgenic Alopecia is not the only form of hair loss that has responded well to PRP. In 2013, Dr. Trink et al. used PRP to treat alopecia areata in a randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma. The author found that when compared to the current standard of care, triamcinolone acetonide (TrA), and placebo, patients treated with PRP had a significant increase in hair growth (96% of the patients) with only 31% relapse within 1 year (1). By January 2021, a review of all clinical evidence was performed by Dr. Roohaninasab et al. Among the 64 studies included, 62.5% of patients saw an improvement in their hair loss condition by receiving PRP therapy, with these cases experiencing an increase in growth and thickness of hair (4). However, buyer beware that not all PRP is created equal and the authors of the above review noted that differences in PRP preparation may have influenced patient response to treatment.
In one recent study, authors evaluated high and low-concentration PRP treatments for androgenic alopecia. They found that that higher numbers of platelets led to a greater effect than lower number of platelets in regard to hair densities, follicle diameters and terminal hair densities but exhibited minimal effects on vellus hair densities at the month-6 evaluation period (5).
This is because some PRP does not contain a sufficiently high concentration of platelets (and thus, growth factors) to provoke a strong healing response during your hair loss treatment plan. Harvest PRP contains as many as 12x more platelets than other PRP preparation systems, and the results we've seen in patients that have received Harvest PRP have been extraordinary to say the least!
When can I expect to see results and how long do they last?
Generally speaking, most patients can expect to some results in 6-8 weeks from onset of treatment with hair regrowth continuing to develop for several months following. The results on average last for 12 - 16 months (6). The intensity and duration of results can vary depending on the severity of the condition at the time of treatment. To reduce the likelihood of relapse, most clinical evidence supports a "maintenance" program involving at least 1 PRP injection each year following the initial treatment plan.
What does a PRP for hair loss treatment look like?
In order to produce PRP, 30-60ml of whole blood will be drawn and placed it into a specialized centrifuge to isolate and concentrate the platelets. This process generally takes about 25-30 minutes at which point the PRP is ready for injection.
Throughout the available clinical evidence and reports, most authors followed a treatment plan involving 3 x PRP injections at 30-day intervals. The injections are performed either free-hand or with the use of an injection gun that allows the practitioner to precisely inject 0.05-0.1ml/cm2 of PRP into the scalp through a very small needle, at an approximate depth of 1.5-2.5mm. A nappage technique is often employed which involves multiple small injections in a linear pattern one-cm apart.
Patients may experience minor discomfort during the procedure, including a burning or tingling sensation that lasts for only a few seconds. To mitigate this, practitioners may use a topical anesthetic or nerve block to numb the area prior to treatment.
Am I a candidate for PRP for hair loss?
Most individuals suffering from hair loss will be viable candidates for PRP, with the following conditions having supporting literature:
Androgrenic alopecia / pattern baldness
Alopecia Areata
Traction alopecia (hair pulling out from braids, ponytails, etc.)
A patients current stage of hair loss will play a strong role in determining whether they will respond to treatment or not. PRP effectively stimulates declining hair follicles, but it cannot reactivate completely inactive hair follicles. An ideal candidate is somebody at the beginning stages of hair loss, with those more advanced in their hair loss condition requiring more treatments.
Conclusion
With limited options available to individuals suffering from hair loss, the emergence of PRP in cosmetic and aesthetic medicine is a hopeful light. Considering its excellent safety profile, promising clinical results and relatively low cost, PRP hair treatment is a great option for patients with thinning hair. For those that have failed prior treatment or are suffering from physical and emotional stress related to hair loss, we encourage you to book an appointment with your primary care physician to discuss whether this is a viable option for you.
References
1. Trink A, Sorbellini E, Bezzola P, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013;169:690–694
2. Khatu SS, More YE, Gokhale NR, Chavhan DC, Bendsure N. Platelet-rich plasma in androgenic alopecia: myth or an effective tool. J Cutan Aesthet Surg. 2014;7(2):107-110. doi:10.4103/0974-2077.138352
3. Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V. The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo- Controlled Trial. Stem Cells Transl Med. 2015;4(11):1317-1323. doi:10.5966/sctm.2015-0107
4. Roohaninasab M, Goodarzi A, Ghassemi M, Sadeghzadeh‐Bazargan A, Behrangi E, Najar Nobari N. SYSTEMATIC REVIEW OF PLATELET‐RICH PLASMA (PRP) IN TREATING ALOPECIA: FOCUSING ON EFFICACY, SAFETY AND THERAPEUTIC DURABILITY. Dermatologic Therapy.:e14768. — 3708
5. Sasaki GH. The Effects of Lower Versus Higher Cell Number of Platelet-Rich Plasma (PRP) in Hair Density and Diameter in Androgenetic Alopecia (AGA): A Randomized, Double-Blinded, Placebo, Paralleled Group Half Scalp IRB Study, Aesthetic Surgery Journal, 2021;, sjab236
6. Badran KW, Sand JP. Platelet-Rich Plasma for Hair Loss: Review of Methods and Results. Facial Plastic Surgery Clinics. 2018 Nov 1;26(4):469-85.
This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and any related subjects. The views and opinions expressed in this post are those of the author and may not reflect the views and opinions of MDBiologix. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if any treatment is right for you.