What is PRP or Platelet Rich Plasma Therapy?
Platelet Rich Plasma (PRP) therapy (aka the vampire treatment) is a new “off label” treatment for hair loss conditions such as alopecia areata (‘spot baldness’) and androgenetic alopecia (male pattern hair loss and female pattern hair loss), do you see me.
What Happens During PRP Treatment?
Platelet Rich Plasma Therapy can be broken down into three main steps.
Step One: Retrieve Plasma
Obtaining plasma, a component found within blood, is the main goal of this step1. This is obtained by removing a small amount of blood from your arm. The amount of blood needed is only a fraction of what is taken when you donate blood.
Step Two: Activation of Platelets
Platelets located in your drawn blood are then concentrated2. Activated platelets are used in PRP as they contain healing properties and growth factors. Growth factors can encourage hair growth as they help in the development of new blood vessels and can promote the survival of hair follicles3.
Step Three: Injection
The last step of PRP is to inject these activated platelets into hair loss areas.
Advantages of PRP
- PRP can encourage hair growth in a wide range of hair loss conditions such as alopecia areata and androgenetic alopecia.
- PRP can be combined with hair transplantations or can be used as a solo treatment.
- No oral or topical medications are required to perform PRP treatment.
- PRP can help preserve hair grafts during hair transplants.
How effective is PRP?
The effectiveness of PRP on hair loss has been evaluated in numerous studies. In one such study, PRP treated alopecia areata patients achieved greater hair regrowth as compared to patients without PRP treatment (N=45)4. Complete remission of alopecia areata was found in 60% of these PRP treated patients4.
How does PRP compare to other non-surgical hair loss treatments?
The effectiveness of PRP has been directly compared to other hair loss treatments. In a placebo controlled study, regrowth in PRP treated patients occurred earlier than minoxidil treated patients5.
What Conditions Can PRP Be Used To Treat?
PRP can also be used in many different medical fields such as sports medicine, dentistry, aesthetics, hair restoration, skin rejuvenation and orthopaedic surgery6–8.
The use of PRP as an adjuvant treatment during dental reconstruction can help aid in tissue regeneration by providing a microenvironment that supports regrowth9. PRP can also help encourage dentinal thickening when applied during dental surgery10. Dentinal is the bony tissue that teeth are made of10.
In addition, the application of PRP during dental reconstruction can help heal injuries created to the tissues surrounding the root of the tooth (periapical healing)10. PRP may not however significantly improve the outcome of sinus lift procedures (bone added to your upper jaw) as evident in several recent meta-analyses11,12.
Platelet concentrates are thought to be helpful in bone regeneration as they can contain bone healing and regeneration properties such as fibroblast growth factors, vascular endothelial growth factors, insulin-like growth factors13,14. PRP treatment has shown some success in patients with carpal tunnel syndrome, rotator cuff tears and osteoarthritis15–17.
In addition, PRP has been reported to improve skin texture and skin elasticity18,19. In a study of 12 healthy patients, improvements in skin elasticity, smoothness, and scaliness were obtained after 3 sessions of PRP injections18. In an additional study, PRP was reported to improve skin firmness and reduce facial wrinkling without altering facial pigmentation20. These findings suggest that PRP can help reduce the clinical signs of ageing.
PRP has also been successfully incorporated into facelift procedures, increasing fat graft survival and encouraging stem cell growth21–23. PRP in combination with fat grafts have yielded high patient satisfaction rates when used during facial lipostructure surgery24,25. PRP has also been used in cartilage-related conditions, tendon disorders, meniscus-related conditions, and ligament disorders26. Evidence collected across several sport injury studies suggests that PRP treatment can help injured athletics return to the field earlier when compared to control treatments such as placebo and rehabilitation27.
Platelet Rich Plasma Treatment Encourages Hair Growth
The platelets that are concentrated from plasma can also provide healing properties and growth factors that encourage hair growth28-29. PRP has shown very promising results for hair loss patients. In a study conducted in 2015, hair loss regions of 23 patients were treated with PRP or placebo30. After 3 months, a higher hair count was found in PRP treated hair loss regions (a 33.6 hair increase) as compared to placebo-treated regions (a 3.2 hair decrease)30.
PRP can also increase terminal hair density (terminal hairs/cm2)30,31. Terminal hairs are fully matured follicles that are thick and pigmented. In comparison, vellus hairs, which can be present in patients with hair loss disorders, are short, slightly coloured hairs. An increase in terminal hair density was achieved by end of treatment in two studies that used 3 sessions of PRP30,31.
PRP Patient Photo Gallery
Encouraging Long Term Results
Similar results have also been found in long term studies. For instance, in a study of 22 androgenetic alopecia (AGA) patients, PRP treatment enhanced hair density 1 year post treatment, as compared to baseline measurements32.AGA is a common hair loss condition where hair follicles shrink (miniaturize), affecting both men and women33.In this study, most patients (85%) noticed an improvement in hair quality and were satisfied with the results32. No major side effects were reported, although patients did notice some pain and scalp sensitivity32.
PRP can Also be Used in Patients with Alopecia Areata
PRP has also been shown to be effective in alopecia areata (AA) patients34,35. AA commonly presents as hair loss patches (patchy alopecia) and can lead to complete scalp hair loss (alopecia totalis) or total body hair loss (alopecia universalis)36. In a recent study, 45 AA patients were treated with three different treatments; PRP, a topical corticosteroid (triamcinolone) and placebo4. Hair regrowth was significantly higher in PRP treated lesions as compared to placebo and triamcinolone treated lesions4. Complete remission of AA occurred in 60% of the PRP treated lesions, a much higher success rate than triamcinolone treated lesions (27%)4.
How does PRP work in AGA patients?
In androgenetic alopecia (AGA), the normal cycling of hair follicles is changed, and the resting phase (telogen) lasts longer than the growth phase (anagen), causing the hair follicle to miniaturize.
Further, dihydrotestosterone (DHT) is often elevated in AGA, which also contributes to reduced hair growth37. DHT acts on cells found at the base of hair follicles and inhibits the follicle from moving from the resting phase to the growth phase38.
Through preventing pathways, such as the Wnt/ß-catenin pathway, DHT can also reduce hair growth, cell survival, proliferation and angiogenesis (new blood supply)39,40.
PRP platelets contain many growth factors, including insulin-like growth factor 1 (IGF-1), platelet-derived growth factor (PDGF), transforming growth factor-ß (TGF- ß), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and fibroblast growth factor (FGF) can help combat the effects of AGA41,42.
These growth factors interact with cells in the hair follicle. These interactions activate a process (ß-catenin pathway) within the cell that encourages the growth of new blood vessels, cell proliferation, stops cell death, cell growth, cell survival and transition of hair from resting phase to growth phase43.
Comparing PRP to Other Available Hair Loss Treatments
Platelet Rich Plasma can provide a more inclusive hair restoration alternative as compared to other hair loss treatments. For instance, finasteride, an FDA and Health Canada approved hair loss treatment, can be quite effective in alopecia patients, resulting in increased hair counts in placebo controlled trials44,45.
However, finasteride’s applicability is limited as this oral therapy is only approved for hair loss in men and several adverse effects have been reported (e.g. sexual dysfunction)44,46. PRP, on the other hand, has been associated with no major side effects and has been successfully used off label in both men and women5,32.
In addition to finasteride, minoxidil is another non-surgical option available and is approved to treat both men and women47,48. Minoxidil, as a treatment of hair loss, is only available in a topical format (solution or foam) which can contain skin irritants49. PRP, on the other hand, is a non-allergenic procedure as activated platelets are created using a person’s own blood to encourage hair growth. Studies have also suggested that PRP may produce desired results faster than minoxidil treatment.
In a recent study, minoxidil was directly compared to PRP using 90 AA patients5.Three treatment groups were used in this study; 30 patients were treated with minoxidil (5% twice daily), 30 patients were treated with PRP (injections every 4 weeks) and 30 patients were treated with placebo5. Of the different AA types (e.g., patchy alopecia, alopecia totalis, alopecia universalis), PRP was most successful in re-growing hair in patchy alopecia patients5. Regrowth in PRP treated patients occurred earlier than minoxidil treated patients5. Additionally, as compared to minoxidil and placebo treated patients, PRP treated patients had fewer alopecia areata characteristics (yellow dots and less short fine hairs) posttreatment5.
Platelet Rich Plasma Treatment + Hair Transplantation
PRP can also be used in combination with hair transplants50. Hair follicles that are being transplanted are susceptible to dehydration and injury51. Mixing PRP into hair graft storage solutions may help preserve grafts and encourage follicles to be in an actively growing state43,52. PRP treatment during hair transplants can also help to promote tissue repair and minimize scar formation53.
During follicular unit transplantations (also known as a strip), a strip of hair follicles is removed during the procedure creating a linear scar. This can become an issue for patients that want to keep their hair short. With PRP application during strip surgeries, this scar could become less noticeable.
PRP can also be useful in follicular unit extraction (FUE) procedures. In FUE hair follicles are removed individually from the scalp during harvesting, this avoids the linear scarring created by the strip procedure. Encouraging results have been found in a recent PRP study using 40 FUE transplant patients54. In this study, 40 male AGA patients were treated with or without PRP during their FUE procedure54. One month after transplant, a greater number of PRP treated FUE hair transplant patients (12/20) experienced an increase in hair density (>75%) as compared to untreated (no PRP) FUE patients (0/20).
PRP may also be applicable in scarring alopecia (cicatricial alopecia), a rarer form of hair loss. In this condition, the hair follicles are so severely damaged that permanent hair loss occurs55. In a case study, a 24-year-old patient with lichen planopilaris (a scarring alopecia condition), underwent FUE combined with PRP followed by minoxidil application (twice daily)55. Ten months after treatment, approximately 80% of the transplanted grafts survived55.
Limitations with PRP Studies
PRP has been found to encourage hair growth in a number of studies as a single therapy for hair loss as well as in combination with hair transplantations. Comparing across PRP studies may be difficult as the exact steps taken during the PRP process are not always the same56–60. Creating standard PRP methods can help address this issue. Across PRP in AGA patients, most studies have short follow up periods (3-6 months) with very few studies evaluating past 12 months30,32,57,61.
Increasing the length of time patients are followed up with can showcase how many PRP treatments are needed to achieved desired results. Additionally, more research into the applicability of PRP in scarring alopecia patients is needed as large scale studies have not yet been conducted.
Frequently Asked Questions about Platelet Rich Plasma
1. What is PRP?
PRP stands for platelet-rich plasma. PRP can be summed up in three main steps:
- A small amount of blood is removed
- Platelets are concentrated
- PRP is injected
2. How does PRP work?
PRP solution contains platelets which break down to release growth factors and cytokines28. These molecules interact with cells in hair follicle and surrounding tissues to activate a process that encourages:
- Cell survival
- Cell growth
- Cell proliferation
- Growth of new blood vessels
- Stops cell death
- Transition of hair from resting phase to growth phase
3. Is PRP just a hair loss treatment?
No. PRP treatments are used in a wide array of fields such as sports medicine, dentistry, aesthetics, hair restoration, skin rejuvenation and orthopedic surgery.
4. Are there any side effects to PRP treatment?
There are no major side effects that have been reported. Some temporary pain, discomfort and scalp sensitivity may occur32. PRP is considered a non-allergenic procedure as the patient’s own blood is used.
5. What should I expect after my first PRP session?
You may notice an initial increase in hair shedding. This is evidence that the PRP solution is helping move your hair follicles into the next stage of the hair cycle.
6. How many treatments do I need?
The number of treatments required may depend on how severe your hair loss is69,70. A consultation can help gauge the number the treatments you may require.
7. How can PRP help my hair?
8. How does PRP compare to other alopecia areata treatments?
In alopecia areata studies, PRP treated patients achieved hair restoration results faster than minoxidil and triamcinolone acetonide treated patients4,67.
In a randomized, placebo-controlled study, almost all PRP treated patients (96%) achieved fully pigmented hair at the beginning of hair growth whereas only 25% of triamcinolone acetonide treated patients achieved pigmented hair4.
It has also been found that PRP treated patients are able to achieve hair regrowth earlier than minoxidil treated patients5.
9. How does PRP compare to other androgenetic alopecia treatments?
Based on data collected across several studies, the mean change in hair count induced by PRP may be equivalent to the results found with finasteride, minoxidil and dutasteride71. Further research using head to head studies is required to confirm this result.
10. Can PRP be used in scarring alopecia?
The anti-inflammatory properties of PRP may be of value to scarring alopecia patients however large scale studies using scarring alopecia patients have not yet been conducted.
Promising results from a recently conducted case study suggests that PRP may be helpful in hair transplantations, reporting a high graft survival rate (80%) 10 months after treatment72.
11. Where Can I Get The Platelet Rich Plasma Treatment?
At our hair transplant center, Sure Hair International
and the (Dr. Aditya Gupta and Dr. Cam Simmons), we have obtained very good results with PRP as either a stand alone therapy for hair loss or in conjunction with FUE or FUT hair transplants. If you would like more information please give us a call at 416-747-7873
or simply fill out the form below to sign up for a Free Online Consultation.
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