Platelet-Rich-Plasma (PRP) for Hair Loss: Dermatologist’s Insights
Platelet-rich plasma treatment became the talk of the aesthetic town overnight when Kim K posted a bloody picture of her face divulging that the secret of her flawless glowing skin is ‘Vampire lift’, a colloquial term for platelet-rich plasma treatment on the face.
But long before Kim K made it a craze, dentists, dermatologists, and orthopedicians have been using platelet-rich therapy for other indications, one of the most common applications being hair loss, especially androgenetic alopecia or male/female pattern hair loss.
In this article, we will talk all about the utility of platelet-rich plasma in hair loss.
What is PRP, and how does it work?
Platelet-rich plasma (PRP) is a regenerative medicine practice involving components of our own blood to stimulate hair growth. Platelets are the cells in our blood that help in clot formation, and they are rich in growth factors.
When released in the hair follicles, these growth factors act on the stem cells to stimulate new follicles and blood vessels. This improves the blood supply of the scalp and increases the density of hair. It also extends the life of hair in the growth phase (anagen), resulting in reduced miniaturization and increased thickness of individual hair.
What kind of hair loss can be treated with PRP?
PRP is used most commonly for androgenetic alopecia, but it also shows decent improvement in almost all cases of chronic hair loss like chronic telogen effluvium. It is, however, not suitable or advisable for the treatment of acute worsening of hair fall (hair loss due to illness, etc.). It is also ideal as maintenance therapy after hair transplantation.
However, it should be noted that the treatment works best in areas with thinning or baby hair. It is not very efficacious in cases with advanced stages of hair loss.
Some data suggest that PRP can also help with autoimmune hair loss like alopecia areata, but the evidence is insufficient to use it as primary therapy.
Does PRP work?
PRP has shown benefits against hair loss both as a monotherapy as well as in adjunct to other therapies like minoxidil and finasteride. It improves the results of other therapies.
PRP can also be used as a monotherapy for someone who doesn’t tolerate or chooses not to go for traditional medical therapies against androgenetic alopecia.
But like any other treatment option in hormonal hair loss, it requires maintenance to avoid relapse, and the success rate is significant, but treatment failures are not rare.
A randomized controlled trial of 23 male patients with hormonal hair loss treated with only PRP for three sessions done monthly showed an increase in the hair density of 45.9 hairs per cm2.
On microscopic examination, it also showed an increase in the number of stem cells, the thickness of the scalp, and new blood vessels after the therapy. Four out of these patients showed a progressive hair loss 12 months after finishing the sessions, requiring maintenance therapy.
In a case series of 54 male and female patients with androgenetic alopecia in the age group 18-44 years, mild improvement was noted in more than 50% cases and a moderate improvement in around 40% after three sessions done at 6-week intervals.
Males were more responsive to the treatment as compared to the female subjects. A follow-up after six months showed reversal of response in around 40% of the patients.
In a split head study with 25 cases of androgenetic alopecia, the cases were divided into two groups: one group received PRP on both sides of the head. One group received PRP on the right half and saline solution on the left.
After 3 and 6 months, the side treated with PRP showed an increased number of hairs in the growth phase (anagen) and hair density.
A comparative study of PRP and minoxidil with minoxidil alone in 50 patients showed better PRP and minoxidil group improvement. Around 23 patients showed moderate to excellent improvement in PRP plus minoxidil group compared to only 12 in the minoxidil group after six monthly sessions of PRP.
However, a head-to-head study between PRP and minoxidil shows that minoxidil produces a better treatment response than PRP alone.
A meta-analysis of 6 studies with 177 patients has further shown that PRP effectively increases hair density (hairs/cm2) and has a mild positive effect on hair thickness.
In a literature review of 12 studies for PRP in the cases of hormonal hair loss, 10 showed successful outcomes, whereas two studies, one of them only with female subjects, failed to notice an improvement in hair growth.
In one of those two studies, however, the treated patients reported a subjective improvement in hair loss and thickness.
What to expect during a PRP procedure?
Since PRP involves extracting the platelet-rich component of your blood to release growth factors, it starts by drawing blood (like in a regular blood test). The blood is centrifuged to separate a layer of platelet-rich plasma, which is then activated to release growth factors.
There are two ways in which this plasma is delivered to the hair follicles:
1. Superficial injections: The platelet-rich plasma can be delivered to hair follicles of the affected areas by multiple small injections superficially, at a depth of 1-2 mm, on the scalp using a very thin needle, a procedure similar to mesotherapy. It is done either manually or with a mesotherapy gun.
2. Microneedling: Another method employs a micro-needling device like a dermaroller or a dermapen to make micro-injuries on the scalp that act as a port of delivery. The plasma is then applied to the area, and it gets transported to the hair follicles through this port.
This method allows relatively less PRP to get to the hair follicles. But the micro-injuries generated through the multiple pricks also initiate a wound healing response, and additional growth factors are sent by the body to the scalp to repair the superficial trauma.
Which method is superior has not been established, and it largely depends on the physician’s personal preference.
You may be asked not to wash your hair for 24 hours to give the micro-injuries enough time to heal.
How often does PRP need to be performed?
Most physicians advise PRP treatment to be done every 4-8 weeks until the hair loss stabilizes, mostly in 3-5 sessions. After the initial set, maintenance sessions are done every six months if required.
How long does it take to see the results of PRP?
Microscopic changes start immediately after the procedure, but to see a visible result, it could take anywhere between 2-6 months depending on the length of the hair, the amount of hair loss, and other therapies.
If you do not see any improvement in 2-3 sessions, this treatment may not be working for you.
How much does PRP cost?
Depending on where you get it done, it can cost you 500-1000 dollars per session.
Side-effects of PRP therapy
Since PRP involves processing one’s own blood to derive the growth factors, there is a minimal risk of intolerance or allergic reactions. The treatment is very well tolerated, apart from a few transient side effects:
In most cases, it could be a lunchtime procedure, and you should be fit for all activities immediately after the procedure.
PRP should be avoided in the following conditions:
Platelet-rich plasma is a safe and effective treatment for mild to moderate hair loss. Although it could either be administered alone as a monotherapy, the best response is seen when it is combined as adjunctive therapy with FDA-approved treatments like minoxidil and finasteride.
However, it should be kept in mind that, like any other treatments for androgenetic alopecia, early beginning and maintenance is the key.