Published data on PRP for hair growth is limited. Among the research, in 2006, Uebel et al.1, kept follicular grafts in a PRP solution for 15 minutes before implantation. Seven months after follicular unit transplantation (FUT), the researchers noted a 3% to 52% increase in follicular density. In 2011, Rinaldi et al.2, found that PRP reduced diffuse hair loss and stimulated hair growth. In 2012, Kang et al.3, suggested the CD34+ hematopoietic stem cells concentrated using Smart PReP PRP (Harvest Technologies, harvesttech.com) could assist angiogenesis.
Despite a lack of compelling literature, physicians are using PRP with positive results.
In Sarasota, Florida, Joe Greco, MD, of the Greco Medical Group is injecting Emcyte Pure PRP with Cytokine-Rich Plasma and extracellular matrix to prolong exposure to growth factors. His company, OroGen Bioscience, developed a method patent for processing blood to produce Cytokine-Rich Plasma. His treatment technique involves the use of an anti-inflammatory diet, medications, depot injections, and Dermapen microneedling or rollers. He estimates 70% of patients return for additional hair treatments.
In Beverly Hills, California, Baubac Hayatdavoudi, MD, reports success using PRP with follicular unit extraction for hair transplantation surgery in the scalp, as well as PRP monotherapy to increase follicular density and induce anagen in telogen (resting) follicles.
Gordon Sasaki, MD, FACS, co-author of this article, is combining PRP depot injections with Dermapen microneedling to enhance the topical absorption of PRP in the scalp. Microneedling creates thousands of microchannels in the epidermis to stimulate growth and healing. Each microchannel serves as an express conduit for PRP absorption through the epidermis and a center of the cascade of wound healing in an enhanced cauldron of human growth factors. Dr. Sasaki believes that microneedling itself has a positive effect on the early stages of AGA.
Garry Lee, MD, co-author of this article, uses PRP depot injections alone and in conjunction with microneedling, and is in the process of adding medications and LED laser treatments to treat hair loss.
Patient selection is critical for success. Drs. Lee and Sasaki exclude patients with advanced AGA (Norwood V-VII or Ludwig III). This includes patients with traumatic alopecia and autoimmune alopecia, as they may have insufficient adnexal normal tissue to mount an adequate response. The concern with autoimmune alopecia is that even if the healing cascade is stimulated and anagen prolonged, the baseline autoimmune etiology may counter treatment efforts.
Contraindications for treatment with PRP include: significant platelet dysfunctions; hypofibrinogenemia; local infection or septicemia; pregnancy; poor blood clotting; keloid-prone patients; sensitivity to bovine thrombin—if used; and hemodynamic instability.
Prior to treatment, Dr. Sasaki obtains labs including CBC with platelets; serum iron; and estrogen, testosterone, thyroid, pituitary and antibody panels. He follows with photography and computerized microphotography hair count at tattooed alopecic sites.