Androgenic alopecia (AA) is one of the most prevalent aesthetic concerns, affecting an estimated 30% of men over the age of 40. Building on the potential promise of platelet-rich plasma (PRP) to reduce hair loss, I have developed a new technique that involves injecting a bolus of PRP into the subcutis to reverse the effects of AA. The technique—which I refer to as Rapaport Subdermal Depo PRP Injection—has become one of my favorite and most gratifying cosmetic procedures, as I see immediate changes in my patients’ emotional states once their hair is improved.
As with any cosmetic procedure, patient selection is extremely important. Patients with AA whose hair loss occurred within the past three years benefit most from this procedure. A thorough consultation must be performed to avoid treating those who have telogen effluvium, scarring alopecia, infections, inflammation or other nonviable diagnoses.
Patients are instructed to consume 45 ounces of water with sea salt the day before the procedure to make blood draw easier. We also ask that they wash their hair on the day of the procedure to remove any fibers, hair spray or spray coloring. To assess the level of hair loss at baseline, we take global photos of the patient’s head as well as dermatoscope photos to measure the hair shafts, follicles and hair density.
The patient’s blood is drawn into a 22ml tube—usually one is enough for the procedure. Extreme caution is taken in the labeling of their blood. We use a single spin technique (2,950 rpm for 12 minutes) to produce the plasma. The platelet-poor plasma is removed, leaving behind a concentration of four to five times the normal plasma concentration of platelets.
The key to this procedure’s success is the injection technique. I inject the PRP below the level of the skin into the subdermal space, which houses the bulb of the hair follicle. This causes the bolus to slowly diffuse out at the level of the bulb. To reach the subdermal space, I inject the syringe to the periosteum then pull back until there is a lack of resistance.
In addition to allowing me to deliver PRP more directly to the bulb of the hair follicles, the physiological space in the subdermal layer creates less resistance to injection, making the procedure more comfortable for the patient. If you are in the wrong plane, the patient will feel more pain. While there is little danger to injecting above or below the subdermal space, I believe the injections will be less effective and may cause more trauma to the areas treated.
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