PRP Hair Growth/ Follicle Stimulation therapy

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1) What is Platelet Rich Plasma Injection Therapy?

Paichitrojjana A, Paichitrojjana A. Platelet Rich Plasma and Its Use in Hair Regrowth: A Review. Drug Des Devel Ther. 2022 Mar 10;16:635-645. doi: 10.2147/DDDT.S356858. PMID: 35300222; PMCID: PMC8922312.

Blood consists of plasma and blood cells. Platelets are one type of the blood cells among white blood cells and red blood cells. Platelets carry growth factors that promote cell regeneration and growth.

Platelet Rich plasma is terminology used to describe a growth factor rich serum that is extracted by centrifugation of blood. Techniques are varied but focus on extracting a high concentration of growth factors plasma to enhance the effects of the treatment.

PRP therapy has become a popular treatment for many conditions in regenerative medicine and hair loss treatment as it contains cytokines and growth factors that trigger hair follicle development and maturation as well as stimulating the hair growth cycle.

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2) How is Platelet Rich Plasma prepared for injection into the scalp

Platelet Rich Plasma is extracted from your own blood. It is therefore a product that is completely safe to reinject and will not trigger adverse reactions. This is because it is a fraction of your own blood.

To prepare platelet rich plasma:

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20-40mls of blood will be taken from your arm in the same way as you would have blood taken for a blood test.
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This blood is placed directly into tubes that contain an anti-clotting agent. This prevents the blood from clotting.
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The tubes are placed into a centrifuge and the blood is separated into its component parts.

Your Hair Loss London Consultant will then extract the Platelet Rich Plasma from the centrifuge tubes and administer it via an injecting device into the scalp.

3) Why do we use PRP to counteract hair loss?

Platelets are cells that are involved in healing repair and tissue regeneration. They trigger the release of numerous growth factors and cytokines that stimulate:

1) Cell proliferation (new cell growth)
2) Angiogenesis (new blood cell formation)
3) Stem cell induction (the triggering of the formation of new structures such as hair follicles)

Research has shown that PRP also can increase the survival of hair follicle cells. Many hair loss processes involve the gradual loss and destruction of hair follicle cells through a process of programmed cell death called apoptosis. PRP therapy has been shown to extend the anagen phase of the hair cycle and also increase blood supply to the hair follicles through the process of new blood vessel formation (angiogenesis). Studies have compared the effects of PRP vs Placebo. Even though the mode of action is not fully understood we can see that the stimulative effects on hair growth and density are definitive. At the present moment the benefits of PRP in hair loss are beyond question. The key is in understanding the mechanisms of stimulation in a more detailed way which hopefully will enable more effective treatment.

Mechanisms of PRP action in hair follicle stimulation that have been elucidated are as follows:
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PDGF (platelet derived endothelial growth factor), Transforming Growth Factor β (TGF β ), Fibroblast Growth Factor – 2 (FGF-2), Vascular Endothelial Growth Factor (VEGF), Insulin-like growth factor-1 (IGF-1), Epidermal Growth Factor (EGF) and Glial Cell line Derived neurotrophic factor (GDNF) are all shown to play a major role in cell proliferation, angiogenesis and differentiation that stimulate growth and proliferation of hair follicles.

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Hair cell growth occurs at the dermal papilla. PRP triggers development and proliferation of the dermal papilla cells via ERK and FGF-7 growth factor.

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PRP derived GDNF (glial cell line derived neurotrophic factor) protects hair follicles from premature catagen transition.
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PRP derived VEGF (vascular endothelial growth factor) stimulates an increase in new blood vessel formation around hair follicles and is a potent stimulator of hair growth.

4) What type of hair loss PRP is most effective for?

Function of PRP Androgenic hair loss.

 Female Pattern Hair Loss (FPHL)+ Male Pattern Hair Loss (MPHL)

 Telogen Effluvium (TE)

Active stage (severe hair shedding)

 Telogen Effluvium (TE) Chronic or Diffuse Hair Loss Alopecia Areata (AA) Cicatricial Alopecia (Scarring Alopecia)
Prolongs anagen (growing stage) Prolongs anagen stage (growing stage), but does not block DHT; effective in combination with DHT blockers.

 

Highly effective treatment combination with Dutasteride mesotherapy injections

 Prolongs anagen (growing stage) as a result stops excessive hair loss at early onset of heair loss; highly recommended as combination or solo treatment for active TE Prolongs anagen (growing stage); reduces the chance of loosing hair volume over time.

Recommended as combination or solo treatment for active TE

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Blocks Dihydrotestosterone (DHT) Does not block DHT Not required to block DHT Not required to block DHT Not required to block DHT Not required to block DHT
Reduces inflammatory destruction of follicles n/a unless inflammation process present n/a unless inflammation process present n/a unless inflammation process present n/a Helpsto reduce inflammation as part of clinical treatment regimen
Stimulates collagen production in the scalp Increases dermal elasticity. Improves collagen production.

 

Collagen contains of three main amino-acids proline, glycine and hydroxyproline that aid in formation of keratin and hair growth.

 

The most benefit from PRP treatment will see women with aging hair and postmenopausal

 Increases dermal elasticity. Improves collagen production.

 

Collagen contains of three main amino-acids proline, glycine and hydroxyproline that aid in formation of keratin and hair growth.

 

The most benefit from PRP treatment will see women with aging hair and postmenopausal hair loss

 Increases dermal elasticity. Improves collagen production.

 

Collagen contains three main amino-acids proline, glycine and hydroxyproline that aid in formation of keratin and hair growth.

 

The most benefit from PRP treatment will be seen by women with ageing hair and postmenopausal hair loss

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The table above shows how PRP is effective in various different types of hair loss causes. In the table above the only type of hair loss which is not usefully treated with PRP is Alopecia Areata (AA). In everything else it plays a potent restorative role. PRP therapy is a much more potent hair loss treatment than topical drug therapy alone. When used in conjunction with appropriate drug therapy such as DHT blockers (oral finasteride or injectable dutasteride, oral/topical minoxidil) the synergistic effects on reversing hair loss are potent.

In specialist centres around the world PRP therapy is a potent and evidence based tool in the advanced treatment of hair loss. It is used as part of a combined treatment pathway.

Why is PRP availability and quality inconsistent across organisations that treat hair loss?

In order to perform PRP therapy for hair loss effectively one must have adequate medical training and understand the cause and diagnosis of hairloss.

This requires an appropriate consultation and examination with a hair loss specialist. Blood tests and biopsy will be performed. Trichoscopic examination will be performed. A patient with hair loss requires the cause of their hair loss to be correctly diagnosed. Without this an appropriate treatment plan cannot be formulated. Without appropriate examination and tests carried out by a Hair Loss London Consultant causes of hair loss cannot be appropriately ascertained and treatment may be inappropriate, unnecessary, or even hazardous.

This is why aesthetic clinics that extend PRP offering to hair patients but only offer treatment and no appropriate assessment or diagnosis should be avoided. Before any treatment an appropriate diagnosis of the hair loss condition must be made. Anything else is just guesswork. Whilst in many cases positive effects may be seen it may or may not be required depending on the cause.

Once your case has been seen here by our Hair Loss London Consultant, your Medical History, Diagnostic tests, Treatment Plan and Follow up information is recorded in our system and can be made available to other centres where you may continue treatment without need for repetitive testing.

Essentially hair loss is due to a medical condition. The outcome have a cosmetic implication. However medical conditions require appropriate diagnosis, management and treatment.

5) Is the quality of all PRP therapy the same?

The answer to this question is that it depends on the quality of the extraction procedure. This is explained below.

The process of obtaining PRP will dictate the yield of growth factors and its activity and as a result the efficacy of the treatment.

The Hair Loss London Consultant will draw the blood from the patient. So, the first factor is how much blood is drawn and how many tubes are used in the procedure. It can be 10ml, 20ml or 30 ml as an example.

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The second very important factor is the type of the tube used. There are many centrifuge companies with various price range. Price does not always dictate the quality; however, the more sophisticated centrifuge machine (‘closed system’) and the tube design will be more costly that will reflect in the cost of the procedure.

Then the blood in tubes is spun in the centrifuge. After centrifuging, the Poor platelet plasma (PPP) rises to the top and the Rich platelet plasma (RPP) will be just in the middle with the red blood cells at the bottom. The speed, time and force are important factors in yield of the growth factors and its activity. There fore the type of certrifuge used is very important.

The extractions of RPP if highly important not to lose valuable product and to preserve maximum amount of growth factors and to minimize any debris of red blood cells that may cause inflammation process during the injections.

While using a tube with gel separation technique (most popular) is cheaper and most convenient for the practitioner, this method does not separate Rich platelet plasma (RPP) and Poor platelet plasma (PPP) and may contain some impurities that may trigger an inflammatory process that can result in suppression of hair growth.

Close system PRP is the most sophisticated method of extractions growth factors.

One more advantage of separating Rich platelet plasma (RPP) and Poor platelet plasma (PPP) is due to injection practice into the scalp. Scalp is very sensitive area and not every patient can tolerate injections of growth factors in large volume. Therefore, injecting the most important part Rich platelet plasma (RPP), which is small volume is better experience for the patient. For those patients who can tolerate further injections, Poor platelet plasma (PPP) can also be injected additionally as it contains low yield of growth factors, but still beneficial.

Avoiding Lidocaine blockage anaesthesia due to potential frontal oedema side-effect is advisable.

Therefore, not every PRP treatment is equivalent and will not deliver the same results for a hair loss.

For optimal results a PRP extraction mechanism that allows for a high DEPA score should be used. This is important in ensuring efficacy and consistency of treatment

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DEPA Score is Categorized in Order from A to D
Dose of Injected Platelets (Billions) Efficiency of the Process (Platelet Recovery Rate %) Purity of the PRP (Relative Composition in Platelets %)
A >5 very high dose A >90 high A >90 very pure PRP
B 3–5 high dose B 70–90 medium B 70–90 pure PRP
C 1–3 medium dose C 30–70 low C 30–70 heterogeneous PRP
D <1 low dose D <30 poor D <30 whole blood PRP

What should I ask doctor about PRP treatment before starting the treatment course:

What type of centrifuge system is used?
First essential to retrieve quality PRP is to maximise the recovery rate of platelet. Platelets start to degrade from the point of blood collection. Using very high gage (smaller and thinner needle) of butterfly needle that is used to draw blood is already damaging to the platelets. So, when the doctor is offering the thinnest painless needle to draw the blood, he does not do you a favour. We try to use the least damaging type of needle to the platelets depending on the physiology of the patient.

The speed, time and position of centrifuge is another highly important factor in platelets recovery. We use horizontal centrifuge (not under the angle) to maximise platelets recovery and to minimise mechanical damage to the platelets.

What volume of the blood is drawn and what volume of PRP is injected?
The volume of blood will determine the volume of the PRP extracted and will directly affect the results of the treatment. We use 20-30mls of blood. For most patient we use 25mls of blood.
Are there any impurities in PRP that can be harmful?
Yes, when used tubes containing gel there is a chance of gel impurities to be injected together with PRP. We do not use any contaminants in the tube such as gel to separate the PRP from red blood cells (RBC). Also, red blood cells (RBC) are also considered as impurities. The pure PRP should not contain RBC. Our PRP is gel free and red blood cell (RBC) free.
How would I know is there are Red Blood Cells (PBC) or gel inside PRP?
Avoid PRP gel system. There will be a gel inside the tube separating the PRP from red blood cells (RBC). PRP should be straw colour, not pink as one with RBC impurities.
What is PRF?
PRF is platelets rich fibrin. It is second generation of PRP with higher cumulative release of growth factors compared to PRP. On average from 25ml blood draw we produce 3ml of PRF with 2.74bil platelets.
How do I know if I get a good quality of PRP or not?
The quality of PRP is determined by the concentration and number of platelets. We extract very useful dose of platelets from 3 to 8 billion. From 25ml of blood on average we use buffer coat 1ml with 1.24 bil platelets with PRF of 3ml with 2.74bil platelets in addition to PRP 4ml with 880mil platelets.
Are all PRP the same?
It is not. You should ask your doctor the system they use to understand the quality (number of platelets) you receive per procedure. We inject from 3 to 8 billion platelets in one procedure.
Why do I not get any results from PRP treatment?
The main reason is because you do not get enough platelets injected per procedure. The system is used of poor standards or PRP infected is of low quality. Secondly, you should have full diagnosis of type of hair loss you have before commencing the treatment to determine whether it is an appropriate treatment for you. We advise seeing hair loss specialist for PRP treatment injected into scalp for hair loss problems.
What is recovery rate of platelets in PRP?
The recovery rate is a ratio between the volume of extracted PRP to the volume of blood sample. Our recovery rate is over 80%.

How it works

a) How does this treatment work?
In the appropriate hair loss conditions PRP therapy is delivered to stimulate hair growth by helping hair follicles to revivie and survive. It promotes anagen phase of hair follicles. It prevents programmed cell death or apoptosis of hair follicles. It also increases blood flow to the scalp by generating new blood vessels. This potently stimulates hair growth. Also, it take off scalp inflammation that promotes a healthy environment for hair growth. In Male and Female pattern hair loss it is used in conjunction with DHT blocker therapy to enhance hair regrowth.
b) How do I prepare for the procedure?
Similar to skin microbiome, your scalp microbiome contains a diverse mix of microorganism including bacteria, fungi, and viruses, that exists in one habitat. It is very important that you wash your hair on the day of the procedure or the night before and do not use any cosmetic hair products or oils; your hair is well brushed and not tangled or matted.
c) How long is the procedure?

Generally allow 1 hour for your procedure. On arrival the Hair Loss London Consultant will take pictures of the hair, examine scalp and answer any questions that you may have. Pre procedural reading will be given and is also available on the website to help undersatand your procedure. A consent form will be completed by yourself and the practitioner. The procedure itself will take around 45 minutes. You can get back to your normal daily activities immediately.

d) How many treatments do I need?

The treatment regimen will depend on the type of hair loss that you have. Typically three PRP procedures advised to be completed as part of the initial course of the treatment at the intervals of four to six weeks. Patient will require a follow up appointment to assess further treatment plans. The frequency of which can be determined following analysis of the response to the initial course.

Chronic conditions require ongoing maintenance. These conditions are:

  • TE chronic,
  • Male and Female Pattern Hair Loss
  • Cicatricial Alopecia.

In many cases of chronic hair loss maintenance cycles are typicaly repeated at 6 month intervals. A PRP procedure is typically used synergistically with other procedures. It will be a part of combination treatment with other treatmeents like Minoxidil, Dutasteride or Finasteride.

e) What is the recovery/downtime?
You can resume your daily activities immediately following the PRP treatment.
f) What are the side effects / risks of Complications:
Following the procedure, you may experience some soreness and bruising at the injection sites. PRP injections are made up of your own cells and plasma and therefore it is a very safe procedure and does not carry any significant risks of adverse reaction or complications.
g) What is your next step / What is our process?

If you suspect a hair loss and you are not sure what type or hair loss you have or you know your diagnosis already, we still advise you to book an appointment with our Hair Loss specialist for assessment and diagnosis first:

  • Click on the booking form link
  • Fully complete the booking form
  • By giving us complete information you will help us appropriately assess your concerns
  • Information is not used for any marketing purpose – It is essential medical information
  • Send us pictures of your hair loss for assessment
  • Follow the booking form process and you will be duly contacted by Harriet. She will arrange your consultation.
  • You can have a procedure on the day following appropriate assessment of your hair loss specialist.
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