What is Platelet Rich Plasma PRP

One of the most talked about “new” hair restoration treatments is Platelet Rich Plasma or “PRP.” Although it may be somewhat new in the field of hair restoration, PRP has been used as a healing and growth agent in surgeries for decades. It first rose to prominence in orthopedic joint surgeries. Orthopedic surgeons sought ways to help speed recovery after surgery and encourage new tissue growth in worn joints, so they began to inject patients with the PRP serum.

To create the serum, the doctors first draw a small amount of blood from the patients; they then “spin” the blood several times in a centrifuge device to separate the different particles in the blood. This process separates the blood into one concentrated portion “rich” in platelets (the element of blood responsible for clotting) and another portion “poor” in platelets – meaning it contains a very small amount of the platelets and instead is comprised of the other elements of blood (water, red blood cells, inflammatory agents, proteins, electrolytes, et cetera). The concentrated platelet fraction or the “platelet rich plasma” is then drawn up into a syringe and reinjected back into the patient.

But why? How would a patient’s own blood platelets aid in healing and tissue repair?

The process of concentrating the platelets also concentrates growth factors associated with and contained within these platelets. These include growth factors responsible for tissue growth, blood vessel growth, and new tissue development.  After showing promise in orthopedic procedures, doctors began investigating the use of PRP in oral surgery, general plastic surgery, and, eventually, in hair restoration.

PRP was first used as a hair restoration treatment around 2008. At the time, a small group of dedicated hair restoration doctors began slow experimentation with the treatment. Results were initially positive and many believed it would serve as an excellent adjunct treatment for hair loss sufferers. This initial positive response led to an explosion of practitioners offering PRP scalp injections to patients. As more patients were treated and more data became available, it became clear that PRP was not the panacea treatment it was once thought to be. While PRP can create a temporary improvement in a select subsect of patients, it does not work the same for everyone and the time at which the benefit is seen is extremely variable. Furthermore, recent studies have revealed that the immense variation in how the PRP is prepared and applied make the results even more inconsistent across the board. Almost every doctor has their own protocols when it comes to the amount of serum utilized, the way it is prepared, the centrifuge used the prepare it, the amount rejected into the scalp, the frequency of which it is injected (a small number of larger injections or a greater number of smaller injections), the depth at which it is injected, and whether or not it is “activated” – meaning the platelets are purposely “lysed” or ruptured using a needle to puncture the scalp after injection or by using an active ingredient in the preparation process. There is also debate and variation as to whether or not adding an extra cellular matrix medium like “ACell” helps the results or makes them last longer.

Patients considering PRP should be aware that, in our considered experience, only a small subsect of patients may see a benefit from PRP. Furthermore, that benefit is temporary (usually lasts 3-6 months). Most importantly, repeated injections and needle-related trauma to the scalp does cause inflammatory scar build-up under the skin (“fibrosis”) overtime. This damaged tissue is unhealthy and its presence may worsen or cause greater amounts of hair loss. Therefore, those seeking PRP may be leveraging a temporary benefit now for a worse, and permanent, outcome in the long-term. Because of this, we do not offer PRP at our clinic.