The application of blood platelets for hair restoration is sometimes difficult to understand in the context of the many hair restoration products available. At our Institute we like to present the science to show you theoretically how this works at the cellular and molecular level. This science comes from leading research institutes and publications.
- PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells.
- The collected platelets are then injected into an area of thinning hair on the scalp.
- These treatments can then stimulate hair regeneration in many people. The treatment is aptly named Platelet Rich Plasma therapy as it is blood plasma that is rich is platelets. Now let’s find out how they work.
Injections of autologous platelet-rich plasma into the scalp represent an interesting alternative treatment for androgenetic alopecia
A February 2021 paper (1) from a team of European researchers wrote: “Androgenic alopecia is a genetically determined and leads to a progressive hair loss of the vertex, affecting both men and women. It is related to an important psychological and social distress. Medical therapies include topical minoxidil, oral 5-reductase inhibitors and estroprogestative drugs with anti-androgen effects for women. The surgical option is autograft hair transplantation. Recently, phototherapy with low-level energy lasers became available. All these treatments may present adverse effects and their effectiveness is questionable. Subcutaneous injections of autologous platelet-rich plasma into the scalp represent an interesting alternative treatment for androgenetic alopecia, as monotherapy or as an adjuvant treatment.”
A May 2021 paper (2) had researchers evaluating 42 studies comprising 1,569 patient cases, including 776 female participants with female pattern hair loss. The findings were that th patients in this study had PRP stimulated hair growth enough to allow the researchers to conclude: “PRP showed excellent efficiency as a novel therapy of female pattern hair loss through hair density evaluation.”
A September 2020 study (3) concluded with the simple finding: “Platelet-rich plasma is a safe, effective, steroid sparing, and suitable alternative in Alopecia areata.”
A June 2018 study in the Journal of cosmetic dermatology (4) reported these findings about PRP for hair loss and how it worked.
“The clinical application of platelet-rich plasma (PRP) is based on the increase in the concentration of growth factors that are released from (the) alpha-granule (simply the container within the blood that holds growth factors) of the concentrated platelets and in the secretion of proteins which are able to capitalize on the healing process at the cellular level. It has been invented to restore the natural beauty by starting the natural rejuvenation process of the skin and aiming to make it function as a younger one and to keep the skin youthful and maintain it. Besides that, it is also emerged to include hairs as a new injectable procedure to enable stimulating hair growth locally and topically; preventing its fall; improving hair shaft, hair stem, and its caliber; increasing its shine, vitality, and pliability; and declining hair splitting and breakage.”
Why another hair loss treatment when there are so many to choose from?
This is what doctors at university medical centers in Greece published their review of PRP’s effect on androgenetic alopecia and alopecia areata seem to suggest At the beginning of their paper, the Greek doctors answered the question posed above: why another hair loss treatment when there are so many to choose from?
Here is their answer:
“Despite available therapeutic options, the search for new, more effective hair restoration treatment is constant. Platelet-rich plasma could be the more effective treatment. . . Growth factors in platelets’ granules of PRP bind in the bulge area of hair follicle, promoting hair growth making PRP a potential useful therapeutic tool for alopecias, without major adverse effects.” (5)
The Greek doctors answered the question. Why PRP as a hair loss treatment? It works.
Platelet-rich plasma “safe and effective alternative procedure” when compared to Minoxidil ®, Finasteride ®
An April 2020 study published in the International journal of molecular science (6) compared Platelet-Rich Plasma use in Androgenetic Alopecia with Minoxidil®, and Finasteride®.
Here are some of their learning points:
- 12 clinical trials were analyzed for the effectiveness of Platelet Rich Plasma in the treatment of Androgenetic Alopecia.
- In total, 84% of the studies (10 of 12) reported a positive effect of PRP for Androgenetic Alopecia treatment.
- The information analyzed highlights the positive effects of PRP on Androgenetic Alopecia, without major side effects and thus it be may considered as a safe and effective alternative procedure to treat hair loss compared with Minoxidil® and Finasteride®.
Another April 2020 study, this one published in the journal Expert opinion on pharmacotherapy.(7) offered similar observations:
- “Androgenetic alopecia progresses over time and although the current available medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves a more optimal outcome. Non-pharmacologic treatments like PRP can be considered in patients refractory to medical treatment.”
PRP VS. Minoxidil ® 5% and PLACEBO
More on Mixoxidil comparisons: Doctors at university medical centers in Egypt compared topical minoxidil 5% and platelet rich plasma treatments for alopecia areata, a disease that results in one or more areas of coin-sized hairless patches.
- Patients treated with minoxidil 5% and platelets rich plasma both have significant hair growth than placebo.
- Patients treated with platelets rich plasma had an earlier response in the form of hair regrowth, reduction in short vellus hair and dystrophic hair unlike patients treated with minoxidil and control.
With these findings the Egyptian doctors were able to conclude that platelets rich plasma is more effective in the treatment of alopecia areata than topical minoxidil 5%.(8)
Doctors at the University of Rome reported their results of a randomized, placebo-controlled, half-head group study to compare the hair regrowth with PRP versus placebo.
- In this study of three treatment cycles, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 33.6 hairs in the target area and a mean increase in total hair density of 45.9 hairs per square centimeter compared with baseline values.
- No side effects were noted during treatment. The data clearly highlight the positive effects of PRP injections on male pattern hair loss and absence of major side effects.(9)
Creating greater hair density and thickness
A study in the journal Facial plastic surgery clinics of North America, November 2018 also found PRP to be an effective treatment in creating greater hair density and thickness:
- “(In numerous studies) Overall positive clinical response to the use of PRP in androgenetic and alopecia areata patients is observed. The effects on hair density, count, and thickness were demonstrated through multiple clinical trials. . . “(10)
At the University of Connecticut, doctors found that PRP showed a benefit on patients with androgenic alopecia, including increased hair density and quality.(11)
Here are the summary learning points of this study:
- After (PRP) therapy, mean hair density/diameter increased and terminal/vellus hair ratio was also improved.
- Patients presented epidermal thickness, perifollicular neoangiogenesis (new blood vessels to fee new hair), cell proliferation, and terminal/miniaturized hair ratio (less pattern hair loss) improvement. Plasma rich in growth factors seemed to reduce the perivascular inflammatory infiltrate (inflammation of the blood vessels that has been linked to hair loss), promote the remodeling of dermo-epidermal tissue, and increase bulge stem cell niches. (Hair follicles have a niche for mature stem cells—hair follicular stem cells (HFSCs)—a so-called “bulge” in the attachment region of arrector pili muscles, (the small muscles attached to hair follicles). (Note: There are stem cells in your hair. They are just not active, PRP can make them active.)
- Patients declared an overall positive satisfaction, and a high clinical improvement score was achieved.
PRP INDUCES THE PROLIFERATION OF DERMAL PAPILLA CELL (HAIR FOLLICLES)
Doctors at the Santosh Medical College in India documented similar findings, in their study in the Asian Journal of Transfusion Science, (12) doctors conducted a study of 10 patients with hair loss. In the introduction of the study the doctors acknowledged that Platelet-rich plasma (PRP) has shown remarkable beneficial effects without any major adverse reactions in the treatment of androgenic alopecia, as did the Greek doctors.
Here is what the Indian doctors found: The growth factors in autologous (your blood) PRP induces the proliferation of dermal papilla cell (Hair follicles). Ten patients were given PRP injections prepared from their own blood on the affected area of alopecia over a period of 3 months at interval of 2-3 weeks and results were assessed. Three months after the treatment, the patients presented clinical improvement in the hair counts, hair thickness, hair root strength, and overall alopecia. They concluded that PRP appears to be a cheap, effective, and promising therapy for androgenic alopecia with no major adverse effects.
In another study from Greek researchers lead by the Democritus University of Thrace, 20 patients, 18 males and 2 females, with androgenetic alopecia had three PRP treatment sessions performed every 21 days and a booster session at 6 months following the onset of therapy. At 6 months and at 1 year, hair volume was significantly increased.(13)
PRP promotes hair growth and increase the number of hair follicles is by inducing angiogenesis
In an October 2017 research study published in the European journal of medical research, doctors confirmed earlier research that suggests one of the ways PRP promotes hair growth and increase the number of hair follicles is by inducing angiogenesis. The formation of new blood vessels that brings growth factors to the scalp.(14)
This agrees with earlier research from the journal Dermatologic surgery suggesting Platelet-rich plasma therapy stimulates hair growth through the promotion of vascularization and angiogenesis (the creation of new blood vessels that brings new blood circulation to the scalp), as well as encourages hair follicles to enter and extend the duration of the anagen phase (the most active growth portion of the hair growth cycle).(15)
In the Journal of cosmetic dermatology, Elghblawi Ebtisam MD, a Libyan Amazagh researcher, published her findings in support of PRP for reversing skin aging and hair restoration. Here is what she wrote in this September 2017 study:
The clinical application of platelet-rich plasma (PRP) is based on the increase in the concentration of growth factors that are released from alpha-granule of the concentrated platelets (the small particles that house a lot of healing growth factors include those that stimulate hair growth), and in the secretion of proteins which make the healing process go and the cellular level. (So in general, you have growth factors released from the platelet particles and directed by protein messages.)
“(PRP treatments) restores natural beauty by starting the natural rejuvenation process of the skin and aiming to make it function as a younger one and to keep the skin youthful and maintain it.
Besides that, it is also emerged to include hairs as a new injectable procedure to enable stimulating hair growth locally and topically; preventing its fall; improving hair shaft, hair stem, and its caliber; increasing its shine, vitality, and pliability; and declining hair splitting and breakage.
PRP proved to promote wound healing and aid in facelift, volumetric skin, skin rejuvenation, regeneration, and reconstruction; improve wrinkling; stimulate hair growth; increase hair follicle viability and its survival rate; prevent apoptosis; increase and prolong the anagen hair growth stage; and delay the progression to catagen hair cycle stage with increased density in hair loss and hair transplantation.”(16)
Dr. Ebtisam’s findings were based on a comprehensive review of the current medical literature.I would like to also point out that was Dr. Ebtisam who was the researcher in the above study calling PRP, “magical”.
In August 2016, a team of researchers from Patna Medical College and Hospital in India also published in the Journal of cosmetic dermatology that Platelet-rich plasma has shown beneficial effects in the treatment of androgenic alopecia with its growth factor properties in accelerating the dermal papilla. In this study the technique of micro-needling was added.
Note: PRP injections followed by micro needling stimulates new hair growth by re-activating dormant follicles and heals the follicle at a cellular level. This results in healthier thicker hair.
In this research from India, patients with mild to moderate androgenic alopecia, aged 18-45 years in the study group were given autologous platelet-rich plasma injections with microneedling over a period of 3 months at 3 weekly interval.
Hair growth started after the first session. Patients’ satisfaction was more than 75% on patients’ subjective hair growth assessment scale.(17)
AFTER SIX PRP SESSIONS
Doctors and researchers from the Department of Dermatology, Hospital Clínic, University of Barcelona, Barcelona, Spain published their clinical findings of six years experience utilizing PRP for androgenetic alopecia.
Utilizing a standard treatment protocol that they had developed, the University of Barcelona doctors reported that after six PRP sessions, they were able to achieve these results:
- In MEN with androgenetic alopecia
- successful outcome in 71.4%
- stayed them same 21.4%
- worsening hair loss problems 7.1%
- In WOMEN with androgenetic alopecia
- successful outcome in 73.4%
- stayed them same 16.3%
- worsening hair loss problems 10.2%
The researchers concluded: “PRP together with a periodical application protocol can be considered effective as a coadjuvant therapy in patients who no longer respond to pharmacological treatments.”(18)
One year later, after PRP, mean hair density/diameter increased and terminal/vellus hair ratio was also improved
Another Spanish university study from May 2017 (19) published new findings suggesting that platelet rich plasma injections played an important role in hair follicle restoration.
In their research, the doctors gave 5 PRP injections to 19 patients with androgenetic alopecia. One year later, after PRP, mean hair density/diameter increased and terminal/vellus hair ratio was also improved. Terminal and Vellus are the two types of hair that grow on the scalp of men with male pattern baldness. Terminal hair is darker, thicker, longer.
In addition patients showed:
- epidermal thickness,
- perifollicular neoangiogenesis (new blood vessel formation in the scalp),
- cell proliferation, and terminal/miniaturized hair ratio improvement. (Miniaturized hair is hair that shrinks over time).
Plasma rich in growth factors seemed to reduce the perivascular inflammatory infiltrate (inflammatory conditions which can lead to hair loss as in androgenetic alopecia ), promote the remodeling of dermo-epidermal tissue, and increase bulge stem cell niches (Hair undergoes a regenerative and rest stage managed by stem cells in a region of the skin known as the “bulge.”) Patients declared an overall positive satisfaction, and a high clinical improvement score was achieved.
Female pattern hair loss
There has been a lot of research suggesting the benefit of PRP in male pattern hair loss. Part of the reasoning is that some research suggest that PRP works so much better for men. But it also works for women.
A study published in February 2019 in the Journal of cosmetic dermatology (20) investigated the efficacy, tolerability, and clinical improvement of PRP for the treatment of female Androgenetic alopecia.
PRP for patients not responding to and minoxidil.
- A total of 10 female patients affected by Androgenetic alopecia and not responding to treatment with minoxidil and/or oral antiandrogens were enrolled and treated with PRP.
- After 12 weeks, the medium hair diameter in frontal area showed a significant increase and after 24 weeks the vellus relative change instead showed a decrease, especially in the front and the central area, while for the vertex, the decrease was mainly visible at the end. (The vellus hair are the short, thin hair that comes in to try to replace the hair that has fallen out. More vellus hair, more hair loss).
- Platelet-rich plasma injections have a positive therapeutic effect on hair density and hair diameter improvement.
Another study in the Journal of cosmetic dermatology (21) found PRP to be an effective therapeutic tool for hair loss in women. Thirty female patients with female pattern hair loss were randomly assigned to receive PRP injections into a selected area, and another area of hair loss and was injected with normal saline as a placebo. Sessions were performed weekly for a maximum total of four sessions. Patients were followed up 6 months after the end of last session.There was a statistical significant difference between PRP and placebo areas regarding both hair density and hair thickness as measured by a folliscope. Platelet-rich plasma injections can be regarded as an alternative for the treatment of female pattern hair loss with minimal side-effects and a low cost-to-benefit ratio.
A January 2021 (22) study offers us an up to date overview of PRP therapy for hair loss and restoration in cases of alopecia.
- “PRP is a safe and easy method for treating hair loss and has limited adverse effects. Optimization of this method depends on dosage, number of sessions and their intervals, and injection techniques. According to the results, the use of PRP due to its relatively high efficiency, low and tolerable side effects, and low recurrence rate can be a good method for the treatment of alopecia and hair loss.”
1 Moreau T, Castronovo C, Kaux JF, Nikkels AF, Paquet P. A new treatment for androgenetic alopecia: platelet-rich plasma injections. Revue Medicale de Liege. 2021 Feb 1;76(2):117-21.
2 Balakrishnan A, Joy B, Thyvalappil A, Mathew P, Sreenivasan A, Sridharan R. A comparative study of therapeutic response to intralesional injections of platelet-rich plasma versus triamcinolone acetonide in alopecia areata. Indian Dermatology Online Journal. 2020 Nov;11(6):920.
3 Zhou S, Qi F, Gong Y, Zhang C, Zhao S, Yang X, He Y. Platelet-Rich Plasma in Female Androgenic Alopecia: A Comprehensive Systematic Review and Meta-Analysis. Front Pharmacol. 2021 May 6;12:642980. doi: 10.3389/fphar.2021.642980. PMID: 34140889; PMCID: PMC8204330.
4 Elghblawi E. Platelet‐rich plasma, the ultimate secret for youthful skin elixir and hair growth triggering. Journal of cosmetic dermatology. 2018 Jun;17(3):423-30.
5 Maria-Angeliki G, Alexandros-Efstratios K, Dimitris R2, Konstantinos K. Platelet-rich Plasma as a Potential Treatment for Noncicatricial Alopecias. Int J Trichology. 2015 Apr-Jun;7(2):54-63. doi: 10.4103/0974-7753.160098.
6 Gentile P, Garcovich S. Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil®, Finasteride®, and Adult Stem Cell-Based Therapy. Int J Mol Sci. 2020;21(8):2702. Published 2020 Apr 13. doi:10.3390/ijms21082702
7 York K, Meah N, Bhoyrul B, Sinclair R. A review of the treatment of male pattern hair loss. Expert Opin Pharmacother. 2020;21(5):603-612. doi:10.1080/14656566.2020.1721463
8 El Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatol Ther. 2017 Jan;30(1). doi: 10.1111/dth.12437. Epub 2016 Oct 28.
9 Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V. The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial. Stem Cells Transl Med. 2015 Nov;4(11):1317-23. doi: 10.5966/sctm.2015-0107. Epub 2015 Sep 23. PMID: 26400925; PMCID: PMC4622412.
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15 Gupta AK, Carviel J. A Mechanistic Model of Platelet-Rich Plasma Treatment for Androgenetic Alopecia. Dermatol Surg. 2016 Dec;42(12):1335-1339.
16 Elghblawi E. Plasma‐rich plasma, the ultimate secret for youthful skin elixir and hair growth triggering. Journal of Cosmetic Dermatology. 2017 Sep 8.
17 Jha AK, Udayan UK, Roy PK, Amar AK, Chaudhary RK. Platelet‐rich plasma with microneedling in androgenetic alopecia along with dermoscopic pre‐and post‐treatment evaluation. Journal of Cosmetic Dermatology. 2017 Aug 3.
18 Ferrando J, García-García SC, González-de-Cossío AC, Bou L, Navarra E. A proposal of an effective platelet-rich plasma protocol for the treatment of androgenetic alopecia. International journal of trichology. 2017 Oct;9(4):165.
19 Ferneini EM, Beauvais D, Castiglione C, Ferneini MV. Platelet-Rich Plasma in Androgenic Alopecia: Indications, Technique, and Potential Benefits. J Oral Maxillofac Surg. 2017 Apr;75(4):788-795. doi: 10.1016/j.joms.2016.10.040. Epub 2016 Nov 15.
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21 Tawfik AA, Osman MAR.Tawfik AA, Osman MA. The effect of autologous activated platelet‐rich plasma injection on female pattern hair loss: A randomized placebo‐controlled study. Journal of cosmetic dermatology. 2018 Feb 1;17(1):47-53.
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