PRP for hair loss. Dr. Gary Linkov talks about non-surgical hair loss treatment. He explains how PRP works and if it is an effective way to stop hair loss and promote hair regrowth.
Video Transcript:
Today we’re going to talk about PRP for hair restoration. You’ll find out what it is and if it’s the procedure to help you with your hair loss.
At the end of the video I’ll be talking about a new technique to deliver PRP in a very novel way, and I published on this just last year so stay tuned till the end and I’ll show you what it’s all about (hint it’s completely painless).
So PRP stands for platelet-rich plasma and it’s all about concentrating platelets, and this was originally used for the treatment and prevention of blood loss; both in surgery and for other types of medical conditions where one experienced blood loss. And it’s still used for some of those purposes today.
There are also many other applications now in numerous specialties that implement PRP for various rejuvenation and healing modalities and applications.
The platelets contain a high concentration of growth factors. As the platelets open up they release these growth factors and we’re going to flash on the screen some of these different types of growth factors. And what they’re doing is stimulating cell proliferation, matrix remodeling. and angiogenesis which is the growth of new blood vessels.
How does PRP generally work?
Well, you start off with collecting whole blood; so basically a regular blood draw from the person and it’s processed in a centrifuge. Centrifuge is a machine that spins at very high speeds and it separates out the different components of blood or anything else you put into there into different densities. So depending on the density of what’s inside the blood it’s going to separate out. And once you have that separation you can then isolate the platelets which are in what’s called the buffy coat and then that gets delivered into the scalp.
This type of treatment PRP for hair loss is administered typically one month apart for three sessions. So that’s for three months total one month apart and that’s considered the initiation phase. Then every three to four months you come back for another treatment and that’s considered the maintenance phase.
This type of treatment for hair loss does require maintenance in order to maintain results. So if you want to continue to see results of hair improvement, you need to keep doing the PRP. It’s not a one and done type of treatment.
So in this picture here I want to show you the separation of whole blood. So when you get the blood from the vein, you spin it down and you get this initial separation where you have platelet-poor plasma so that’s this yellowish type of component that’s almost like a see-through type of substance it doesn’t really have any major cells in it. Then you have the buffy code that’s what the BC there is for and that’s where you have your primary concentration of the platelets. And then you have the red blood cells and that actually gets discarded because that’s not what you’re using to promote hair restoration.
So once you discard the red blood cells you have platelet poor plasma and this buffy coat and sometimes you still have some red blood cell component left behind and different systems will concentrate the platelets to varying degrees and we’ll talk about that.
So what about the efficacy of PRP for hair loss?
Well, there was a systematic review in 2018 from Harvard that showed that out of 24 studies 21 actually reported positive outcomes using PRP. With outcome measures that range from photographic assessments to hair counts and hair density evaluations.
It has been shown to help in androgenic alopecia, which as you all know from my videos, is the most common type of hair loss in men and women. And PRP can also help in isolated alopecia areata, not my type of alopecia areata which is universalis, which is a more aggressive type, but in isolated cases where you have a couple of patches of persistent areata spots of hair loss in a circular pattern you can use PRP and it has been shown to help accelerate the regrowth of hair.
Now this PRP for hair mainly helps with hair thickness, but it has also been shown to improve hair density and has been shown to help reduce shedding as well. And so for studies that have evaluated hair density and hair diameter, the average increase in those parameters across the literature ranges from about 15 to 50 percent.
Which PRP system is best?
Well, some systems do an initial spin that separate out the red blood cells from the plasma and the buffy code, as I showed earlier, and other systems take an additional step that will further concentrate those platelets even more. There are many parameters to consider when trying to choose a PRP system; that includes how much blood volume is needed, the centrifuge size, the collection method, the content of the concentrate, and the primary factor is what is your platelet concentration at the end of the preparation of the PRP. The higher the platelet concentration, presumably the better stimulation of hair to grow and to improve.
Now this figure here shows you all the different factors that one can consider when on the physician side you’re choosing to buy a PRP machine, or on the patient side you’re trying to decide which provider do I go to based on maybe the type of machine that they have. So these are the different factors you can look at, but the platelet concentration is a very important one.
Let’s look at the comparison of various PRP systems that are out there on the market because there are many of them. There is a study in 2019 that assess 33 PRP systems for hair restoration, and what they found was that the EMCYTE system, emc yte, generated the greatest platelet concentration out of all the systems that they tested. And that was at 1643 times 10 to the third platelets per microliter.
So I use this system primarily because of this study and because it’s a well-known system that produces consistent results. And I use the dual spin 6d cc m site kit in my practice and we concentrate the platelets in a certain amount of volume based on which area of the scalp we’re injecting or delivering the PRP to. And we’ll show you a brief clip of me doing this procedure from some of our prior videos that we have out on the web.
So now I am extracting the platelet rich plasma into this other syringe and I’m leaving all that heavy red blood cell stuff behind and you can see it right there. There’ll come a point where the red stuff starts to come up faster and that’s where we seal it off. Right there.
So we’ve now treated this entire area here, the mid scalp, the parietal scalp, and the crown area. Now we’re going to focus in on this frontal scalp area. You can see here I’m going in and really watching for these blebs that are forming.
There are two main types of delivery mechanisms for PRP. You have one that uses needles and then there’s a newer method that is needless. And that’s what I was hinting at the beginning of the talk.
So let’s go through the most common type of way which is with needles. Most people are using needles to get the PRP into the scalp. The variables here are numbing. Is your doctor or your provider using some form of numbing whether it’s topical or an injected type of numbing to get you comfortable before they put the PRP to your scalp?
I personally in my practice when I’m doing needle technique, I do a ring block which is similar to what we do during hair transplant surgery, but basically a block around the scalp assuming we’re treating the entire top and crown and the whole bit of the scalp. Then I’ll do that type of block. If I’m just treating the frontal scalp for example or the temples then we’ll do a more limited block, but I like to numb the scalp with an injection of lidocaine prior to doing PRP.
Some people just use topical VLT cream or some sort of numbing topical and others actually don’t numb at all. So they just go for it with the PRP and that’s one way to do it. There’s also the way that you clean the scalp. So I like to use betadine for most of my needle techniques, but again people use different solutions to clean the scalp.
Then there’s the injection technique some people go just into the dermis of the scalp some go deeper into the subcutaneous level. There’s no reason to go too deep like onto the periosteum of the scalp because there’s no that’s not where the follicles live they live at most about four millimeters or so under the skin surface. But what’s been shown is that even a very superficial injection right into the dermis has a lot of benefit and works just the same if not better than a deeper injection towards where the bulb of the follicle actually lives. Which is interesting and which is also why needless PRP seems to work, but more on that later.
Then microneedling post PRP is something to also consider. I personally like to do that so I do a little micro needling technique at the end of the PRP injection. Not everybody does that. And then the way that the needles are placed into the scalp are can be different too, the size of the needle, there are also these multi injectors that you can see here and they allow for again kind of a more rapid injection because there are many different needles where the pierpew comes out of at once.
So this jetpl needless PRP study. That’s something I published on last year in 2021 and the jetpl machine is a machine that combines oxygen with any other type of liquid into a jet that incorporates this type of solution into the skin through little micro channels at subsonic speeds. So this was a pilot study of 14 patients and what was interesting is that 86% of the patients actually showed improvement in the overall hair restoration based on standardized photo scales.
On the questionnaire that we gave patients at the end of the study, 93% of patients stated that they would recommend this treatment to others. And the overall satisfaction score in this study was 81%. So this is something that you can go and read and we’re gonna you know put it into the description and flash it up on the screen.
The best part of the needleless system is that there’s absolutely no pain. And that’s its biggest advantage. And of course we need more studies on this this is just a pilot study, but the technique is definitely showing a lot of promise and many patients come to my practice asking for this.
And this is a picture here of what the machine looks like and what the hand piece looks like. So the PRP in the syringe actually gets twisted on onto the side port of this hand piece and then we hold the nine degrees we have a clip here that we’re going to play. And you’ll also see here some of the results from the study as well.
So is PRP for hair loss safe?
Overall yes, it’s very safe. In dozens of studies there were actually no complications reported other than some transient edema erythema which is just some redness to the scalp mainly with the needles and occasionally some pain and headaches associated with the procedure that usually go away if not the next day than the day after. Some absolute contraindications meaning reasons for not doing PRP for the scalp would be platelet dysfunction, very low platelet numbers, and active infection. Either on the site where you have to get the blood or on the scalp or obviously some blood-borne infection.
Relative contraindications; things that you might have that you might like think twice about getting PRP or or your provider might not want to do it as if you’re on anticoagulation, if you have systemic steroids on board, if you have a bone or blood cancer, and also if you have relatively low platelet numbers.
So now something that people ask me about is PRF; platelet rich fibrin. So what is that? So the blood is collected without any anticoagulant for PRF, and it’s immediately centrifuged. The platelets are activated in this process and they form this congeal type of matrix. And this is a natural type of coagulation process so it’s generally simpler and less expensive to do than PRP. It’s useful for generating this thick type of glue-like substance; this matrix that can be useful for surgery and for some wound healing applications, but it’s less useful for hair restoration.
When you need to actually deliver this through the scalp so it’s better in that situation to have an anticoagulant on board and to process it through one of these special kits and that’s where we get into the PRP. So PRF you can see in this picture it forms this almost like a clot a pretty thick cloth you can see a forcep holding this clot up. Not terribly useful for hair restoration and there are no studies that show that PRF is any better than PRP for hair.
How about using PRP during a hair transplant?
Is that effective? Well, in my practice the focus when we do PRP with a hair transplant is actually to reduce shock loss of the existing hairs in that recipient area. So if you already have a lot of miniaturized hairs we like to do the PRP with the hair transplant to actually try to save those hairs so they don’t fall out because we traumatize the area implanting new hairs.
And there was a study in 2016 that looked at 40 patients when PRP was added to the recipient side during a hair transplant what they found was that there was a faster growth of transplanted hair. There was a reduction in the catagen loss of transplanted hair. That’s that period of time after a few weeks of a hair transplant that the hair shafts actually fall out. So they found that there was a reduction in that, and there was a faster skin recovery, and there was an activation of the dormant hair follicles in that vicinity.
So all interesting things and so I think PRP during hair transplant definitely has a role in the right patient. If there’s an area that has absolutely no hair and you’re transplanting hair into it doing PRP is really not going to do a whole lot.
Is PRP better than finasteride for men with androgenic alopecia?
Well, finasteride and minoxidil in men is still the first line treatment for androgenic alopecia. PRP is a reasonable second line treatment if someone cannot tolerate one of those other medications or if they don’t even want to try it. It does work better with certain people’s schedules. Some people don’t like taking pills or applying topicals every single day, they rather come in every three to four months for a PRP injection. I don’t see it as a replacement to finasteride or minoxidil, but it can be a nice adjunct and sometimes for certain people can be something that they can do instead of doing nothing for their hair.
Now that you know what PRP is and how it works you need to watch this video to find out what minoxidil is and how it’s useful for hair loss; another non-surgical way to help get your hair back.
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