Platelet rich plasma (PRP) treatment isn’t a magical hair loss cure, and it takes from eight months to a year to assess whether it’s working to grow hair. Nevertheless, PRP may be a viable treatment alternative to daily oral or topical medications for patients with compliance issues. It works in half or more of cases, and it’s a potential adjunctive treatment, which might enhance hair transplant surgery and other tried-and-true approaches to hair loss, according to Marc R. Avram, M.D., a Manhattan-based dermatologist and clinical professor of dermatology, Weill Cornell Medical College, New York City.
“In dermatology, PRP is the new treatment option for men and women with hair loss,” says Dr. Avram, who presented on the topic of PRP and hair loss at the August 2017 Masters of Aesthetics symposium in San Diego.
First demonstrated in studies to enhance healing of some orthopedic sports injuries, PRP has been gaining ground in other specialties, including dermatology for hair loss and skin rejuvenation.
“During the last two years, worldwide, there has been a lot of published data that PRP can help maintain or stimulate hair growth in patients,” Dr. Avram says. “We don’t know the mechanism of action, but we also don’t know how minoxidil works. We just know it works.”
Dr. Avram’s experience, approach
In the two years that Dr. Avram has been performing PRP to treat hair loss, he says the approach helps 50% to 65% of patients.
“It’s not a cure for hair loss or a paradigm shift, but it’s an important new treatment option for people with hair loss,” he says.
The treatment is relatively simple and safe, but it’s important to manage patient expectations, he says.
PRP hair loss treatment includes drawing from 20 cc to 30 cc of blood from each patient; centrifuging the blood for 10 minutes to separate the platelet rich plasma; and discarding the red blood cells. Dr. Avram then injects the PRP in the scalp — into the hair follicles where hair is thinning.
He does that once a month, for three months. Then, waits for eight to 12 months to determine, based on the hair growth cycle, if the treatment is working. If PRP treatment is working, Dr. Avram says he recommends patients get maintenance PRP treatment every eight to 12 months. If it doesn’t help, he stops treatment or recommends something else.
Adding PRP treatment to the practice setting isn’t too costly, according to Dr. Avram. To get started, physicians need a centrifuge, as well as a kit for each PRP treatment, to help separate the PRP. Different companies make the kits, and those generally cost from $100 to $400 each, he says.
PRP patient selection
There are other nonsurgical options for hair loss. Propecia [finasteride; Merck] is an effective once-a-day medication that has been approved for androgenetic alopecia, or hair loss, for about two decades. And Rogaine [minoxidil; Johnson and Johnson], is an effective over-the-counter topical, approved and marketed for more than 20 years, according to Dr. Avram.
“They’re definitely still widely used, and we use them in our practice,” he says.
But many hair loss patients don’t want to take a daily pill, and not every hair loss patient is compliant using a daily topical. For some, the treatments don’t work as well as they’d like or at all; for many others, oral or topical medication causes side effects.
All those patients are candidates for PRP, according to Dr. Avram.
The dermatologist says he has yet to see a side effect, including infection or hematoma, in PRP hair loss patients.
“I think it’s safe, but I always tell anybody with any active medical condition to run it by their doctor first to make sure there isn’t a problem,” he says.
There’s a small risk that in some PRP patients there can be a temporary increase in hair loss, according to Dr. Avram.
“We know in the case of Rogaine, that [initial hair loss] means they’ll do very well with Rogaine. It means they’re turning their hair growth cycle over faster; so, it’s usually a very good sign. We can’t say that about PRP just because I haven’t seen it enough to really know. I don’t think anyone has long-term experience, yet,” he says.
Setting patient expectations
Hair loss patients considering PRP treatment should know it’s not FDA approved for hair loss. They also should be prepared to wait for results that might not happen, according to Dr. Avram.
Still, he says, many will opt for the seemingly safe treatment that uses their own blood and doesn’t require long-term daily oral or topical medication compliance.
Dr. Avram says that, in some cases, he’ll combine PRP with the topical or oral hair loss treatment. However, it’s not yet clear if the addition of PRP enhances results in either case.
“I do hair transplants. And PRP has been done in conjunction with hair transplants because it may help the hair grow in quicker,” he says. “Now, the jury is out on that. In the future, PRP may have a role as an adjunct to hair transplantation.”
