Alan J. Bauman, M.D., and other hair experts offer advice to help guide providers on developing an optimal PRP process.
This is part 4 in a 4-part series
It’s not entirely clear how aesthetic doctors can optimize PRP preparation as a hair restoration treatment, but Dr. Bauman believes quality matters.
“Some popular PRP kits and preparation or separation methods we tested and tracked yielded low platelet counts that can result in sub-optimal results,” he says.
“We think of PRP as platelets in plasma, but there are a lot of other cell lines,” Dr. Hausauer says. “It’s much more complex and the ratio of cells types matters. There are red cells and white cells in addition. And we are only beginning to understand what concentrations of these, if any, should be incorporated. There are still many research questions and work to be done to optimize and standardize the solution injection. This will help ensure more consistent patient results and satisfaction.”
There are important clues that can help guide providers on developing an optimal PRP process. All of these systems are used off label for this indication and generally fall into two basic categories.
One is the buffy-coat system, initially designed for orthopedic surgery. Buffy-coat processing involves spinning blood twice.
“It layers out by the weight of the different cells in the solution, so there’s nothing dividing all of the different cell lines,” she says. “The platelets tend to hang out in the middle portion. That middle portion also has a lot of white blood cells.
Single-spin gel systems use smaller test tubes. Aesthetic practices often use these PRP systems because they were designed for point-of-care and use smaller volumes of blood, according to Dr. Hausauer.
“The gel in those tubes actually provides separation, so it holds the red cells and the white cells below and the platelets and plasma sit above,” she says.
Dr. Callender uses the Eclipse PRP (Eclipse) system, which is an FDA-cleared single-spin gel system for PRP processing. She says most dermatologists use that system, and she finds it easy to use.
Dr. Hausauer, who used Eclipse’s system in her research and currently uses it in her practice, says the separation of cells is a benefit because white blood cells contain a growth factor or signaling molecule that the hair follicle uses as an indicator to go into a resting phase.
As a result, she tries to use a system that minimizes the white blood cells in her PRP concentrations but still provides a sufficient platelet concentration. Having fewer red blood cells is also a plus, because the red blood cells change the pH of the solution and can cause burning and discomfort during treatment. Discomfort associated with treatment is a big complaint based on what patients say about their experiences on the internet.
“In my hands, when you use something that has the right proportion of cell lines and inject it in the right manner, the average pain score is 2 out of 10,” Dr. Hausauer says. “That is without a ring block of injected medication, chiller device or topical numbing. I use a subdermal injection technique that provides excellent results with minimal discomfort.”
For patient comfort, Dr. Bauman recommends carefully applying a local anesthetic ring block outside the treatment zone’s periphery.
“Lidocaine may detrimentally affect platelet function, so administer a ring block of articaine with epinephrine, along with nitrous oxide analgesia with [the] Pro-Nox device [CareStream Medical] to keep patients comfortable throughout the process,” he says.
To help ensure consistency in PRP processing, Dr. Bauman says he measures the patient’s whole blood and exactly what’s in their PRP.
“You may be surprised that the gel-separator system you are using doesn’t concentrate the platelets as well as your sales rep promised,” he says. “We have a hematology analyzer at the bedside to know pre- and post-centrifugation platelet counts, hematocrit and monocyte counts. This keeps the quality of our PRP consistent and any issue with our dual-spin [EnrichedPRP] preparation process can be spotted before treatment is applied to the patient. We can also measure the [red blood cell] discard and the platelet-poor plasma to sleuth out any particularly low platelet concentrations.”
To optimally use PRP, providers should first diagnose the patient’s hair loss, doing a skin biopsy if needed.
Photography is also an important tool for showing patient results, according to Dr. Callender.
The bottom line, according to Dr. Sclafani: “PRP shouldn’t be overpromised, and we don’t know all the details of how it works, but from what we do know there seems to be a positive effect.”
1. Hausauer AK, Humphrey S. The Physician's Guide to Platelet-Rich Plasma in Dermatologic Surgery Part I: Definitions, Mechanisms of Action, and Technical Specifications. Dermatol Surg. 2020;46(3):348-357
2. Hausauer AK, Humphrey S. The Physician's Guide to Platelet-Rich Plasma in Dermatologic Surgery Part II: Clinical Evidence. Dermatol Surg. 2020;46(4):447-456.
For Further Reading:
Gupta AK, Cole J, Deutsch DP, et al. Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia. Dermatol Surg. 2019;45(10):1262-1273.
Gupta AK, Versteeg SG, Rapaport J, Hausauer AK, Shear NH, Piguet V. The Efficacy of Platelet-Rich Plasma in the Field of Hair Restoration and Facial Aesthetics-A Systematic Review and Meta-analysis. J Cutan Med Surg. 2019;23(2):185-203.
Hausauer AK, Jones DH. Evaluating the Efficacy of Different Platelet-Rich Plasma Regimens for Management of Androgenetic Alopecia: A Single-Center, Blinded, Randomized Clinical Trial. Dermatol Surg. 2018;44(9):1191-1200.