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PRP is a revolutionary hair restoration therapy for some patients, but experts say there are still limitations and unknowns.
When New York City facial plastic surgeon Anthony P. Sclafani, M.D., presented on the science behind platelet-rich plasma (PRP) for hair restoration last fall at the Global Aesthetics Conference in Miami, Fla., there were research gaps that left him and colleagues wanting more.
“There’s not a lot of uniformity in the studies in the sense of what is PRP,” Dr. Sclafani says. “It’s not a single item. There’s a lot of variation to what’s being produced and what’s being used. And that’s a big part of the problem in terms of making the statement that PRP works or doesn’t work.”
Dr. Sclafani, who uses PRP as a hair restoration option for some patients in his practice, says there’s some scientific proof and good anecdotal evidence that PRP works.
“In the last five years, there have been a number of quality studies, again with issues, but they’ve been good enough to where I think you can really analyze them and make some sense out of them,” he says.
According to Alan J. Bauman, M.D., full-time American Board of Hair Restoration Surgery (ABHRS)-certified hair transplant surgeon, Boca Raton, Fla., his hair restoration practice Bauman Medical has used PRP for more than a decade, performing over 7,000 individual PRP treatments for men and women to protect and enhance hair growth.
“It’s a wonderful ‘tool in the toolbox’ because it leverages the patient’s own platelet-derived growth factors and natural healing/regenerative pathways with minimal risk and no downtime to improve hair follicle function,” Dr. Bauman says. “PRP has been used as a regenerative medicine modality for decades in the areas of sports medicine, orthopedics, dentistry, cardiothoracic surgery, dermatology and many others. What PRP does in the specialty of hair restoration is limited to its effects on follicles that can still be rejuvenated and are not yet ‘beyond repair.’ It can also be used in hair transplant surgery to improve the graft take-rate, as well as accelerate the healing and hair growth results of the transplanted area.”
Studies show that PRP works best as a treatment for androgenetic alopecia (AGA).
“That’s where it has been studied and vetted the most vigorously,” according to Amelia K. Hausauer, M.D., a cosmetic fellowship trained dermatologist and director of dermatology at Aesthetx in Silicon Valley, Calif.
Dr. Hausauer, who ran one of the largest randomized, and controlled trials on PRP in androgenetic alopecia to date, also co-authored a two-part fully comprehensive paper on the use of PRP in aesthetic medicine, which came out last year in Dermatologic Surgery.1,2
She teaches internationally on the topic and was chief editor for the textbook PRP and Microneedling in Aesthetic Medicine, which is the first of its kind.
While she believes that PRP can be a revolutionary therapy for some patients, she concedes that there are still limitations and unknowns that need to be addressed.
“In my experience, and the published literature supports this, the best results are seen in patients with mild-to-moderate patterned hair loss, who are early in the process. It’s very difficult to grow hair on an area that’s completely bald,” she says. “Our study showed that people who were in the first five years of apparent hair loss had a much more reproducible and robust response to PRP. For example, I have had some with 60% hair regrowth.”
Dr. Sclafani says he uses PRP mostly in patients who are Norwood class 5 or less, with some thinning. But it’s not a treatment for bald spots.
“I have injected PRP into long-standing bald scalp, and I’ve seen some sprouting of new hairs but it’s really insignificant clinically, so I don’t recommend using it on a totally bald scalp,” he says. “For me, PRP is for the person who doesn’t want to use Propecia [finasteride, Merck] and who wants to maintain and thicken the hair they have. I think PRP is a viable alternative to Propecia. If patients are on Propecia and they want more, I will certainly give them PRP and let them continue on Propecia.”