Platelet Rich Plasma (PRP) - Bernstein Medical - Center for Hair Restoration
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Hair Restoration Answers

What is a Double Centrifuge System for PRP and What are the Benefits?

Q: What is a double centrifuge system for PRP and what are the benefits? — S.B. ~ Manhattan, N.Y.

A: The double centrifuge system is a process used in preparing Platelet-Rich Plasma (PRP) where the whole blood is spun two times to optimize the concentration of the platelets. In the first spin, the red blood cells are separated from the plasma, which contains the platelets. In the second spin, the cellular components in the plasma are further concentrated. The platelets and growth factors that are recovered from the plasma are then injected into the scalp. Additional growth factors are released from the platelets after the injections and it is these proteins that provide the benefit of helping to maintain the hair and to stimulate growth. By using a double centrifuge technique, the ideal concentration of platelets and growth factors are achieved.

  • Read more about Platelet-Rich Plasma (PRP) for Hair Loss
  • View a slideshow of how PRP is prepared
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Hair Restoration Answers

Is PRP Safe for Older People with Hair Loss?

Q: I am a 65 year old female who has recently experienced thinning hair and I’ve heard of PRP treatments. Is PRP safe and does it work for older people? — R.E., Upper East Side, NY

A: PRP (Platelet Rich Plasma) is safe for persons of any age, although we don’t administer it to pregnant women and those under 18. It can be helpful as long as the person has enough miniaturized hair for it to work on. It will not work on a totally bald area of the scalp.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How are PRP Treatments Different at Bernstein Medical?

Q: How are PRP treatments for hair loss different at Bernstein Medical – Center for Hair Restoration? — E.D., Huntington, N.Y.

A: There are three reasons Platelet Rich Plasma (PRP) treatments are different at Bernstein Medical from other facilities. First, we use the Emcyte Pure PRP System, the most sophisticated system for the preparation of Platelet Rich Plasma. Second, by using a double centrifuge technique, we generate the optimal concentration of growth factors in PRP. Third, and most important, we have the knowledge to know when PRP is appropriate and the skill to inject the proper quantity of PRP at just the right depth to achieve the desired result — a skill that cannot be overstated.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Notes Increasing Trend of Women Seeking Hair Loss Treatments in New York Post Article

New York PostAs the taboo of women’s hair loss gradually dissipates, more women than ever are seeking treatment for hair loss caused by stress, pregnancy, genetics, and a variety of other medical conditions and behavioral causes. Dr. Bernstein is quoted in an article in the New York Post identifying the upward trend of women seeking hair loss treatments.

“Approximately 40 percent of women experience some form of hair loss in their lives, and stress is the second biggest cause after genetics,” says Dr. Robert Bernstein, a professor of dermatology at Columbia University and a hair restoration specialist with a Midtown practice. “Over the last five years there had been a 50 percent increase in the number of women coming to our office to seek help.”

The article discussed four women of varying ages who sought treatment for different hair loss conditions. Among the treatments discussed are Rogaine for Women, Platelet-Rich Plasma (PRP), and Laser Therapy.

Read about Women’s Hair Loss
See before and after photos of Female Hair Transplant patients

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Have PRP During a Hair Transplant?

Q: Do you administer PRP (Platelet Rich Plasma) during a hair transplant? — R.W., Manhattan, NY

A: The wounds created in the hair transplant procedure (recipient site creation) promote blood platelet migration and the activation of growth factors making PRP therapy unnecessary for the actual surgery. That said, doctors may wish to use PRP for areas of the scalp that are thinning, but were not addressed by the hair transplant. An example might be using PRP for the crown if the doctor only transplanted hair to the front part of the scalp.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Treatments for Hair Loss in Women Detailed in Article Featuring Dr. Bernstein

NYCityWoman.com

Dr. Bernstein was interviewed for an article in NYCityWoman.com that ran the gamut of available treatments for hair loss in women. Read below for some select quotes on a wide range of topics related to hair loss in women and treatments for female patients with androgenetic alopecia (common genetic hair loss).

On the fading stigma of hair loss in women:

“Women today are more comfortable talking about their hair loss.”

On indicators of hormone-driven female hair loss:

“It is typical to have a positive family history of hair loss and the presence of miniaturization (short, fine hairs) in the thinning areas.”

On minoxidil for regrowth of thinning hair:

“Rogaine (minoxidil) can increase the quality (length and diameter) of hair that is just starting to thin.”

On the different strengths of Rogaine (minoxidil):

“I generally recommend the 5 percent for women and men. Although it’s sold in separate packages for men and women, the basic ingredients are essentially the same.”

On Rogaine Foam:

“It is an elegant mixture, made for compliance,” says Dr. Bernstein. “It is an aerosolized foam, so it is less irritating than liquid Rogaine, but can be more difficult to get directly on the scalp.”

On LaserComb vs. cap-based Low Level Laser Therapy (LLLT) devices:

“The cap is both easier to use and more effective for very thin hair, due to the greater number of lasers. But for higher-density hair, a laser comb or the LaserBand82 may be more effective, as it’s probably better at getting the laser therapy beam to the scalp.”

On Platelet-Rich Plasma (PRP) therapy for hair loss:

“Platelet-rich plasma therapy involves spinning the patient’s own blood (preferably twice) in a centrifuge to separate out the growth factors.”

On Follicular Unit Transplant (FUT) surgery:

“FUT hair transplants allow many women to have a completely natural hair restoration, producing a dramatic change in their appearance.”

On Robotic FUE hair transplants:

“Robotic FUE allows for unparalleled precision, without any line scars in the donor area and no post-operative limitations on physical activity.”

See before and after photos of some of our female hair transplant patients
Read about the causes, classification, diagnosis and treatment of hair loss in women

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Study Adds Credence to Effectiveness of PRP Treatments

An article in the September/October 2015 issue of Hair Transplant Forum International highlighted results of a 6-month study of platelet rich plasma (PRP) treatment in a 23-year-old male diagnosed with androgenetic alopecia (common male pattern baldness) ((Kahen, John (ISHRS 2015). “The Use of Platelet Rich Plasma in Treating Hair Loss.” Hair Transplant Forum International. 25 (5): 189)). The study showed a significant increase in hair density and decrease in miniaturized follicles, as well as an apparent darkening of hair pigmentation.

The patient, who was instructed not to use hair loss medications such as Propecia (finasteride) or Rogaine (minoxidil), was given several treatments of PRP solution in a single session. At six months after the treatment, digital densitometry was used to assess any changes to the scalp compared to pre-treatment. He noted fewer follicles in a miniaturized state and an increase in hair density.

Another clinical observation was a change in the patient’s hair color from light brown to dark brown. The author hypothesized that this change in pigmentation may be due to significant numbers of hairs rapidly transitioning to the anagen (growth) phase of the hair cycle. As a result of this shift, there was an increase in hair shaft diameter and an apparent darkening of the patient’s hair color.

This study has several limitations: it is not a peer-reviewed, controlled study; it is an assessment of only one patient; and no empirical data on the hair growth was recorded. However, this research joins a number of other studies which appear to show that PRP therapy may be an effective, and safe, treatment for androgenetic alopecia.

Read more about Platelet Rich Plasma (PRP) Treatment for Hair Loss

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Long-Term Study Sees Benefits in PRP Therapy for Hair Loss

Research published in the online edition of the journal STEM CELLS: Translational Medicine has found that Platelet-Rich Plasma therapy (PRP) may boost hair regrowth in people with androgenetic alopecia (common hair loss). Previous studies have shown that PRP has the potential to reverse hair loss, but these were limited by a short duration of study. This is the first published research showing the long-term efficacy of PRP therapy for hair loss.

Background/About the Study

PRP has long been thought of as a potential treatment for hair loss, and it has been successfully employed in other areas of regenerative medicine. The researchers of this study, from the University of Rome Tor Vergata and the Catholic University of the Sacred Heart, devised a randomized, evaluator-blinded, placebo-controlled study to test the efficacy of the treatment over a two-year span.

Twenty-three men between the ages of 19–63 with varying degrees of hair loss were enrolled. Twenty of these were given three injections of “activated” Platelet-Rich Plasma (PRP) at 30 day intervals. The activation of platelets with calcium molecules initiates the secretion of growth factors that are critical to the development of new hair follicles and the growth of new blood vessels.

“It is proposed that growth-factors released from platelets may act on stem cells in the bulge area of the follicles, stimulating the development of new follicles, and promoting vascularization.” ((Gentile P, Garcovich S, Bielli A et al. The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial. Stem Cells Transl Med. 2015 Sep 23.))

Once derived and activated, the PRP treatment was applied to one side of each patient’s head, while the other side was injected with a placebo. Patients were evaluated in six stages over a span of 24 months. Three of the subjects were excluded from the study due to a predisposition to develop keloids.

Findings

After the third treatment, the researchers found that subjects experienced an average growth of 33.6 hairs per cm2 and an increase in total hair density of almost 46 hairs per cm2 in the areas treated with PRP. The control side (injected with placebo instead of PRP) continued to lose hair at a rate of 3.2 hairs per cm2.

The density of terminal hairs rose significantly, by a mean of 40.1 hairs per cm2 in the treated area, while falling by 5.6 terminal hairs per cm2 in the untreated/placebo area.

Researchers observed a thicker epidermis (outer layer of skin) within two weeks of PRP treatment, and an increase in the number of hair follicles. Within three months, new hair was seen growing in the treated area at a mean of 33.6 hairs per cm2.

At one year after the last treatment, researchers noted signs of hair loss relapse. Progressive hair loss was observed in four of the patients at that time, with the hair loss more evident 16 months after the last treatment.

There were no major side effects from PRP treatment in the course of the study.

Conclusion/Summary

This study confirms prior studies which have suggested that there is a positive therapeutic effect of Platelet-Rich Plasma injections on male hair loss. Equally as important, this is the first study to measure the ability of PRP to induce hair regrowth over the long-term. The evaluation of PRP as a hair loss treatment is particularly important because there is increasing demand for alternative options to hair transplantation or medications. As the popularity of hair restoration continues to increase, so too will the population seeking alternative treatments, since not everyone experiencing hair loss is indicated for existing medical and surgical treatments. Platelet-Rich Plasma may become an important treatment option for this population of patients. While the results of this study are significant, more research is needed to better understand the mechanism of PRP and to design ways to improve the treatment.

For more on this topic:

Bernstein Medical’s PRP section
PRP FAQ

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

New York Magazine ‘Best Doctors’ Issue Includes Dr. Bernstein for Sixteenth Consecutive Year

Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was included in New York Magazine’s ‘Best Doctors’ issue for the 16th consecutive year.

Best Doctors 2015 - New York Magazine

New York, NY — Robert M. Bernstein, MD, MBA, FAAD, a Clinical Professor of Dermatology at Columbia University in New York and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures, was included in New York Magazine’s annual ‘Best Doctors’ issue for the sixteenth consecutive year.

On being chosen for his sixteenth consecutive ‘Best Doctors’ issue, Dr. Bernstein said: “I am honored to be considered among the best doctors in New York and it is a credit to the hardworking staff at Bernstein Medical that, after two decades of incredible progress, we are still making significant advances in the surgical treatment of hair loss.”

Recognition of Dr. Bernstein and his contributions to the field of surgical hair restoration comes as he continues to push the envelope with advances in Robotic FUE hair transplants, improving more traditional hair restoration techniques and exploring adjuvant treatments such as Platelet Rich Plasma (PRP).

Among the improvements Dr. Bernstein has made to the robotic hair transplant procedure include: automated selection of follicular unit grafts, robotic creation of recipient sites, reducing wound size, and a “long-hair” FUE technique that allows a patient to have an FUE hair transplant without the donor area being visible in the post-op period. Collectively these improvements make the robot more efficient, reduce scarring from the procedure, and improve the outcome for patients. Dr. Bernstein’s internationally renowned hair restoration facility, Bernstein Medical – Center for Hair Restoration, is a beta-testing site for Restoration Robotics, Inc., the company that produces the ARTAS® robot. Dr. Bernstein is a medical advisor to the company.

New York Magazine’s ‘Best Doctors’ issue is a special annual edition of the acclaimed magazine which contains a directory of the New York City area’s best physicians. The directory is created by Castle Connolly, Ltd., through a survey of doctors in the New York Tri-State area. To be included, doctors in New York, New Jersey and Connecticut are nominated by their peers and then must pass a rigorous physician-led review of their qualifications, reputation, and skill in diagnosis and treating patients. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fourteen editions.

About Robert M. Bernstein, M.D., F.A.A.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York, founder and lead surgeon at Bernstein Medical – Center for Hair Restoration, and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures. Dr. Bernstein was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 60 medical publications have fundamentally transformed surgical hair restoration. Dr. Bernstein has received the Platinum Follicle Award, the highest honor in the field given by the International Society of Hair Restoration Surgery (ISHRS), and has appeared as a hair restoration expert on many notable television programs and news and lifestyle publications over the years. Examples include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, New York Times, Wall Street Journal, Men’s Health Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is dedicated to the diagnosis and treatment of hair loss in men and women using the most advanced technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients who visit from 58 countries and all 50 states. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients. In 2011, Bernstein Medical became one of the first practices in the world to offer Robotic FUE hair transplant procedures using the image-guided, computer-driven technology of the ARTAS Robotic System. Bernstein Medical is a beta-testing site for this technology.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is Platelet-Rich Plasma (PRP) and How Does It Promote Hair Growth?

Q: I’ve heard a lot about platelet-rich plasma (PRP). What is platelet-rich plasma, and how does it promote hair growth? — A.V., Scarsdale, NY

A: To begin, first let’s define a few basic terms: blood plasma, platelets and PRP

What Is Blood Plasma?

Blood plasma holds the blood cells in a liquid suspension. Blood plasma makes up about 55% of the body’s total blood volume. There are three basic types of blood cells: red blood cells (that carry oxygen), white blood cells (that have immune functions to help fight infection) and platelets (that facilitate coagulation, wound healing and repair).

What is a Platelet?

A platelet is a type of white blood cell containing approximately 50 to 80 tiny encapsulated structures called alpha-granules. Each alpha-granule contains a high number of growth factors, many playing a fundamental role in healing following tissue damage. ((Eppley BL, Pietrzak WS, and Blanton M. Platelet-Rich Plasma: A Review of Biology and Applications in Plastic Surgery. Plastic and Reconstructive Surgery, 2006.)) Many of these platelets are also known to regulate the growth cycle of hair follicles. ((Itami S, Kurata S, Takayasu S. Androgen induction of follicular epithelial cell growth is mediated via insulin-like growth factor-I from dermal papilla cells. Biochem Biophys Res Commun. 1995; 212: 988–94.))

Platelets are formed in the bone marrow and circulate throughout the bloodstream in a concentration of approximately 140,000 to 400,000 platelets/mm3.

What is Platelet-Rich Plasma?

Derived from a patient’s own blood plasma, platelet rich plasma is concentrated blood plasma which contains approximately five times the number of platelets and growth factors normally found in the blood.

How Does Platelet-Rich Plasma Work to Promote New Hair Growth?

Studies that have looked at the therapeutic effects of PRP on hair loss have found that it promotes hair survival and hair growth in both laboratory studies ((Li ZJ, Choi HI, Choi DK et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 2012; 38: 1040–6.)) and human clinical trials, but exactly how PRP promotes new hair growth isn’t clear. Researchers have suggested a few possible mechanisms.

In a recent pilot study ((Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014; 40(9): 1010-9.)) that found that PRP injections resulted in noticeable improvement in both males and females with androgenetic alopecia, researchers suggested that PRP may have stimulated hair growth by prolonging the anagen (growth) phase of the hair follicle.

In another study ((Cervelli V, Garcovich S, Bielli A, Cervelli G, Curcio BC, Scioli MG, Orlandi A and Gentile P. The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation. BioMed Research International 2014; 1-9)) that showed PRP promoted hair growth in males with alopecia, researchers suggested that PRP may have protected the hair follicles against one of the possible main mechanisms of pattern hair loss: the death of dermal papilla cells in the hair follicle. ((Whiting DA. Possible mechanisms of miniaturization during androgenetic alopecia or pattern hair loss. J Am Acad Dermatol. 2001 Sep;45(3 Suppl):S81-6.)) The death of these cells leads to a gradual shrinking and eventual disappearance of the hair shaft, a process called miniaturization.

Other studies have observed that PRP seems to promote the growth of new blood vessels around treated hair follicles. Because of this, researchers have suggested that the growth of new blood vessels may be helping to stimulate new hair growth. ((L. Mecklenburg, D. J. Tobin, S.Muller-Rover, et al. “Active hair growth, anagen, is associated with angiogenesis.” Journal of Investigative Dermatology 2000, 114:5; 909–916.))

In sum, while published studies so far suggest that PRP therapy is a safe and effective treatment option for male and female androgenetic alopecia, there is still a need for more extensive studies to better understand the mechanism by which PRP treatments promote hair growth.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Which Platelet Rich Plasma (PRP) System Do You Use?

Q: I have seen some talk about different forms of platelet rich plasma (PRP). Which is the best system for preparing PRP for hair loss? Which are you using? — E.C., Seattle, WA

A: We use the Emcyte Pure PRP system. It is a double centrifuge system that I think is the best.

Platelet Rich Plasma (PRP) FAQ
See the PRP Treatment Slideshow

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Have Platelet Rich Plasma Therapy Instead of Hair Transplant Surgery?

Q: It was recommended by the doctor that I have a hair transplant. Can I do platelet rich plasma (PRP) instead? — W.D., Denver, CO

A: PRP will generally be inadequate for patients who are candidates for a hair transplant. PRP works to reverse miniaturization (thinning hair) as do other medical treatments (Propecia, Rogaine, LLLT). Unfortunately, medical treatments do not grow hair back once it has been lost.

Platelet Rich Plasma (PRP) FAQ

See the PRP Treatment Steps

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Does Platelet Rich Plasma (PRP) Therapy For Hair Loss Involve Surgery?

Q: How is platelet rich plasma therapy for hair loss performed? Does it involve surgery? — T.A., Tribeca, NYC

A: Platelet rich plasma (PRP) therapy for hair loss is performed during a simple office visit, takes about 30-45 minutes, and does NOT involve surgery.

The first step in PRP treatment for hair loss involves drawing a patient’s blood into a syringe.

Next we use a double-centrifuge platelet concentration system (the Emcyte Pure PRP system) to separate and then concentrate platelet-rich plasma from the blood.

The last step involves transferring the platelet-rich plasma into a syringe and then injecting the plasma directly into the patient’s scalp.

After the treatment, some patients may experience very temporary soreness and/or swelling, but many patients will experience nothing.

After the initial treatment, patients will typically receive two more treatments at 6 week intervals. After that, they will receive additional treatments every 3 months over the course of the first year. After the first year, patients will receive treatments approximately every 6 months.

Platelet Rich Plasma (PRP) FAQ

See the PRP Treatment Steps

Read about the latest research into PRP therapy for hair loss

Read more in our section on Platelet Rich Plasma

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Are There Any Side Effects or Safety Concerns in Using PRP to Treat Hair Loss?

Q: I’ve heard about using platelet rich plasma (PRP) therapy to treat hair loss. Are there any potential serious side effects that I should be aware of? — L.S., Roslyn, Long Island, NY

A: PRP is a therapy that has been used since 1987 to help promote the healing of hard tissue (bone, joints) and soft tissue (skin). To date, there have been no reported major side effects. ((Hall MP, et al “Platelet-rich Plasma: Current Concepts and Application in Sports Medicine” J Am Acad Orthop Surg, Vol 17, No 10, October 2009, 602-608.))

Only a handful of published studies have tested PRP’s effectiveness and safety in treating hair loss; however, none of those studies have reported serious side effects. ((Kang JS1, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2012 Jan;28(1):72-9)), ((V. Cervelli, S. Garcovich, A. Bielli, G. Cervelli, B. C. Curcio, M. G. Scioli, A. Orlandi, P. Gentile. “The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation,” BioMed Research International Volume 2014)), ((Khatu S.S, More Y.E, Gokhale N.R, Chavhan D.C, Bendsure N. Platelet-rich plasma in androgenic alopecia: myth or an effective tool. J Cutan Aesthet Surg. 2014 Apr;7(2):107-10.)), ((Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9.)), ((Takikawa M, Nakamura S, Nakamura S, Ishirara M, Kishimoto S, Sasaki K, Yanagibayashi S, Azuma R, Yamamoto N, Kiyosawa T. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.Dermatol Surg. 2011 Dec;37(12):1721-9)), ((Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, Rinaldi F. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013 Sep;169(3):690-4.))

This lack of any reported major side effects coupled with the fact that PRP is obtained from a patient’s own blood makes doctors relatively confident that PRP treatments are safe for hair loss. ((Platelet-rich plasma: Clarifying the issues. The American Academy of Orthopaedic Surgeons website, www.aaos.org, September 2010.))

All this said, researchers are continuing to evaluate both the efficacy and the safety of PRP therapy for the treatment of male and female pattern baldness.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Does Platelet Rich Plasma (PRP) Treat Androgenic Alopecia?

Q: How does PRP therapy for hair loss work? — B.T., Upper West Side, NYC

A: In theory, platelet rich plasma (PRP) stimulates the growth of hair follicles by reversing the hair miniaturization (thinning hair) process seen in androgenic alopecia (common baldness).

While it is not exactly known how PRP reverses miniaturization, researchers do have a few ideas. First, PRP may counteract miniaturization by prolonging the growth (anagen) phase of hair follicle. ((Z. J. Li, H.-I. Choi, D.-K. Choi et al., “Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth.” Dermatologic Surgery, vol. 38, no. 7, part 11, pp. 1040–1046, 2012.)) Second, PRP has been observed to increase the number of stem cells in hair follicles. This is known to help protect a hair follicle from apoptosis, a natural process of programmed cell death. Researchers think that this anti-apoptotic effect could stimulate new hair growth. ((Takikawa M, Nakamura S, Nakamura S, et al. “Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.” Dermatol Surg. 2011 Dec;37(12):1721-9.)) Finally, PRP treatment has been observed to promote growth of new blood vessels around treated hair follicles. Researchers have suggested that this could also stimulate new hair growth. ((L. Mecklenburg, D. J. Tobin, S.Muller-Rover, et al. “Active hair growth (anagen) is associated with angiogenesis.” Journal of Investigative Dermatology, vol. 114, no. 5, pp. 909–916, 2000.))

In sum, a number of factors may come into play to effect new hair growth during treatment with platelet rich plasma. Research is ongoing to further clarify the specific mechanisms involved.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is There Any Research on Platelet Rich Plasma (PRP) As A Hair Loss Treatment?

Q: I have read conflicting reports on the use of PRP to treat hair loss. What is your assessment? Are there any research publications that suggest it does work?

A: Two recent studies published in 2014 have presented preliminary evidence that platelet rich plasma (PRP) therapy may stop or reverse genetic hair loss (androgenetic alopecia) in both males and females.

The first study, published in the medical journal Dermatologic Surgery, found at least some improvement in male and female patients with androgenetic alopecia. This study concluded that 47% of those patients experienced at least moderate to very good improvement, ((Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9)) a level that the researchers defined as “clinically important.” Because this was just a pilot study without a control group, the authors could not reliably claim that PRP was effective in treating hair loss.

A second study, published in the journal BioMed Research International, concluded that treatments of platelet-rich plasma stimulated hair growth in men with pattern hair loss. ((V. Cervelli, S. Garcovich, A. Bielli, G. Cervelli, B. C. Curcio, M. G. Scioli, A. Orlandi, P. Gentile. “The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation,” BioMed Research International Volume 2014.)) In this clinical study, the researchers found a statistically significant increase in both hair density and terminal hairs.

While more comprehensive testing needs to be done, these studies provide preliminary evidence that platelet rich plasma therapy may stimulate hair growth in patients with male or female pattern baldness.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Pilot Study Finds Platelet-Rich Plasma (PRP) Reverses Male and Female Pattern Baldness

Growth factors in platelet-rich plasma (PRP) have been used to help soft tissue healing since the mid-1990’s. Recently, researchers have started to look at whether or not the growth factors in PRP might also help to reverse male– and female-pattern baldness (androgenetic alopecia).

Evidence that PRP may help to reverse this type of hair loss was found in a 2014 pilot study, “Platelet-rich plasma for androgenetic alopecia” published in Dermatologic Surgery. ((Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9.)) In this study, researchers observed at least some noticeable improvement in 64 patients with androgenetic alopecia. Moreover, 47% of those patients experienced at least moderate to very good improvement, a level that the researchers defined as “clinically important.”

Platelet-Rich Plasma Possible Role in Hair Growth

Ongoing research has suggested various mechanisms by which PRP could reverse pattern baldness. For example, using human hair follicles in both cell cultures and in mice models, a 2011 study found that PRP was able to stimulate the proliferation of human dermopapillar cells, ((Takikawa M, Nakamura S, Nakamura S, Ishirara M, Kishimoto S, Sasaki K, Yanagibayashi S, Azuma R, Yamamoto N, Kiyosawa T. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.Dermatol Surg. 2011 Dec;37(12):1721-9.)) which in turn protected hair follicles cells from apoptosis, a process of programmed cell death. Additionally, this study suggested that PRP may be able to stimulate hair growth by prolonging the anagen (growth) phase of the hair cycle. More recently, a 2012 study found that PRP treatment significantly increased hair diameter. ((Li ZJ, Choi HI, Choi DK, Sohn KC, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 2012;38:1040–6.))

Platelet-Rich Plasma for Androgenetic Alopecia: a Pilot Study

In order to better verify whether PRP could be a useful treatment for androgenetic alopecia, researchers used two treatments of PRP separated over a period of 3 months. Three months after the second treatment there was at least some improvement in almost all the patients due to an increase in hair thickness and/or more hairs, and 47% of the patients had at least moderate to very-good improvement. Patients with the most severe hair loss saw the greatest amount of improvement. Interestingly, both men and women in all age groups responded equally well to treatment.

Limitations of this Pilot Study

A limitation of the study was that each patient served as his or her own control. To more reliably test whether PRP therapy has clinical benefit for androgenetic alopecia, future studies will need to control for any spontaneous improvement by randomly assigning patients to separate treatment and control groups.

In addition, the data indicated that a retreatment with PRP at 10 to 12 months after an initial treatment may be advisable; however, a prolonged, more systematic observation on a larger number of patients would be needed to establish a reliable retreatment schedule.

In sum, this pilot study provides some preliminary evidence that PRP therapy may provide clinical advantage to patients with mild to moderate male or female pattern baldness.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Clinical Study: Platelet-Rich Plasma (PRP) Promotes Hair Growth in Men with Pattern Hair Loss

Growth factors in platelet-rich plasma (PRP) have been used to facilitate wound healing. Recently, studies have suggested that PRP may also serve as a safe and effective treatment option for male and female pattern hair loss, ((Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9.)), ((A. Trink, E. Sorbellini, P. Bezzola et al., “A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata,” British Journal of Dermatology, vol. 169, no. 3,pp. 690–694, 2013.)) but those studies lack scientific controls.

To address these limitations, researchers conducted a controlled clinical study that was recently published in the journal BioMed Research International. The researchers found that treatment with platelet-rich plasma stimulated hair growth in 10 males with pattern hair loss (androgenetic alopecia). ((V. Cervelli, S. Garcovich, A. Bielli, G. Cervelli, B. C. Curcio, M. G. Scioli, A. Orlandi, P. Gentile. “The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation,” BioMed Research International Volume 2014.))

Study: The Effect of Autologous Activated Platelet Rich Plasma Treatments on Pattern Hair Loss

In a bilateral controlled clinical study of 10 male patients with patterned hair loss, researchers treated half of a subject’s scalp with PRP and the other half with a placebo. Each patient received three PRP treatments at one-month intervals.

The researchers evaluated the benefit of PRP treatments by comparing the treated half of a scalp to its non-treated (control) half using three measures of hair growth: mean hair count, total hair density, and terminal (healthy) hair density.

Results

Compared to the non-treated portion of the scalp, the researchers found an increase in hair density of 27.7 hairs/cm2 while in the non-treated portions the mean total hair density decreased by 2.0 hairs/cm2. They also found significant increases in terminal hairs compared to the control side.

A Possible Mechanism of PRP-Driven Hair Growth

Past research has suggested that the presence of keratinocytes in the outer root sheath and in the dermal papilla causes growth in new blood vessels (angiogenesis) during anagen, ((L. Mecklenburg, D. J. Tobin, S.M¨uller-R¨over et al., “Active hair growth (anagen) is associated with angiogenesis,” Journal of Investigative Dermatology, vol. 114, no. 5, pp. 909–916, 2000.)) the growth phase of the hair follicle. Research suggests that these new blood vessels play an important role in hair growth.

This new study suggests that PRP may stimulate hair growth by causing an increase of keratinocytes in the epidermis and in the follicular bulge cells, along with an increase of small blood vessels around the hair follicles in the treated area.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Platelet-Rich Plasma (PRP) Treatments Containing CD34+ Cells Have “Positive Therapeutic Effect” on Hair Loss

Research published in the Journal of the European Academy of Dermatology and Venereology found that autologous platelet-rich plasma (PRP) preparations containing CD34+ cells might be an effective treatment for male and female pattern hair loss. ((Kang JS1, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2012 Jan;28(1):72-9))

Background

Autologous PRP (concentrated blood plasma and growth factors obtained from a patient’s own blood) has been shown to improve blood vessel growth around hair follicles. ((Takikawa M, Nakamura S, Nakamura S et al. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth. Dermatol Surg 2011; 37: 1721–1729)), ((Li W, Enomoto M, Ukegawa M et al. Subcutaneous injections of platelet-rich plasma into skin flaps modulate proangiogenic gene expression and improve survival rates. Plast Reconstr Surg 2012; 129: 858–866)) Researchers have suggested that this is one of the ways PRP can promote hair growth. ((Mecklenburg L, Tobin DJ, Mu¨ller-Ro¨ver S et al. Active hair growth (anagen) is associated with angiogenesis. J Invest Dermatol 2000; 114: 909–916))

CD34+ cells are also known to promote new blood vessel growth. These cells are typically found in bone marrow, but are also found in the body’s circulating blood, having migrated from the bone marrow. Since the CD34+ cells in circulating blood occur in such low amounts, and because they age after migrating from the marrow, they usually lose much of their ability to create new blood vessels. ((Mackie AR, Klyachko E, Thorne T et al. Sonic hedgehog-modified human CD34+ cells preserve cardiac function after acute myocardial infarction. Circ Res 2012; 111: 312–321)), ((Jujo K, Ii M, Losordo DW. Endothelial progenitor cells in neovascularization of infarcted myocardium. J Mol Cell Cardiol 2008; 45: 530–544))

Because PRP preparations only contain CD34+ cells from the body’s circulating blood supply, researchers tested the idea that adding bone marrow-derived CD34+ cells to PRP preparations might improve the efficacy of PRP as a treatment for genetic hair loss. ((Kang JS1, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2012 Jan;28(1):72-9))

Results

PRP preparations containing CD34+ cells were found to grow significantly more hair with greater thickness at up to six months after treatment. There were no major side effects of the treatment.

The researchers suggest bone marrow-derived CD34+ cells have a synergistic effect on PRP’s ability to form new blood vessels, and this is what might explain the effects on hair growth. This results suggest that the PRP/CD34+ preparation had a positive therapeutic effect on pattern baldness in both men and women.

Posted by Robert M. Bernstein M.D.



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