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.
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.
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.
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.
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.
- 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
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
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
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
Read about the latest research into PRP therapy for hair loss
Read more in our section on Platelet Rich Plasma
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.
- Read about the latest research into PRP therapy for hair loss
- Read more in our section on Platelet Rich Plasma
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.
- Read about the latest research into PRP therapy for hair loss
- Read more in our section on Platelet Rich Plasma
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.
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