Platelet-Rich Plasma (PRP)

Introduction

Men and women who are considering hair transplantation are likely to research the subject first, including search of the World Wide Web. A Web search of “hair transplantation” and related terms may turn up references to “platelet-rich plasma” or its acronym PRP, described as a procedure to enhance healing and hair growth after hair transplantation. Abundant references can be found to use of PRP in sports medicine to enhance healing after injury. Some Web articles make extravagant claims for PRP.

How is PRP used in hair transplantation? What is its purpose? Does it really contribute to better healing and hair growth after transplantation surgery?

Hair transplantation today is often performed in a single “megasession” or in multiple sessions over a period of weeks or months. A megasession completes the entire procedure—harvest of hair follicles from a donor site at the back of the patient’s scalp and placement of harvested follicles in a recipient site on the scalp—in a single session lasting several hours. Multiple sessions may be a better choice for some patients, based on a patient’s wishes and factors such as medical conditions.

Over the ensuing 3 to 6 months after transplantation, most transplanted follicles will thrive and produce hair at their new site. Some transplanted follicles will fail to thrive in their new environment.

Search for a way to enhance survival of transplanted hair follicles and promote healing with minimal scarring after transplantation led to trials of PRP. A growing literature already existed on use of PRP in sports medicine, orthopaedic surgery and dental surgery and a number of other medical and surgical specialties to enhance tissue repair and healing after surgical procedures or injury.

Exploration of questions about PRP may best begin with a look at platelets, the centrepiece of platelet-rich plasma.

What Are Platelets?

Platelets are biological constituents of blood, along with red and white blood cells. Unlike red and white blood cells, platelets do not have a nucleus and therefore do not qualify to be called “cells”. They are somewhat smaller than red and white blood cells.

What is PRP?

PRP is blood plasma containing a concentration of platelets many times greater than occurs normally in blood. PRP is “autologous”, meaning that it comes from the patient’s own body. This is similar to the practice of having a patient donate his/her own blood before a surgical procedure, to be used in preference to blood from the hospital blood bank should a transfusion be needed. Another example is the removal and transplantation of a patient’s own skin for a plastic surgery procedure. Because PRP is autologous, it has no potential for causing a foreign-body immunologic reaction. PRP is immunologically neutral.

In another word PRP therapy, also known as Platelet-Rich Plasma therapy is the same as vampire facelift which is done on the face to help reduce lines, wrinkles and acne scars and also helps build collagen.

The procedure involves drawing out one’s own blood and centrifuging it so that the plasma with platelets collects in the tube. This plasma rich in platelets and growth factors is very useful in tissue regeneration and healing.  It is then injected on the scalp or rubbed on the scalp after performing a derma roller treatment in the areas which suffer from hair loss.

PRP in Hair Transplantation

The potential for using PRP to promote healing and hair growth after hair transplantation is centred in three functional applications:

1. To preserve and enhance hair follicle viability during and after hair transplantation;
2. To promote and enhance tissue repair and healing after hair transplantation; and,
3. To reinvigorate dormant hair follicles and stimulate new hair growth.

To Preserve and Enhance Hair Follicle Viability

Between the time that hair follicles are removed from a donor area of the scalp and transplanted into a recipient area, they are subject to damage from several causes:

• Dehydration if the donor follicles are inadequately moistened between the times of removal and transplantation;
• Oxygen and nutrient starvation due to being removed from blood supply during the harvest-to-transplantation time period;
• Temperature and acid/alkaline changes in the follicle environment; and,
• Revascularization injury when the donor follicles are transplanted to the recipient site and must re-adapt to having a blood supply.

A common approach to maintaining donor hair follicle viability during the transition period is to keep them in a storage solution that provides a protective environment of appropriate temperature, chemical balance and nutrient supply. Recent research has indicated that addition of PRP to the storage solution improves follicle viability during and after transplantation, enhances post-transplantation tissue healing and promotes hair growth in transplanted follicles. An approach advocated by some investigators is to bathe the donor hair follicles in activated PRP just prior to transplantation.

Investigators have reported that PRP promotes hair growth from follicles by the action of platelet growth factors on hair follicle stem cells. The platelet growth factors induce follicle stem cells to shift from a dormant state to an active state that starts the process of hair production. While investigators have reported such activity, no advertised claims of PRP efficacy in promoting hair growth can be made because there has been no FDA approval that would allow such claims to be made.