PRP

Hair loss and hair thinning are common hair-related complaints today. Hairfall has multiple causes including nutritional, hormonal or metabolic and treatment of hair loss includes tackling these issues along with treatments aimed to salvage maximum follicles. Conventional treatment involves finding the exact cause of the trigger for hair loss. In conditions like female pattern and male pattern baldness, conventional treatments include Minoxidil and Finasteride. Often they help in controlling hair fall and preventing receding hairline but patients seeking hair regrowth are looking for options like platelet rich plasma or fibrin. 

In this article we talk about the two most important solutions for hair regrowth – Platelet rich plasma (PRP) and Platelet rich fibrin (PRF) with the help of 5 commonly asked questions about them.

Q1) What is PRP? How does it help in hair growth?
PRP is defined as ‘a biological product which is a portion of the plasma fraction of autologous blood with a platelet concentration above the baseline (before centrifugation)’. As such, PRP contains not only a high level of platelets but also the full complement of clotting factors, the latter typically remaining at their normal, physiologic levels. It is enriched by a range of GFs, chemokines, cytokines, and other plasma proteins. Platelets have more than 300 growth factors, the most important are EGF, PDGF. VEGF and IGF etc. The growth factors in PRP promote fibroblast function, stimulate new blood vessel formation and promote wound healing.

We all know that hair growth is dependent on the stem cells in the bulge area of the hair follicle. PRP containing growth factors helps in activation and proliferation of these stem cells preventing hair loss and improving hair fall. PRP also stimulates the blood flow and hence improves the diameter of  the hair follicle. The growth factors also improve the quality of the hair fiber, reducing dry and frizzy hair.

Q2) Is PRP alone effective in Male Pattern baldness? When should it be started?
Male pattern baldness is multifactorial in nature. Minoxidil helps in prolonging the anagen or growth phase of the hair while Finasteride helps in reducing the activity of 5 alpha reductase enzyme which converts Testosterone into Dihydrotestosterone(DHT). But the efficacy of Minoxidil  is limited and we require treatment options to increase the thickness and recruit new hair follicles. This is achieved by supplementary treatments like PRP and PRF. PRP is best combined with conventional treatments especially in pattern baldness.

Q3) Is the PRP procedure technique the same in all clinics? 
The success of PRP treatments depends on the quality of PRP generated. The quality of PRP depends on many factors-

1. Centrifugation tubes or type of PRP kits - Technically plastic coated silica tubes used by many clinics (to reduce cost) are toxic to the human body. Instead only Glass tubes or PRP tubes approved for human use should be used. Check the blood collection tubes. It should not be Vaccutainers used for storing blood.

2. Speed of Mechanical vibration- More cycles of centrifugation or at more speed destroys platelet morphology. It may appear that more ml of plasma is generated but the platelets are destroyed.

3. Temperature- While obtaining PRP should not be more than 21°C-24° 

4. The concentration of platelets- About 2 to 2.5 times the normal platelets count is the best yield for results. More or less is not effective

5. Quality of PRP Kit makes a huge difference in the treatment efficacy. 

Q4) what is the difference between PRP and PRF?
Platelet-rich plasma is obtained by centrifugation ( spinning at a higher speed) which causes the heavier cells in the blood like white blood cells(WBC) and Red blood cells(RBC) , to settle in the bottom part (sediment) and allows the lighter plasma containing platelets  to collect in the top part . The plasma rich in platelets is then extracted and injected into the scalp.

1.  However recent scientific data shows that a platelet product with higher concentration of platelets along with its natural scaffold of fibrin and fibrinogen matrix is even more effective than traditional platelet-rich plasma. 

2. The PRF product is centrifuged with minimal mechanical vibration to preserve the natural platelet morphology. 

3. PRF is classified as a second generation PRP as it is prepared as a natural concentrate without adding any additional anticoagulant or activators. It is actually 100% natural as it doesn’t even have any anticoagulant agent.

4. As there is no anticoagulant added, it is minimally painful and does not require anesthesia.

5. There is slow and sustained release of growth factors sometimes even 7 days after the injections

6. No risk of any bleeding or coagulation problems as no use of anticoagulant in PRF.

Q5)  Is PRP a safe and effective treatment for hair loss?
We at Dr Divya’s Skin and Hair Solutions Clinic use an internationally acclaimed marvel of German bioengineering known as Arthrex PRP system. It is actually PRF and has an excellent track record of safety and efficacy. It has been used for a very long time in sports injury and dental restoration.  The Arthrex system has a lot of scientific backing and as discussed earlier is 100% natural and safe. PRF is definitely better as explained above.

PRP requires maintenance sessions as well as other co treatments working at various other causes of hair fall and factors. It is effective in increasing the hair density and improving the hair follicle diameter and hence increasing the hair volume over a period of time. Hair growth requires a concerted effort from Dermatologist and patience from the patient’s end. 

Dr. Divya Sharma is a faculty member in Special Interest Group (SIG) of IADVl (Indian Association of Dermatologist and Venereologists) in Aesthetics and Regenerative medicine and is a key opinion leader on use of PRF technique and second generation PRP. She is a part of the national faculty to teach upcoming dermatologists on various newer techniques in Regenerative medicine.