ArticlePDF AvailableLiterature Review

Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia

  • Mediprobe Research
  • Cole Hair Transplant Group
  • EmCyte Corporation, and Gulf Coast Biologics Fort Myers, United States

Abstract and Figures

Background: Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular maturation, differentiation, and proliferation. Objective: The objective of this study was to evaluate the effectiveness of PRP as a treatment for androgenetic alopecia (AGA). Materials and methods: A literature search combined with meta-analysis was used to calculate the overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in comparison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to investigate variation in protocols. Results: The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35-0.80) and 0.51 (95% CI: 0.23-0.80, p < .0004) in favor of PRP treatment when compared with baseline and placebo treatment, respectively. Conclusion: Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly sessions of PRP (once monthly ×3 treatments) be used followed by a 3- to 6-month maintenance period.
Content may be subject to copyright.
Platelet-Rich Plasma as a Treatment for
Androgenetic Alopecia
Aditya K. Gupta, MD, PhD,*
John Cole, MD,
David P. Deutsch, MD,*
Peter A. Everts, PhD,
Robert P. Niedbalski, DO,*
Ratchathorn Panchaprateep, MD, PhD,*
Fabio Rinaldi, MD,*** Paul T. Rose, MD, JD,*
Rodney Sinclair, MD, MBBS,
Ryan J. Welter, MD, PhD,
Michael D. Zufelt, DO,*
and Carlos J. Puig, DO*
BACKGROUND Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular
maturation, differentiation, and proliferation.
OBJECTIVE The objective of this study was to evaluate the effectiveness of PRP as a treatment for andro-
genetic alopecia (AGA).
MATERIALS AND METHODS A literature search combined with meta-analysis was used to calculate the
overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in com-
parison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to inves-
tigate variation in protocols.
RESULTS The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35–0.80) and 0.51 (95% CI:
0.23–0.80, p< .0004) in favor of PRP treatment when compared with baseline and placebo treatment,
CONCLUSION Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly
sessions of PRP (once monthly ·3 treatments) be used followed by a 3- to 6-month maintenance period.
The authors have indicated no significant interest with commercial supporters.
Platelet-rich plasma (PRP) is created through
concentrating platelets found in whole blood.
can aid in tissue regeneration, bone regeneration, and
wound repair.
Platelet-rich plasma treatment has
also been suggested to promote hair growth,
encourage cell survival and proliferation, and
prolong the anagen phase of the hair cycle.
Platelet-rich plasma is thought to exert its effects
in androgenetic alopecia (AGA) via delivery of
concentrated growth factors to the hair follicle
and surrounding area (Figure 1). Emerging
evidence has begun to characterize the dermal and
follicular response to several growth factors (e.g.,
platelet-derived growth factor, transforming
growth factor beta).
The main objective of this
article was to assess the effectiveness of PRP
as a monotherapy and adjunct treatment for male
*International Society of Hair Restoration Surgery (ISHRS), Ad Hoc Committee on PRP;
Division of Dermatology,
Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada;
Cole Hair Transplant
Group, Alpharetta, Georgia;
Bosley Medical, Beverly Hills, California;
EmCyte Corporation, Fort Myers,
Northwest Hair Restoration, Tacoma, Washington;
Division of Dermatology, Department of Medicine, Faculty
of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; **International
Hair Research Foundation, Italy;
Hair Transplant Institute Miami, Coral Gables, Florida;
Sinclair Dermatology,
Melbourne, Australia;
Division of Plastic Surgery, Department of Surgery, The Johns Hopkins Hospital and School of
Medicine, Baltimore, Maryland;
New England Center for Hair Restoration, Westwood, Massachusetts;
Restoration Center of Utah, Salt Lake City, Utah;
Physicians Hair Restoration Center, Houston, Texas
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 1076-0512 ·Dermatol Surg 2019;00:112 ·DOI: 10.1097/DSS.0000000000001894
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Platelet-Rich Plasma as a Monotherapy for Male
Androgenetic Alopecia
To analyze the effectiveness of PRP for the treatment
of AGA, a meta-analysis was undertaken. A literature
search was conducted using PubMed on September 7,
2017 and updated on May 18, 2018. The following
terms were used; PRP,”“hair,”“platelet-rich
plasma,”“hair transplant,”“hair loss,”“androge-
netic alopecia,and alopecia.Studies were included
if they evaluated the success of PRP for treatment of
AGA using hair density (hairs/cm
Studies were
excluded if they did not use direct injection, contained
less than 5 participants per treatment, included only
female participants, patients used alternative treat-
ments (5a-reductase inhibitors, minoxidil) within
6 months of study start or if insufcient data were
provided. Study parameters are listed in Table 1 with
characteristics such as a larger patient population and
use of controls, comparators, randomization, and
blinding generally considered more scientically rig-
orous. The meta-analysis was conducted using Rev-
Man 5.3 (Copenhagen, Denmark). Effect size was
measured through use of the standardized mean dif-
ference (SMD), where treatment versus comparator
results close to 0 suggest no difference and increasingly
higher scores are associated with improvement. Het-
erogeneity was evaluated using the I
reported efcacy was compared to baseline measures,
and a p-value < .05 was considered signicant. The
SMD in hair density was 0.58 (95% condence
interval [CI]: 0.350.80) in favor of PRP treatment (10
Figure 1. Mechanism of action. Platelet-rich plasma is prepared from an autologous blood sample that is subsequently
centrifuged to concentrate platelets. Platelet-rich plasma is then activated, often with the addition of calcium chloride to
stimulate the release of growth factors. Platelet-rich plasma is subsequently injected into the patient’s scalp, where various
growth factors are thought to stimulate gene upregulation associated with angiogenesis, cell survival, and proliferation.
AKT, protein kinase B; EGF, epidermal growth factor; ERK, extracellular signal-regulated kinase; FGF-7, fibroblast growth
factor 7; IGF-1, insulin-like growth factor 1; mTOR, mechanistic target of rapamycin; PI3K, phosphoinositide 3-kinase; TGF-
b, transforming growth factor beta; TGFbRI, abrogated transforming growth factor beta receptor I; TGFbRII, abrogated
transforming growth factor beta receptor II; VEGF, vascular endothelial growth factor; smad2, mothers against decap-
entaplegic homolog 2; smad3, mothers against decapentaplegic homolog 3.
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
TABLE 1. Characteristics of Trials Used in Meta-analysis
No. of
Placebo or Untreated
Control Use of Comparator Randomized Blinded
Length of
Study Study Description
Alves and
25 Placebo No Yes Double 6 mo Half-head study
Anitua and
19 No No No No 1 yr Pilot study
Ayatollahi and
15 No No No No 22 wk
Borhan and
17 No No No No 16 wk Open monocentric and
prospective study
Cervelli and
10 Placebo No No No 12 mo Half-head study
Gentile and
18 Placebo No Yes Double 5 mo Half-head study
Gentile and
23 Placebo No No No 5 mo Half-head study
Gkini and
20 No No No No 1 yr Prospective cohort study
Stevens and
10 Untreated No No No 12 wk
Takikawa and
26 Placebo PRP containing dalteparin and
protamine particles
No No 12 wk
PRP, platelet-rich plasma.
00:00:MONTH 2019 3
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
studies, pooled N= 165, p< .00001) (Figure 2A). This
result is consistent with a previously published meta-
analysis that also favored PRP over baseline (SMD:
0.51, 95% CI: 0.140.88, p= .006).
Likewise, PRP
exhibited a greater efcacy over placebo treatments
(SMD: 0.51, 95% CI: 0.230.80, p< .0004) with the
inclusion of 6 trials (pooled N= 99)
(Figure 2B).
In this study, interestingly, and similar to some of the
observations from previous research,
evidence for
investigating male and female patients separately
was found. Inclusion of an all-female study
in the
current meta-analysis (otherwise composed of all male
and mostly male studies) was not possible due to an
introduction of high heterogeneity (measured I
89%), leading to the suggestion that female patients
should be investigated distinctly. This idea has prac-
tical implications for clinicians as there are few AGA
treatment options for female patients and encourages
new research directions to test this hypothesis with the
possibility of creating a unique PRP protocol targeted
directly to female patients.
Investigating methods across AGA studies, with the
exception of a few minor modications, only 2 PRP
protocols were duplicated.
Both studies reported
that subjects treated with PRP had a greater change in
hair density compared to placebo-treated subjects.
Khatu and colleagues and Singhal and colleagues both
used an activated (calcium chloride) PRP treatment (2-
week interval between sessions, 4 sessions total) cre-
ated using a double spin technique (1,500 rpm for
6 minutes and 2,500 rpm for 15 minutes).
These 2
studies did differ in how much PRP was injected; 2 to
3 mL per injection versus 8 to 12 mL per injection.
Cervelli and colleagues and Gentile and colleagues
also used a similar protocol, administering PRP
(0.1 mL/cm
per injection) every 4 weeks for a total of
3 sessions.
Both studies used the Cascade-Selphyl-
Esforax system, centrifuging the PRP solution at
1,100gfor 10 minutes.
Cervelli and colleagues and
Gentile and colleagues reported that PRP-treated
patients had a signicantly greater mean change in hair
density as compared to placebo-treated patients (both
studies p< .0001).
Overall, the results suggest that
PRP therapy resulted in a signicantly greater increase
Figure 2. Forest plot illustrating the results of a meta-analysis of PRP as a treatment for hair loss in AGA patients. (A) Ten
studies (pooled N= 165 participants) that used hair density as a measure of efficacy were compared to baseline. (B) Six
studies (pooled N= 99 participants) that used hair density as a measure of efficacy were compared to placebo. AGA,
androgenetic alopecia; PRP, platelet-rich plasma.
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
TABLE 2. Analysis of Platelet-Rich Plasma Protocols and Techniques
Use of a closed system is recommended for patient safety and reproducibility
Examples of collection systems that are FDA approved (510k clearance) include the Arthex Angel
Biomet GPS III,
Eclipse PRP system,
Emcyte PurePRP Genesis CS concentrating
Harvest SmartPrep,
Magellan TruPRP,
RegenKit Blood Cell Therapy,
and the Selphyl
Each system incorporates its own feature such as an agar plug that may facilitate a high-volume PRP
yield in the Eclipse PRP system,
the compartmentalized reservoir bag that enables different
mediums (whole blood or mixture of blood and bone marrow) to be separated through
centrifugation in the Arthex Angel System,
and the use of calcium chloride in the Selphyl System to
enhance delivery of growth factors through fibrin matrices created by the conversion of fibrinogen to
Each collection system also varies in growth factor and cytokine concentrations, platelet capture
efficiencies, and resulting monocyte populations
A high platelet recovery rate, elevated growth factor and cytokine concentrations, and a low red blood
cell count is desired
The optimum platelet concentration has been shown to be 1.5 million per microliter (about 5-fold more
concentrated than the normal range of 150,000–400,000),
although currently there are no in vivo
studies that compare results for hair growth directly
During centrifugation, high speeds and long durations can inadvertently precipitate platelets or
discharge growth factors (e.g., platelet-derived growth factor), influencing the efficacy of PRP
As a potential alternative to centrifugation, acoustic-based particle manipulation methods could be
used to separate blood cells
Sonication can lyse platelet cell membranes, allowing the release of growth factors and be more
effective in separation of red and white blood cells
Ultrasound-generated PRP demonstrated a greater platelet recovery rate as compared to PRP obtained
through centrifugation (79 69% vs 54 610% over baseline, respectively)
Sonication may increase the survival rate of transplanted follicular units
Activation Activation using calcium chloride or calcium gluconate is frequently used in hair loss studies to induce
agranule release of growth factors from platelets
Extracellular matrix materials such as ACell (FDA approved to repair and remodel damaged tissue)
could also be used to activate PRP solutions, although current evidence for this technique remains
Alternatively, microparticles could be a functional and cheaper substitute
The combination of microparticles, adipose derived stem cells, and follicular stem cells could also be
advantageous and are currently under investigation
Scalp needling to induce inflammation leading to platelet activation has been suggested to be as
effective as use of an exogenous activator
Similarly, it has been suggested that exogenous activation may not make a significant impact on
specific growth factors and cytokines, such as platelet-derived growth factor BB and transforming
growth factor b1,
although a direct comparison (n= 40) of nonactivated versus calcium chloride–
activated PRP resulted in significantly more effective treatment in the former
Thus, although it is clear that activation is necessary for growth factor release, further research is
necessary to determine the impact of various methods of activation on the efficacy of PRP
Needle size It is unknown if needle size can influence the efficacy of PRP
In AGA studies, needles used to administer PRP have ranged from 20 to 32 G, with 30-G needle as the
most commonly used
Injection depth Follicles vary in length below the skin surface, averaging 4.2 mm in length
Subdermal injections have been shown to be efficacious and tolerable in a blinded randomized clinical
trial (n= 40)
; success has been found with intradermal injections, injections into recipient slits
during transplantation, and injections into microneedling channels
Use of a mechanical and thus reproducible device has also been recommended for controlled delivery
of PRP
00:00:MONTH 2019 5
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
in hair density compared to baseline counts and
There are a number of factors that could explain the
variation seen in PRP results (Table 2). Differences in
preparations and delivery have been suggested as a
possible explanation.
In addition to platelet con-
centration, white blood cell, neutrophil, and red blood
cell concentration varies with separation systems as
The resulting effect on efcacy is unknown;
however, individual advantages are expected with the
various systems.
For example, in direct comparison
(n= 6), the Arthex Angel System resulted in signi-
cantly improved hair density versus the Regen Cell
Therapy collection system.
Patient characteristics may also inuence the results
of PRP treatment (Table 3). Variables from each
study (Table 4) were examined using a chi squared
analysis and Fisher exact test to identify any protocol
trends that led to signicant results more often than
expected. Specically, each variable (population
demographics, centrifuge process, concentration of
platelets, injection process, needle gauge, method of
platelet activation, quantity and intervals of treat-
ment, and time of analysis) was examined in search
TABLE 2. (Continued )
frequency and
no. of
Monthly PRP injections had a significantly greater increase in hair count as compared to injections
every 3 mo (mean percent change of 29.6 vs 7.2%, p< .001)
Substantial improvements in hair restoration parameters (e.g., hair density, hair count) have
frequently been reported in PRP studies that administer 3 monthly sessions, suggesting that 3
sessions may be necessary to achieve desired results
A 3- to 6-mo maintenance interval after a monthly PRP treatment regimen could be beneficial
Follow-up periods should extend to 12 mo post-treatment, as an early decrease in hair density
coinciding with the PRP-driven stimulation of hairs into the anagen stage is expected
AGA, androgenetic alopecia; FDA, Food and Drug Administration; PRP, platelet-rich plasma.
TABLE 3. Factors That Could Influence the Efficacy of Platelet-Rich Plasma
Characteristics Evidence
Gender Male patients experienced new growth 2 wk earlier and had a higher increase in hair counts in
comparison to the female population (n= 115)
Statistically significant increase in the mean total hair density for male patients in comparison to
female patients (n= 25)
Severity of alopecia Significantly better response from patients with a lower grade of alopecia (Grade III–IV alopecia,
Disease duration Most studies observed a significantly better response from patients with a shorter disease
Alves and Grimalt
observed a statistically significant increase in the mean total hair density in
patients with greater than 10 years of disease duration
Age Alves and Grimalt
observed a statistically significant increase in the mean total hair density for
patients younger than 40 years
Borhan and colleagues
observed the best response in patients in their early 30s
Onset of alopecia Alves and Grimalt
observed a statistically significant increase in the mean total hair density for
patients with hair loss beginning after 25 years
Presence of vellus
Presence of vellus hair led to better results compared to those who had few but normal hair
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
TABLE 4. Characteristics of Platelet-Rich Plasma Studies Conducted in Androgenetic Alopecia Patients Using Hair Density as a Measure of Efficacy
Study Study Type PRP Method
Gauge Activation
Date Results
Kachhawa and
Split head study of
placebo versus PRP,
50 male patients, HN
Double spin Intradermal 6 treatments at
21-d intervals
4 mo Density increased
compared to baseline
and placebo
Starace and
Pilot study, open-
label, single-group,
single-centre study;
10 female patients
not responding to
treatments; Ludwig
My Cells system 25 Every 2 wks for
4 sessions
12 and
24 wks
Mostly all positive and
increasing over time,
corresponding to
a clinical improvement
Ayatollahi and
13 male patients, HN
III–VI uncontrolled
Regen Lab PRP
Estimate 1.6-fold
from Regen Lab
5 treatments
every 2 wks
22 wks Not significant, p=.37
Stevens and
10 male patients, HN
PRP and adipose-
derived stromal
vascular fraction,
Arthrex Angel
20 1 6 and 12 wks Hair density was
significantly increased
after 6 and 12 wks,
p= .013, p<.013
Gupta and
Open-label pilot study,
30 male patients, HN
Double spin Massage into
Microneedling 6 treatments at
15-d intervals
6 mo Increase in hair density
is observed but
significance is not
Gentile and
(study 1)
Half-head comparison
with placebo, 18
male patients, HN II–
CPunT preparation
5-fold 5 mm 30 3 treatments at
30-d intervals
12 wks Significant
compared to baseline
and placebo as well as
to a previous study
p= .0029
Gentile and
(study 2)
Half-head comparison
with comparator, 6
male patients, HN
Regen Blood Cell
Therapy or
Arthrex Angel
5-fold 25 Calcium 1 treatment 6 mo Significant
improvement in
Arthrex Angel versus
Regen Blood Cell
00:00:MONTH 2019 7
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
TABLE 4. (Continued)
Study Study Type PRP Method
Gauge Activation
Date Results
Alves and
Randomized, placebo-
controlled, double-
blind, half-head
parallel-group study;
12 male patients, HN
II–V; 13 female
patients, Ludwig I–III
Single spin,
leukocyte poor
3-fold 30 Calcium 3 treatments at 1-
mo intervals
3 and 6 mo Significant
improvement from
baseline and placebo
Anitua and
Uncontrolled study; 13
male patients, HN III–
VI; 6 female patients,
Lugwig II/frontal
Single spin BTI
system, leukocyte
layer not collected
2-fold 30 4 treatments at
1-mo intervals
with a final
treatment at 7
12 mo Significant
improvement p< .05
Tawfik and
half-head study; 30
female patients;
Ludwig I–III
Double spin Calcium 4 treatments at
1-wk intervals
7 mo Significant
improvement p< .05
compared to placebo
and baseline
Cervelli and
Randomized, placebo,
half-head study; 10
male patients
Esforax, 0.1 mL/
per injection,
leukocytes not
30 Calcium 3 treatments at
1-mo intervals
12 mo Significant
improvement, control
versus treatment,
p< .0001
Gkini and
Prospective cohort
study; 18 male
patients, HN II–V; 2
female patients;
Ludwig I–III
RegenKit BCT-3 5.8-fold 1.5–2.5 mm 27 Calcium 3 treatments at
21-d intervals,
booster at 6 mo
12 mo Significant
at 6 wks and 12 mo
compared to baseline
Borhan and
Open, monocentric
prospective study, 3
female and 11 male
patients, HN III–IV
Regen Lab, 4–5 mL
used per session,
0.05–0.1 mL per
32 4 treatments total
at 3-wk
intervals, last
treatment at
6-wk interval
16 wk Not significant, p= .8638
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
TABLE 4. (Continued)
Study Study Type PRP Method
Gauge Activation
Date Results
Gentile and
Randomized, placebo-
controlled, half-head
study; 2 male
patients; HN II–IV
Modified versions
of the Cascade-
system and
system, may
30 Calcium 3 treatments at
30-d intervals
2 yrs Significant
improvement in
control versus
treatment, p= .001
Gentile and
18 male patients, HN I–
V; and 5 female
patients, Lugwig I–II
5 mm with
injector gun
30 3 treatments at
30-d intervals
5mo 3162% increase in hair
density for the
treatment group
versus less than 1%
increase in hair
density for the placebo
group compared to
26 participants
PRP mixed with
2 mg/mL
of D/P MP
6-fold Subcutaneous
25 Calcium 5 treatments
at 2-wk
last treatment at
3-wk intervals
12 wks No significant
difference between
PRP and PRP &
(D/P MP) treatments
but significant
from control
D/P MP, dalteparin and protamine microparticles; PRP, platelet-rich plasma.
00:00:MONTH 2019 9
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
of a similar variable appearing more often than by
random probability in the protocols of studies which
achieved statistically signicant results. The use of an
exogenous activator appeared the most connected to
achieving desirable results (p= .08) that was similar
to the conclusions of an earlier meta-analysis.
Nonetheless, this suggestion contrasts a direct com-
parison of nonactivated versus calcium chloride
activated treatments (n= 40), which concluded the
former to be signicantly more effective.
From this
analysis combined with the results of the meta-
analysis (above), specic PRP techniques and meth-
ods are recommended (Table 5).
Platelet-rich plasma could be used to improve
hair restoration parameters (e.g., hair density) in AGA
monotherapy or adjunct therapy. For the former, 3 ses-
sions of PRP at 1-month intervals followed by a main-
tenance regimen is recommended.
Acknowledgments The authors wish to thank S.G.
Versteeg and Dr. M.S. Dotzert of Mediprobe
Research Inc., as well as Dr. M.A. Cole for assisting
in the writing of this manuscript.
1. Dhurat R, Sukesh M. Principles and methods of preparation of platelet-
rich plasma: a review and authors perspective. J Cutan Aesthet Surg
2. Watt-Smith S. Dental and craniofacial applications of platelet-rich
plasma. Br Dent J 2005;199:799.
3. Lin SS, Montemurro NJ, Krell ES. Orthobiologics in foot and ankle
surgery. J Am Acad Orthop Surg 2016;24:11322.
4. Bhanot S, Alex JC. Current applications of platelet gels in facial plastic
surgery. Facial Plast Surg 2002;18:2733.
5. Badran Z, Abdallah MN, Torres J, Tamimi F. Platelet concentrates for
bone regeneration: current evidence and future challenges. Platelets
6. Soffer E, Ouhayoun JP, Dosquet C, Meunier A, et al. Effects of platelet
lysates on select bone cell functions. Clin Oral Implants Res 2004;15:
7. Gaviño Orduña JF, Caviedes-Bucheli J, Manzanares C ´
espedes MC,
Berástegui Jimeno E, et al. Use of platelet-rich plasma in endodontic
procedures in adults: regeneration or repair? A report of 3 cases with 5
years of follow-up. J Endod 2017;43:12941301.
8. El-Sharkawy H, Kantarci A, Deady J, Hasturk H, et al. Platelet-rich
plasma: growth factors and pro- and anti-inammatory properties. J
Periodontol 2007;78:6619.
9. Shumez H, Prasad P, Kaviarasan P, Deepika R. Intralesional platelet
rich plasma vs intralesional triamcinolone IN the treatment OF alopecia
areata: a comparative study. Int J Med Res Health Sci 2014;4:11822.
10. Gilhar A, Etzioni A, Paus R. Alopecia areata. N Engl J Med 2012;366:
11. Hudgens JL, Sugg KB, Grekin JA, Gumucio JP, et al. Platelet-rich plasma
activates proinammatory signaling pathways and induces oxidative
stress in tendon broblasts. Am J Sports Med 2016;44:193140.
12. Gupta AK, Carviel J. A mechanistic model of platelet-rich plasma
treatment for androgenetic alopecia. Dermatol Surg Off Publ Am Soc
Dermatol Surg Al 2016;42:13359.
13. 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(7 pt 1):10406.
14. Heldin CH, Westermark B. Mechanism of action and in vivo role of
platelet-derived growth factor. Physiol Rev 1999;79:1283316.
15. Botchkarev VA, Botchkareva NV, Nakamura M, Huber O, et al.
Noggin is required for induction of the hair follicle growth phase in
postnatal skin. FASEB J 2001;15:220514.
16. Yano K, Brown LF, Detmar M. Control of hair growth and
follicle size by VEGF-mediated angiogenesis. J Clin Invest 2001;107:
TABLE 5. Recommended Techniques for Platelet-Rich Plasma Treatment of Androgenetic Alopecia
Treatment frequency and no.
of sessions
Three sessions of PRP at 1-mo intervals followed by a 3- to 6-mo maintenance period
Injection depth Subdermal
Collection systems Capable of high platelet recovery rate (1.5 million platelets per microliter,
which is 5
times basal concentration), although the average reported concentration is 3 times the
basal amount and influence of the balance of white blood cells, neutrophils, and red
blood cells is still under investigation
(Kushida and colleagues, 2014)
Activation Activation should be considered; however, the best method is up for debate as use of
exogenous agents such as calcium chloride have been contrasted with alternate
techniques, such as scalp needling,
or natural contact with dermal fibroblasts through
the PRP preparation and injection process
Centrifugation and
Use of sonication and microparticles is preferred
Needle size Impact is unclear
PRP, platelet-rich plasma.
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
17. Oshimori N, Fuchs E. Paracrine TGF-bsignaling counterbalances
BMP-mediated repression in hair follicle stem cell activation. Cell Stem
Cell 2012;10:6375.
18. Alves R, Grimalt R. Randomized placebo-controlled, double-blind,
half-head study to assess the efcacy of platelet-rich plasma on the
treatment of androgenetic alopecia. Dermatol Surg Off Publ Am Soc
Dermatol Surg Al 2016;42:4917.
19. Anitua E, Pino A, Martinez N, Orive G, et al. The effect of plasma rich
in growth factors on pattern hair loss: a pilot study. Dermatol Surg
20. Ayatollahi A, Hosseini H, Shahdi M, AhmadNasrollahi S, et al.
Platelet-rich plasma by single spin process in male pattern androgenetic
alopecia: is it an effective treatment? Indian Dermatol Online J 2017;8:
21. Borhan R, Gasnier C, Reygagne P. Autologous platelet rich plasma as a
treatment of male androgenetic alopecia: study of 14 cases. J Clin Exp
Dermatol Res [internet] 2015. Available from: http://www.omicsonline.
aid=57866. Accessed January 26, 2016.
22. Cervelli V, Garcovich S, Bielli A, Cervelli G, et al. The effect of
autologous activated platelet rich plasma (AA-PRP) injection on pattern
hair loss: clinical and histomorphometric evaluation. Biomed Res Int
23. Gentile P, Cole JP, Cole MA, Garcovich S, et al. Evaluation of not-
activated and activated PRP in hair loss treatment: role of growth factor
and cytokine concentrations obtained by different collection systems.
Int J Mol Sci 2017;18:PMC5343942.
24. Gentile P, Garcovich S, Scioli MG, Bielli A, et al. Mechanical and
controlled PRP injections in patients affected by androgenetic alopecia.
J Vis Exp 2018. doi: 10.3791/56406.
25. Gkini M-A, Kouskoukis A-E, Tripsianis G, Rigopoulos D, et al. Study
of platelet-rich plasma injections in the treatment of androgenetic
alopecia through an one-year period. J Cutan Aesthet Surg 2014;7:
26. Stevens HP, Donners S, de Bruijn J. Introducing platelet-rich stroma:
platelet-rich plasma (PRP) and stromal vascular fraction (SVF)
combined for the treatment of androgenetic alopecia. Aesthet Surg J
27. Takikawa M, Nakamura S, Nakamura S, Ishirara M, et al. Enhanced
effect of platelet-rich plasma containing a new carrier on hair growth.
Dermatol Surg 2011;37:17219.
28. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-
analysis. Stat Med 2002;21:153958.
29. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring
inconsistency in meta-analyses. BMJ 2003;327:55760.
30. Gupta AK, Carviel JL. Meta-analysis of efcacy of platelet-rich
plasma therapy for androgenetic alopecia. J Dermatolog Treat 2017;28:
31. Garg S, Manchanda S. Platelet-rich plasma-an Elixirfor treatment of
alopecia: personal experience on 117 patients with review of literature.
Stem Cell Investig 2017;4:64.
32. Tawk AA, Osman MAR. The effect of autologous activated platelet-
rich plasma injection on female pattern hair loss: a randomized
placebo-controlled study. J Cosmet Dermatol 2018;17:4753.
33. Khatu SS, More YE, Gokhale NR, Chavhan DC, et al. Platelet-rich
plasma in androgenic alopecia: myth or an effective tool. J Cutan
Aesthet Surg 2014;7:10710.
34. Singhal P, Agarwal S, Dhot PS, Sayal SK. Efcacy of platelet-rich
plasma in treatment of androgenic alopecia. Asian J Transfus Sci 2015;
35. Gentile P, Garcovich S, Bielli A, Scioli MG, et al. The effect of platelet-
rich plasma in hair regrowth: a randomized placebo-controlled trial.
Stem Cell Transl Med 2015;4:131723.
36. Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Comparison of growth
factor and platelet concentration from commercial platelet-rich plasma
separation systems. Am J Sports Med 2011;39:26671.
37. Mazzocca AD, McCarthy MBR, Chowaniec DM, Cote MP, et al.
Platelet-rich plasma differs according to preparation method and
human variability. J Bone Joint Surg Am 2012;94:30816.
38. Kushida S, Kakudo N, Morimoto N, Hara T, et al. Platelet and growth
factor concentrations in activated platelet-rich plasma: a comparison of
seven commercial separation systems. J Artif Organs Off J Jpn Soc Artif
Organs 2014;17:18692.
39. Degen RM, Bernard JA, Oliver KS, Dines JS. Commercial separation
systems designed for preparation of platelet-rich plasma yield
differences in cellular composition. HSS J 2017;13:7580.
40. Ince B, Yildirim MEC, Dadaci M, Avunduk MC, et al. Comparison of
the efcacy of homologous and autologous platelet-rich plasma (PRP)
for treating androgenic alopecia. Aesthet Plast Surg 2018;42:297303.
41. Angel System [internet]. Arthrex; 2018. Available from: https://www. Accessed
April 25, 2018.
42. GPS III Platelet Concentration System [internet]. Zimmer Biomet; 2018.
Available from:
Accessed April 25, 2018.
43. Eclipse PRP [internet]. 2018. Available from: http://
Accessed April 25, 2018.
44. PurePRP[internet]. Emcyte Corporation; 2018. Available from:
Accessed April 25, 2018.
45. Platelet-Rich Plasma (PRP) Prepared Using the HarvestSmartPrep
Multicellular Processing System [internet]. Harvest TerumoBCT; 2018.
Available from:
home/prp/products. Accessed April 25, 2018.
46. Discover Tru PRP Brochure [internet]. Discover Tru PRP; 2018. Available
from: Accessed April 25, 2018.
47. RegenKitBCTA-PRPPRPRegenPRPTMRegen Extracell
Product Highlights [internet].RegenlabUSAPRP&CellTherapy
Specialists; 2018. Available from: Accessed
April 25, 2018.
48. What Is Platelet-Rich Plasma (PRP)? [internet]. Selphyl; 2018. Available
from: Accessed April 25, 2018.
49. About Eclipse PRP [internet]. Eclipse; 2017. Available from: http:// Accessed April 25, 2018.
50. AngelConcentrated Platelet Rich Plasma (cPRP) SystemOperators
Manual [internet]. Angel Concentrated Platelet Rich Plasma (cPRP)
System; 2018. Available from: https://d1psc3qesfsa61.cloudfront.
Accessed April 25, 2018.
00:00:MONTH 2019 11
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
51. Sclafani AP. Applications of platelet-rich brin matrix in facial plastic
surgery. Facial Plast Surg FPS 2009;25:2706.
52. Giusti I, Rughetti A, DAscenzo S, Millimaggi D, et al. Identication of
an optimal concentration of platelet gel for promoting angiogenesis in
human endothelial cells. Transfusion (Paris) 2009;49:7718.
53. Gupta S, Revathi TN, Sacchidanand S, Nataraj HV. A study of the
efcacy of platelet-rich plasma in the treatment of androgenetic
alopecia in males. Indian J Dermatol Venereol Leprol 2017;83:412.
54. Garg S. Outcome of intra-operative injected platelet-rich plasma
therapy during follicular unit extraction hair transplant: a prospective
randomised study in forty patients. J Cutan Aesthet Surg 2016;9:157
55. Nam J, Lim H, Kim D, Shin S. Separation of platelets from whole blood
using standing surface acoustic waves in a microchannel. Lab Chip
56. Wu Y, Kanna MS, Liu C, Zhou Y, et al. Generation of autologous
platelet-rich plasma by the ultrasonic standing waves. IEEE Trans
Biomed Eng 2016;63:164252.
57. Cole J, Cole M, Insalaco C, Cervelli V, et al. Alopecia and platelet-
derived therapies. Stem Cell Investig 2017;4:18.
58. Ferrando J, Garc´
ıa SC, González-de-Coss´
ıo AC, Bou L, et al. A
proposal of an effective platelet-rich plasma protocol for the treatment
of androgenetic alopecia. Int J Trichology 2017;9:16570.
59. Mapar MA, Shahriari S, Haghighizadeh MH. Efcacy of platelet-rich
plasma in the treatment of androgenetic (male-patterned) alopecia:
a pilot randomized controlled trial. J Cosmet Laser Ther Off Publ Eur
Soc Laser Dermatol 2016;18:4525.
60. El Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M. Platelets rich
plasma versus minoxidil 5% in treatment of alopecia areata:
a trichoscopic evaluation. Dermatol Ther 2017;30. doi: 10.1111/dth.
61. Trink A, Sorbellini E, Bezzola P, Rodella L, et al. 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;169:6904.
62. Acell, Inc. Receives New FDA Clearances, Prepares for Future Growth
[internet]. ACell; 2015 Available from:
receives-new-fda-clearances-prepares-for-future-growth/. Accessed
April 24, 2018.
63. Acell, Inc. Receives FDA Clearance for Concurrent Use of its Wound
Management Devices [internet]. ACell; 2016. Available from: https://
wound-management-devices/. Accessed April 24, 2018.
64. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for
androgenetic alopecia: a pilot study. Dermatol Surg Off Publ Am Soc
Dermatol Surg Al 2014;40:10109.
65. Jimenez F, Izeta A, Poblet E. Morphometric analysis of the human scalp
hair follicle: practical implications for the hair transplant surgeon and
hair regeneration studies. Dermatol Surg Off Publ Am Soc Dermatol
Surg Al 2011;37:5864.
66. Hausauer A, Jones D. Evaluating the efcacy of different platelet-rich
plasma regimens for management of androgenetic alopecia: a single-
center, blinded, randomized clinical trial. Dermatol Surg 2018;44:
67. Puig CJ, Reese R, Peters M. Double-Blind, placebo-controlled pilot
study on the use of platelet-rich plasma in women with female
androgenetic alopecia. Dermatol Surg Off Publ Am Soc Dermatol Surg
Al 2016;42:12437.
68. Platelet-rich Plasma Injections Efcacious for Androgenetic Alopecia
[internet]. Healio Dermatology; 2017 Available from: https://www.
efcacious-for-androgenetic-alopecia. Accessed March 27, 2018.
69. Picard F, Hersant B, Niddam J, Meningaud J-P. Injections of platelet-
rich plasma for androgenic alopecia: a systematic review. J Stomatol
Oral Maxillofac Surg 2017;118:2917.
70. Kachhawa D, Vats G, Sonare D, Rao P, et al. A spilt head study of
efcacy of placebo versus platelet-rich plasma injections in the
treatment of androgenic alopecia. J Cutan Aesthet Surg 2017;10:869.
71. Starace M, Alessandrini A, DAcunto C, Melandri D, et al. Platelet-rich
plasma on female androgenetic alopecia: tested on 10 patients. J
Cosmet Dermatol 2018;18:5964.
72. Arshdeep, Kumaran MS. Platelet-rich plasma in dermatology: boon
or a bane? Indian J Dermatol Venereol Leprol 2014;80:514.
Address correspondence and reprint requests to: Aditya K.
Gupta, MD, PhD, Mediprobe Research, Inc., 645
Windermere Road, London, ON, Canada N5X 2P1, or
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
... Currently, PRP is commonly used in surgery and regenerative medicine to improve the recovery potential of soft tissues (e.g., ligaments, tendons, cartilage, and nerves) and bones [32][33][34][35][36][37]. Its clinical use has also been extensively reported for cutaneous wounds, burns, and skin donor sites, as well as for esthetic applications (e.g., cutaneous and capillary) [28,[38][39][40][41][42][43]. Finally, PRP applications in sports medicine have been shown to enhance recovery following tendon lesions and, in particular, result in shortened overall recovery periods for athletes [7,8,33]. ...
... Importantly, highly contradictory reports and analyses of PRP clinical efficacy are available in current scientific literature sources, when considering all therapeutic indications and manufacturing methods [12,14,24,25,27,38,40,44,45]. The critical importance of standardizing sample processing workflows and therapeutic protocols has been identified in order to obtain maximal benefits from orthobiologic treatments. ...
Full-text available
Platelet-rich plasma (PRP) preparations have recently become widely available in sports medicine, facilitating their use in regenerative therapy for ligament and tendon affections. Quality-oriented regulatory constraints for PRP manufacturing and available clinical experiences have underlined the critical importance of process-based standardization, a pre-requisite for sound and homogeneous clinical efficacy evaluation. This retrospective study (2013–2020) considered the standardized GMP manufacturing and sports medicine-related clinical use of autologous PRP for tendinopathies at the Lausanne University Hospital (Lausanne, Switzerland). This study included 48 patients (18–86 years of age, with a mean age of 43.4 years, and various physical activity levels), and the related PRP manufacturing records indicated a platelet concentration factor most frequently in the range of 2.0–2.5. The clinical follow-up showed that 61% of the patients reported favorable efficacy outcomes (full return to activity, with pain disappearance) following a single ultrasound-guided autologous PRP injection, whereas 36% of the patients required two PRP injections. No significant relationship was found between platelet concentration factor values in PRP preparations and clinical efficacy endpoints of the intervention. The results were in line with published reports on tendinopathy management in sports medicine, wherein the efficacy of low-concentration orthobiologic interventions appears to be unrelated to sport activity levels or to patient age and gender. Overall, this study confirmed the effectiveness of standardized autologous PRP preparations for tendinopathies in sports medicine. The results were discussed in light of the critical importance of protocol standardization for both PRP manufacturing and clinical administration to reduce biological material variability (platelet concentrations) and to enhance the robustness of clinical interventions (comparability of efficacy/patient improvement).
... In 2021, a metaanalysis by Cruciani [8]. Besides, three systematic reviews published similar results [21][22][23]. Our findings on hair density are consistent with these reviews, but some of the methods used in these studies differ. ...
Full-text available
Background Androgenetic alopecia (AGA) is a common yet difficult-to-treat condition, which is an important psychosocial problem. Platelet-rich plasma (PRP) therapy has been considered as a promising treatment for AGA. However, the current evidence on the efficacy of PRP for treating AGA is still controversial. This study evaluated the efficacy of PRP monotherapy in the treatment of AGA. Methods We searched PubMed, Embase, Cochrane Library and Web of Science to collect randomized controlled trials on use of PRP in AGA for a meta-analysis. Results Ten trials with a total 555 treatment units were identified. The hair density in PRP group was significantly higher than control group [MD = 25.09, 95%CI: 9.03–41.15, p = 0.002], but there was no significant difference in hair diameter between two groups [SMD = 0.57, 95%CI: − 0.23 to 1.38, p = 0.16]. Subgroup analyses indicated that hair density was significantly higher among the male-only trials than in the mixed-sex samples ( p = 0.02). In addition, neither the split-head design nor the year of publication affected hair density ( p = 0.05, p = 0.06). However, hair density was significantly higher in trials with a sample size less than 30 ( p = 0.0004). Conclusions PRP treatment increased hair density in participants with AGA, but not hair diameter. In terms of hair density, PRP elicits stronger effects in male patients. There was a trend toward differed treatment effect by gender with PRP injection, which warrants further investigation. Especially in the case of female. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .
... PRP contains high concentration of growth factors such as platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), insulin-like growth factor (IGF), etc., which binds to the cell membrane surface through transmembrane receptors to promote the regeneration of endometrial tissue. In recent years, several studies have demonstrated the effectiveness of PRP in many fields of medicine [10][11][12][13][14][15]. In the field of gynecology, a few recent studies have studied the effect of PRP in the treatment of patients with IUAs [16][17][18], however, these studies were either retrospective in design or limited sample size and focused mostly on menstrual patterns and postoperative adhesion stage, while the data on post-operative recurrence rate of IUAs was not consistent. ...
Full-text available
Purpose Intrauterine adhesion (IUAs) in women is a debatable topic and there is no clear consensus in its management and treatment strategies. Previous treatment measures have limitations which necessitates to consider effective measures for prevention of recurrence of IUAs. Hence, the aim of this study to explore the efficacy and safety of intrauterine infusion of autologous platelet gel (APG) and medical chitosan in preventing recurrence of IUAs in females after transcervical resection of adhesion (TCRA). Methods A prospective, randomized controlled trial was conducted among 80 patients presented with moderate to severe IUAs. Patients were randomized into two groups, APG group (n = 40) and medical chitosan group (n = 40). All patients were injected with either APG or medical chitosan after TCRA. Results The postoperative recurrence rate of adhesions in APG group was significantly lower than those in medical chitosan group (21% vs 49%). The median AFS score during the second-look hysteroscopy was significantly lower in APG group than in medical chitosan group (P = 0.008). The median AFS score reduction after TCRA surgery was significantly higher in APG group than in medical chitosan group (median, 95% CI 7.000, 6.0 to 8.3 vs. 6.000, 5.0 to 7.0, P = 0.004). Subgroup analysis of platelet concentration (1000 as cut-off value) into high- and low-dose subgroups reported no significant correlation existed between APG and baseline characteristics, recurrence rate and postoperative AFS reduction score except for previous intrauterine operation (P < 0.05). Conclusion Thus, after TCRA, intrauterine injections of APG provides better efficacy and safety compared with intrauterine injections of medical chitosan in preventing recurrence of intrauterine adhesions.
... A meta-analysis by Gupta et al evaluated studies using PRP as a treatment for AGA. 83 Nearly every study demonstrated a statistically significant increase in hair growth and hair density in the PRP treatment group compared to the placebo. The authors recommended that PRP therapy should be conducted at 1-month intervals for 3 months followed by maintenance therapy. ...
Full-text available
Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.
... A meta-analysis of ten studies (N = 165 participants) examining PRP treatment in patients with AGA showed a statistically significant overall standardized mean difference in hair density of 0.58 compared with baseline. Authors concluded that PRP is beneficial in the treatment of AGA [17]. Hair transplantation is an established effective treatment for AGA in male patients, especially in advanced stages, with graft survival being greater than 90% [18], but is limited by a weak occipital donor area in many female patients with AGA [19,20]. ...
Full-text available
Abstract Introduction This study assessed the levels of compliance to topical minoxidil (TM) among male and female patients with androgenetic alopecia (AGA) and analyzed the factors associated with minoxidil discontinuation. Method A retrospective study was conducted among 400 consecutive patients with AGA who presented to a dermatology clinic and who were prescribed minoxidil 2% or 5% in the past 5 years. Demographic factors, other previous treatments, and minoxidil parameters including the dose (2% or 5%), total duration of use, treatment results, and side effects were collected. Result The mean age of the patients was 32.41 years [standard deviation (SD) 8.18], and 66.5% were female. The majority of patients (82.5%) did not receive any previous treatment for AGA. Of the total patients, 345 (86.3%) have discontinued minoxidil. Discontinuation rate showed no association with sex (p = 0.271), age category (p = 0.069), or previous treatment (p = 0.530). Furthermore, the likelihood of minoxidil discontinuation decreased with the increase in treatment duration (p
... In addition, the American Academy of Orthopaedic Surgeons has published a consensus paper aiming to improve and accelerate the clinical evaluation, clinical use, and multifactorial optimization of biologicalbased therapies for musculoskeletal diseases and affections [26]. From a therapeutic standpoint, PRP applications have frequently been used within tissues with low intrinsic healing potential and for indications such as tendinopathies, calcaneal and plantar fasciitis in the foot, muscle strains, ligament sprains, articular cartilage injuries and degeneration, or local preparation before hair transplants [7,[27][28][29][30][31][32][33][34][35][36]. ...
Full-text available
Providing accurate and up-to-date practical tools enabling oversight of platelet-rich plasma (PRP) legislation and of the appropriate standards to be implemented for its manufacture and use in Europe is a demanding task. This is due to rapid medico-technological advancements, slowness and disparity in legislation updates and enforcement between member states, and many reported gray-zone practices, notably for autologous PRP use. The levels of risk associated with blood manipulation processes generally dictate the manufacturing requirements for PRP preparations, which have gradually shifted toward good manufacturing practices (GMP) for standardization and overall quality enhancement. This work firstly outlines Western European and Swiss legislation for PRP products/preparations, providing key simplified information and recommendations for medical doctors seeking to implement this biological-based therapy for safe use in hospital settings, clinics, or private offices. This work secondly shows the importance of PRP-based product manufacturing standardization, which subsequently enables sound clinical evaluation of therapeutic interventions. Although the applicable legal bases provide guidelines for GMP manufacturing infrastructure and basic process design, paramount importance is set on the definition of workflows, technical specifications, and key parameters for PRP preparation and delivery. Overall, the development of simple and robust technologies and processes for PRP preparation is critical for guaranteeing the high therapeutic quality of the intervention, in collaboration with qualified GMP manufacturing platforms. Importantly, this work aims to serve as a practical tool for clinicians based in Western Europe who are willing to appropriately (i.e., administratively and technically) implement autologous PRP treatments in musculoskeletal regenerative medicine workflows, to ensure they make informed and optimal regulatory or process-based decisions.
Aim: We aimed to expound upon previous research examining the effect of platelet rich plasma in the treatment of sacroiliac joint (SIJ) dysfunction and pain. Materials & methods: A systematic review was employed in conjunction with a pooled analysis of the efficacy of platelet-rich plasma (PRP) in SIJ dysfunction and pain. Results: A total of 259 articles were retrieved following database systematic review. As a result, four clinical trials and two case studies were subjected to full text appraisal. The dates of publication ranged from 2015 to 2022. Conclusion: Although a unique modality, there is not enough evidence to support the employment of PRP injections over current steroid standard of care. Further double-blinded, randomized control trials are required to elucidate PRP role in SIJ dysfunction.
Hypertrichosis is a condition characterized by the presence of an abnormal increase in the number of hairs and either occurs in a localized pattern or a generalized pattern. Localized hypertrichosis around a healing wound is an infrequent postsurgical complication. A 60-year-old Asian man came for a consultation because of an increase in the amount of hair around his 2-month postsurgical wound of right knee arthroplasty. Neither history of topical medications nor systemic medications, which can cause hypertrichosis, were presented. A diagnosis of postsurgical hypertrichosis was made clinically without any laboratory investigations. The patient was reassured that the medication was not necessary and he was appointed for follow-ups. Within the next 4 months, the hypertrichosis resolved spontaneously without any treatment. The case demonstrates the correlation between wound healing and hair morphogenesis, especially as both processes involve some similar growth factors and signaling molecules. Further studies might lead to discovery and better management of hair disorders.
Full-text available
Facial aesthetic surgery is an emerging branch worldwide. India, a torchbearer country in facial plastic surgery, has seen tremendous growth in medical technology, resources, and clientele over the past century. This study aims to study past practices and current trends in facial plastic surgery and aesthetic procedures in India by individually addressing commonly performed nonsurgical procedures (Botox, Kybella [Allergan, Irvine, CA], fillers, threads, micro-focused ultrasound, and nonsurgical hair restoration), and surgical procedures (rhinoplasty, blepharoplasty, hair transplant, and facelift). It also aims to further elaborate on the scope of facial aesthetics and make recommendations on prospects in the field. A structured scoping review and a subsequent evidence-based synthesis were done following an extensive literature search on various databases such as PubMed (National Institutes of Health, Bethesda, MD), LILACS (Latin American and Caribbean Center on Health Sciences Information, São Paulo, Brazil), MEDLINE (National Library of Medicine, Bethesda, MD), EMBASE (Elsevier, Amsterdam, the Netherlands), and Cochrane (Wiley, Hoboken, NJ). The initial search yielded 703 articles, out of which 20 were found to be relevant to the present study and discussed. It was found that there is an upward trend in the growth of facial plastic surgery in India, and a gradual shift in patient attitude toward nonsurgical aesthetic procedures was seen. This article affirms the growth of facial aesthetic surgery in India by highlighting the recent development and trends in the practices of surgeons. It also addresses the shortcomings in the current administration and makes recommendations to fill the existing loopholes in plastic surgery. Level of Evidence: 5
Full-text available
Background Androgenetic alopecia (AGA) is characterized by miniaturization of the hair follicles gradually causing conversion of terminal hairs into vellus hairs, leading to progressive reduction of the density of hair on the scalp. Approved therapeutic options are limited and show side effects. Objectives To evaluate injections of stromal vascular fraction (SVF), which is rich in adipose-derived stromal cells (ASCs) in combination with platelet-rich plasma (PRP) in the upper scalp as a new autologous treatment option for AGA. Methods Ten male patients (age range, 25-72 years), suffering from AGA at stage II to III according to the Norwood-Hamilton scale, have been treated with a single injection of autologous PRS (ACPSVF: combination of PRP and SVF) in the upper scalp. Preinjection and 6 and 12 weeks postinjection changes in hair density were assessed using ultra high-resolution photography (Fotofinder). Results Hair density was significantly increased after 6 weeks and 12 weeks postinjection (P = 0.013 and P < 0.001). In hair-to-hair matching analyses, new hair grew from active follicles. Furhtermore nonfunctioning hair follicles filled with hyperkeartotic plugs, up to today assumed incapable of forming new hair, proved to grow new hair. No side effects were noted after treatment. Conclusions A single treatment of platelet-rich stroma injected in the scalp of patients with AGA significantly increased hair density within 6 to 12 weeks. Further research is required to determine the optimal treatment regimen. Preferred options to our opinion include the repetition of PRS or additional treatments with PRP. Level of Evidence: 4
Full-text available
Introduction and Objective Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma. The platelet is a natural source of different growth factors and cytokines. These growth factors act on stem cells in the bulge area of the follicles and stimulate the development of new follicles, and promote neovascularization. The aim of this study was to investigate the efficacy and safety of PRP injections in androgenetic alopecia (AGA) in men. Patients and Methods Fifteen male patients (mean age: 39 ± 9.7 years) with AGA grades III–VI were enrolled in the study. Five injections of 2–4 ml PRP (Regenlab PRP Kit-RegenACR®, Le Mont-sur-Lausanne Switzerland) by single spin process were administered every 2 weeks. Standard photographs, trichogram, and measurement of hair density and diameter in an area marked with a tattoo (with digital photographic hair analyzer) were done at baseline and 3 months after the last injection. In addition, patients completed a patient satisfaction questionnaire at each visit on a −2 to +2 score (−2: much worse, −1: slightly worse, 0: without change, +1: slightly better, +2: much better). Results Thirteen patients completed the study. The number of hairs increased slightly from 149.62 ± 49.56 to 168.46 ± 43.703/cm², however, this increase was not statistically significant (P = 0.24). On the other hand, the thickness of hairs decreased from 0.051 ± 0.105 to 0.045 ± 0.011 mm, which was also not significant (P = 0.37). There was a significant decrease in anagen hairs and increase in telogen hairs, and anagen/telogen ratio decreased significantly from 6.38 ± 4.57 to 2.67 ± 1.87 (P = 0.003). Conclusion Our study could not show any benefit from PRP injections in the treatment of male AGA. There is a strong need for well-designed, randomized controlled trials with large sample size, proper control group, standard treatment protocols (concerning the amount, number and interval of PRP injections, method of preparation and activation, etc.), and long follow-up periods to evaluate the safety and efficacy of PRP in the treatment of male AGA.
Full-text available
Background: Platelet rich plasma (PRP) injections have emerged as a promising regenerative therapy for androgenetic alopecia. To date, injections of both autologous native and activated PRP have been administered to hair loss patients, and positive results have been observed. However, little to no work has yet to be seen wherein PRP treatments are combined with hair restoration surgeries. Furthermore, the PRP activation protocol in the hair restoration setting employs compounds with potentially deleterious side effects, namely thrombin or calcium gluconate. Therefore, the objectives of this work are to evaluate the effectiveness of platelet and platelet-derived products as augmented graft therapies in hair restoration surgeries and to compare the follicular regeneration rate of follicles transplanted in the presence of platelet lysate (PL) versus activated PRP (AA–PRP). Methods: PL was administered to the frontal scalp of three male AGA patients. Three treatment zones measuring 4 cm-2 were mapped in the midline scalp region of each patient and equal number of follicular grafts were placed in each box along with PL, AA–PRP, or normal saline. The transplanted follicular grafts of a fourth patient were placed solely with PL. Hair checks in which the surface area of hair coverage was quantified were performed at follow-up appointments ranging from 3.5 months to 7 months post-surgery. In these appointments, the number of follicular units with hairs measuring 50 mm or more were counted to determine the percentage of graft hair regeneration. Growth factor concentrations (VEGF, TGF-1, PDGF-BB, IGF-1) in PL and AA–PRP were also measured for an independent subject set. Results: Follicular regeneration in transplanted grafts was found to be superior for those placed with PL rather than AA–PRP or saline at all follow-up dates. Specifically, at 3.5 moths post-op, 89±9%, 74±7%, and 57±10% of follicular units had regenerated hair in the PL, AA–PRP, and saline treatment zones, respectively. At 4 months post-op, 99%, 75%, and 71% of follicle regeneration had occurred in the PL, AA–PRP, and saline treatment areas, respectively. Impressively, when PLwas injected alone , the patient experienced a 50% increase in follicular unit density and a 122% increase in hair density 7 months post-injection. When growth factor concentrations were measured, PL generated from a 30 min sonication of PRP was found to have significantly higher levels of VEGF, PDGF-BB, and TGF-1 than AA–PRP. Conclusions: PRP remains a promising hair loss therapy and should be evaluated further for use not only as an independent therapeutic tool, but also as a treatment to augment surgical procedures. PL in particular affords an effective and efficacious therapeutic product given that the lysate may be obtained by mechanical rather than chemical means. Ultrasonic waves provide sufficient energy to rupture platelet cell walls, and centrifugation may be used to separate the lysate from cell fragments prior to delivery.
Full-text available
Background Platelet-rich plasma (PRP) has emerged as a promising treatment for androgenetic alopecia (AGA). In spite of the several studies previously reported, to date, a standardized protocol for PRP preparation and application, as well as a standard method for evaluating results has not been established. Aims The aim of this study is to propose a standardized method for preparation and application of PRP for male AGA (MAGA) and female AGA (FAGA) and assess its safety and efficacy as a co-adjuvant therapy. Materials and Methods Seventy-eight patients, 19 men and 59 women with AGA Grades II–IV in Ebling's scale, currently on treatment with topical minoxidil and/or oral finasteride for more than a year without improvement, were included in this study. PRP was prepared using a single spin method, and injected in affected areas for 3 monthly sessions, followed by 3 bimonthly sessions. A decrease of at least one grade in Ebling's scale was considered a successful result. Results After the 6° session, 71.4% of MAGA and 73.4% of FAGA patients reached a successful outcome while 21.4% and 16.3%, respectively, remained without changes. Only 7.1% of MAGA and 10.2% of FAGA presented worsening of their condition. Conclusions PRP together with a periodical application protocol can be considered effective as a coadjuvant therapy in patients who no longer respond to pharmacological treatments. Ebling's scale was a practical and reliable parameter to allow a better evaluation in both MAGA and FAGA.
Full-text available
Platelet-rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery and dermatology. PRP is a simple, cost-effective and feasible treatment option with high patient satisfaction for hair loss and can be regarded as a valuable adjuvant treatment modality for androgenic alopecia and other types of non-scarring alopecias. Authors have proposed a hair model termed "Golden anchorage with 'molecular locking' of ectodermal and mesenchymal components for survival and integrity of hair follicle (HF)" in this article. Golden anchorage comprises of bulge stem cells, ectodermal basement membrane and bulge portion of APM. PRP with its autologous supply of millions of growth factors works on 'Golden anchorage' along with keratinocytes (PDGF), dermal papilla (IGF and fibroblast growth factor), vasculature (VEGF and PDGF) and neural cells (Nerve Growth Factor) in a multipronged manner serving as an 'elixir' for hair growth and improving overall environment.
Background: Studies suggest platelet-rich plasma (PRP) may mitigate androgenetic alopecia (AGA), but each varies in the frequency of and interval between treatments. Objective: To compare the efficacy, satisfaction, tolerability, and safety of 2 initial PRP injection protocols over 6 months. Methods: Prospective, randomized, single-blinded trial among 40 patients with moderate AGA. Participants received subdermal PRP injections according to 1 of 2 treatment protocols: 3 monthly sessions with booster 3 months later (Group 1) or 2 sessions every 3 months (Group 2). Folliscope hair count and shaft caliber, global photography, and patient satisfaction questionnaires were obtained at baseline, 3 months, and 6 months. Results: At 6 months, both groups demonstrated statistically significant increases in hair count (p < .001). These improvements occurred more rapidly and more profoundly for Group 1 (mean percent change: Group 1, 29.6 ± 13.6 vs Group 2, 7.2 ± 10.4; p < .001). Shaft caliber also increased significantly with no difference between groups. Treatments produced high satisfaction (82% "satisfied" or "highly satisfied") and were safe and well tolerated (mean pain score 2.1). Conclusion: Subdermal PRP injections are an efficacious and tolerable therapy among men and women with AGA. The benefits may be greater if first administered monthly. Clinicians should consider these findings when designing treatment plans.
Background Recently, platelet‐rich plasma (PRP) injection has been proposed as a potential adjuvant therapy to treat androgenetic alopecia. Aims Investigate the efficacy, tolerability, and clinical improvement of PRP for the treatment of female AGA. Patients/Methods A total of 10 female patients affected by AGA and not responding to treatment with minoxidil and/or oral antiandrogens were enrolled. The clinical improvement was evaluated by pull test, global photographs, and Trichoscan at weeks 9, 12, and 24, and hair measurements were performed at baseline and 12 and 24 weeks after the first session. Results After 24 weeks, the median relative percentage change (%RC) for all the parameters of hair density was mostly positive. After 12 weeks, the medium hair diameter in frontal area showed a significant increase (%RD = 12.5, with P‐value < .05), and after 24 weeks (%RD = 14.6, P‐value < .05), the vellus relative change instead showed a decrease, especially in the front and the central area, while for the vertex, the decrease was mainly visible at the end (−6.6%). No adverse events were reported. Conclusion Platelet‐rich plasma injections have a positive therapeutic effect on hair density and hair diameter improvement.
23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the Norwood-Hamilton classification scale, and female pattern hair loss (FPHL) in Stage 1 to Stage 2 as determined by the Ludwig classification scale, were treated with non-activated autologous platelet-rich plasma (A-PRP). Autologous blood (55 mL) was harvested using sodium citrate as an anticoagulant. A-PRP (23 mL) was produced for all cases using a closed system according to the transfusion service protocol. Following centrifugation (260 x g for 10 min) the A-PRP was inserted in a laser light selector device, and after the centrifugation, 9 mL of A-PRP was collected. The scalp of the patients affected by androgenetic alopecia (AGA) was divided into four areas (frontal, parietal, vertex, and occipital); local anesthesia was not performed. Interfollicular A-PRP injections (0.2 mL × cm²) were performed by controlled and mechanical injections scheduled at a depth of 5 mm using a medical injector gun. Treatment sessions were performed with a 30-day interval. For each patient, three treatment sessions were performed. PRP was injected in the androgen-related areas of scalp affected by hair loss. Placebo (normal saline solution) was loaded in another syringe (10 mL) and injected on the adjacent side in a similar fashion.
Background: Androgenetic alopecia (AGA), the most common cause of hair loss in both sexes, accounts for 95% of all cases of hair loss. Although the literature has suggested that both nonactivated (n-PRP) and activated autologous (a-PRP) PRP can be used to treat AGA, we did not find any study investigating the use of homologous PRP (h-PRP) for this purpose. Also, to the best of our knowledge, there are no studies comparing the efficacy of h-PRP, a-PRP, or n-PRP on AGA therapy. Objectives: The aim of this study was to compare the increase in hair density, average number of platelets, complications, preparation, and duration of application in the treatment of AGA using a-PRP, n-PRP, and h-PRP. Methods: Between 2014 and 2015, we studied male patients who had experienced increased hair loss in the last year. Patients were divided into three groups: Group 1 received n-PRP, Group 2 received active PRP, and Group 3 received h-PRP. For Group 1, PRP was prepared by a single centrifugation prepared from the patient's own blood. For Group 2, the PRP was prepared from the patient's own blood, but a second centrifugation was applied for platelet activation with calcium chloride. For Group 3, the PRP was prepared from pooled platelets with the same blood group as the patient from the blood center. PRP was injected at 1, 2, and 6 months. The hair density (n/cm(2)) of each patient before and after injection was calculated. Each patient was assigned a fixed evaluation point at the time of application to calculate hair density. Results: At 2, 6, and 12 months after the first treatment, the increase in hair density was calculated as 11.2, 26.1, and 32.4%, respectively, in Group 1; 8.1, 12.5, and 20.8%, respectively, in Group 2; and 16.09, 36.41, and 41.76%, respectively, in Group 3. The increase in hair density was statistically significantly greater in Group 1 than in Group 2 and more so in Group 3 than in both groups among all controls (p < 0.05). Conclusion: The efficacy of both PRPs was determined in AGA treatment in our study. However, it was determined statistically that the increase in hair density with h-PRP was greater than with autologous PRP groups. We believe that h-PRP therapy can be used in patients with AGA presenting with hair loss. Level of evidence ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .