Top Doctors Debate the Effectiveness of Platelet-Rich Plasma Hair Restoration
Last month, facial plastic surgeons gathered in Nashville, Tennessee for the American Academy of Facial Plastic and Reconstructive Surgery’s annual meeting. Zwivel’s Susan Hornik spoke to participants about one of the most exciting new fields of research in regenerative medicine: platelet-rich plasma injections.
Once considered a thing of science fiction, regenerative medicine is now reality, and facial plastic surgeons are leading the charge into this brave new world where the body’s own cells induce and promote healing. One such technique, platelet-rich plasma (PRP) therapy, shows promise in the fields of hair transplantation and skin rejuvenation.
What is platelet-rich plasma (PRP) therapy?
Platelet-rich plasma (PRP) injections are prepared using a few tubes of the patient’s own blood, which after being centrifuged are injected into the treated areas, releasing growth factors that increase the proliferation of reparative cells.
According to clinical studies done by the New York Hospital for Special Surgery, “PRP injections have improved function and decreased pain to various maladies, including – but not limited to – elbow, wrist, shoulder, hip, knee, and ankle tendonosis. Early work is also showing promise for osteoarthritis.”
The use of platelet-rich plasma first began in sports medicine and dentistry. “In oral surgery and dentistry, these substances have been considered to aid in the successful grafting of bone into areas of the facial skeleton,” says Dr. Fred Fedok, president of the American Academy of Facial Plastic and Reconstructive Surgery. “In the field of sports medicine, there is widespread use of PRP in the management of arthritis, joint injuries, and tendon repair.”
Although much of the science behind PRP is still in its infancy, plastic surgeons are already showing keen interest in the therapy’s potential. “Since platelet-rich plasma is derived from the patient’s own blood, there are no issues with compatibility. It’s also relatively simple to use, namely as a tool to promote growth and healing in the face and scalp,” says Dr. Fedok.
“Although there is limited concrete-hard science supporting the use of PRP at this time, there is growing evidence that it enhances the success rate of hair transplantation, and slows hair loss in patients with several different kinds of alopecia. It’s also used to treat skin wrinkling and sun damage, and to improve the success rates of fat transfer procedures,” he adds.
PRP injections for hair transplantation and regrowth
“We’ve seen a lot of success with PRP in hair transplantation; it’s been proven to make hair grow better and faster when combined with the surgical part of the hair restoration procedure,” says Dr. Samuel M. Lam, a Texas-based facial plastic surgeon who co-chaired the AAFPRS’s meeting last month. “I use PRP injections almost every day during hair transplant surgery. It’s invaluable as a fertilizer for improved graft growth.”
I use PRP injections almost every day during hair transplant surgery. It’s invaluable as a fertilizer for improved graft growth.
Dr. Samuel M. Lam
As for the effectiveness of PRP as a standalone procedure for hair growth without surgery, Dr. Lam says he “definitely sees improvement,” although surgeons don’t have consistent outcomes or protocols for that yet.
Miami facial plastic surgeon Dr. Jeffrey Epstein uses PRP for hair transplantation and as a stand-alone procedure. “It appears that PRP is effective for male and female pattern hair loss in around 70% of cases,” he says. “We’ve seen shedding slow down or stop altogether, and a reversal of some of the miniaturization that occurs with male and female pattern hair loss: finer hairs become thicker, creating the appearance of a fuller head of hair. At times we mix the PRP with acellular dermal matrix (ADM), a biologic additive that comes from porcine bladder and seems to enhance the activity of the PRP. In addition, studies have shown that PRP is effective for alopecia areata (spot baldness).”
We’ve seen shedding slow down or stop altogether, and a reversal of some of the miniaturization that occurs with male and female pattern hair loss: finer hairs become thicker, creating the appearance of a fuller head of hair.
Dr. Jeffrey Epstein
“Nearly all of the hair transplants we perform receive PRP at the same time for several reasons: PRP seems to accelerate recovery and enhance overall hair re-growth. Furthermore, it definitely lowers the risk of shock loss – the temporary shedding of the original hairs. Finally, PRP is an effective way to help slow down the progression of hair loss in the future,” says Dr. Epstein.
For all its success, PRP is not a miracle, nor does it accurately contain stem cells, a term that is used to promote the procedure but which is not accurate, emphasizes Dr. Epstein. “Actual stem cells may have a role in treating hair loss; we just completed the first ever approved FDA study on this, but results are months away.”
Before and after PRP hair restoration treatments. Photo credits: Dr. Jeffrey Rapaport
Another hair restoration specialist for whom PRP has become essential before, during, and after a hair transplant is New Jersey dermatologist Dr. Jeffrey Rapaport. “PRP has the ability to decrease hair loss, increase the thickness of existing hair and re-grow hair that has been dormant for less than 5 years,” says Dr. Rapaport. “ I think it’s a breakthrough because it’s a natural substance that can regrow hair, with virtually no side effects. It’s also used to speed up the healing process in any procedure that disrupts the epidermis, such as a laser and micro needling, and by orthopedic surgeons for tendon injuries and bone recreation.”
I think PRP is a breakthrough because it’s a natural substance that can regrow hair, with virtually no side effects.
Dr. Jeffrey Rapaport
Criticism of PRP treatments
Dr. Lam experiments with PRP as a skin rejuvenation treatment have been inconclusive. “I did not feel I was seeing significant improvement as an adjunctive measure, nor did I not see improved fat grafting survival following the use of PRP, which I did for about a year,” says Dr. Lam.
He does however see promise in stromal vascular fraction (SVF), the process of extracting stem cells and growth factors from liposuctioned fat. “I believe that the quantity and the quality of platelet-rich plasma are vital to achieve excellent outcomes. The future at this point for facial rejuvenation and possibly for hair rejuvenation may be in the use of PRP combined with stem cells from the stromal vascular fraction of adipocytes.”
Other doctors are are more blunt in their assessment of PRP therapy’s benefits.
“Studies supporting the value of platelet-rich plasma are insufficient,” says Beverly Hills surgeon Dr. Kenneth Steinsapir. “The public should view these treatments with skepticism. Research has not established that plasma treatments provide meaningful rejuvenation or improved healing. Many people saw Kim Kardashian have a vampire facial on her show – that’s a skin treatment where PRP is applied to the skin and then the skin is aggressively punctured with a spiked roller covered with needles. Advocates of this treatment suggest it is as effective as fractionated skin resurfacing. Unfortunately, the evidence is just not there.”
The public should view these treatments with skepticism. Research has not established that plasma treatments provide meaningful rejuvenation or improved healing.
Dr. Kenneth Steinsapir
Dr. Steinsapir states that the science behind PRP is “very weak” and not compelling. “The few studies on the use of PRP for hair grafting are poorly designed. They claim that the areas treated with PRP show faster hair growth but the actual differences are not meaningful. In fact, there is simply no evidence that PRP can be described as a breakthrough. Even the best investigations simply fail to substantiate its role. At best, one can say that the proponents of PRP are unscientific, and at worst are fraudulent, looking to take advantage of the gullibility of the public for a profit motive.”
The major downside to PRP is “its failure to live up to the promises and hype,” concludes Dr. Steinsapir. “With so many truly safe and effective treatments, it is unethical to promote services that are not effective. Patients put their lives, trust, and money into the hands of cosmetic surgeons. It is the responsibility of those surgeons to offer scientifically sound treatments, and not traffic in ineffective services that separate people from their hard-earned money with little hope of achieving what is promised.”
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