Platelet Rich Plasma (PRP): An Important Role in Hair Transplant Surgery?
Platelet Rich Plasma or “PRP” is an injectable solution traditionally used in orthopedic medicine for the treatment of joint injury and delayed wound healing. More recently however, hair restoration physicians have discovered it's benefit in providing their patients with the very best hair transplant results.
PRP is created by removing a small amount of blood from a patient, separating the blood into the cellular and fluid-like plasma components, removing a portion of the plasma enriched with platelets (the elements responsible for blood clotting in the body), and injecting the sample back into the patient. The blood is separated into its cellular and plasma components via rapid spinning or “centrifugation.” During the centrifugation process, the platelet enriched plasma becomes naturally enhanced with growth factors, anti-inflammatory elements, and cell signaling molecules; these components are responsible for the healing and growth properties seen in PRP therapy.
Because the therapy promotes cellular growth and healing, many hair transplant surgeons and researchers have investigated PRP as an injectable hair loss solution. Though the “stand alone” injectable PRP results were varied and somewhat controversial, physicians experimenting with the solution noticed something interesting: while PRP may not be a fully effective injectable hair loss treatment, it could still serve a valuable purpose in hair transplant surgery. These physicians believe the role of PRP in hair restoration surgery is twofold. First, PRP may serve as a viable holding solution for harvested follicular unit grafts before implantation; and second, injecting PRP into the recipient region after making the incisions may promote faster healing and better growth.
Graft storage mediums are a crucial aspect of a hair transplant procedure. In many instances, delicate follicular unit grafts are removed and stored for a significant amount of time before being placed into the scalp. If the grafts are stored improperly, they may become excessively dry or malnourished and fail to grow when placed into the scalp. Many physicians store grafts in simple saline, which is a mixture of salt and water that mimics the normal chemistry (salt-to-water balance) of the blood plasma. While this storage solution may prevent desiccation (excessive drying), it does not contain many of the nutrients the follicles normally receive from the scalp’s natural blood supply. To combat this problem and ensure grafts remain healthy and viable while they are outside the body, some hair transplant surgeons are now using PRP or PRP-derived holding solutions. Because PRP contains the body’s natural blood plasma, growth factors, and other molecules necessary for healthy follicles, it may lead to superior grafts and better overall yield when used as a graft medium.
According to Coalition hair transplant surgeon and PRP expert Dr. James Deyarman, the PRP process creates a second excellent holding solution: Platelet Poor Plasma (PPP). Dr. Deyarman states: “When you create PRP, the centrifuge goes through two speeds: during the first cycle, the blood cells are separated from the plasma; and during the second cycle the platelets are concentrated in the plasma. When you draw off the plasma (to further concentrate the platelets) it is referred to as “Platelet Poor Plasma” and possesses less platelets and growth factors in the plasma. I chose to use the PPP as a holding solution for the grafts, and I believe this is better than normal saline.”
Because of Platelet Rich Plasma’s ability to decrease inflammation and promote healing, many surgeons believe injecting it into the recipient scalp during hair transplant procedures may be useful as well. According to Dr. Deyarman:
“I think PRP should be used in every hair transplant procedure. I inject 0.1cc for every square centimeter in the recipient scalp where I transplanted. When patients who underwent a hair transplant procedure with me in the past and did not get PRP come back for a second, they are amazed how fast they heal and how quickly the scalp “redness” clears up. I’ve seen patients experience new hair growth in the second month after the procedure, and this is much faster than my transplant patients who do not receive PRP. Since there are no side effects and it is a safe procedure, why not do this to help the outcome of the transplant?”
Dr. Deyarman believes that because the body naturally increases its amount of platelets during wound healing, adding an increased amount of platelets after the incisions are created will only expedite the healing process. Dr. Deyarman is not alone in this thinking, as other hair restoration experts, such as Coalition hair transplant surgeon Dr. Jerry Cooley, are integrating PRP into their practices as well. Though the use of Platelet Rich Plasma in hair transplant surgery is still new and not yet fully proven, the evidence we’ve seen thus far demonstrates that it may play an important role in promoting healthy follicular unit grafts and increasing healing and growth in the recipient area.
To learn more about Platelet Rich Plasma, visit the following Hair Loss Q&A Blog articles: