It is normal to shed 50 to 100 hair strands in a day; some individuals may even lose more hair than that sometimes. However, when an unwarranted and abrupt relative increase in the loss of hair (estimated by the presence of more hair in the drain, comb or clothing) is noted, an underlying cause can be suspected. Hair loss can be temporary (when lost hair regrows) or permanent. When excessive hair loss becomes a cause of concern for the patient, medical care should be sought from a physician or dermatologist. Causes of hair loss can include hormonal imbalance (due to pregnancy, menopause, thyroid disorders or discontinuing contraceptive pills), autoimmune diseases (like alopecia areata, lupus, lichen planus), infections (like ringworm disease of the scalp), side effects of certain medicines, acute stress, psychological disorders like trichotillomania (hair-pulling disorder) and nutritional deficiencies.

Platelet-rich plasma (PRP) is a concentrate of plasma protein with platelets in it. It is derived from whole blood that has been centrifuged to remove red blood cells from it. Evidence suggests that injection of platelet-rich plasma derived from the patient into their scalp can increase the blood flow and provide the nourishment needed to stimulate the growth of hair. Platelet-rich plasma contains growth factors that positively influence cell proliferation, cell differentiation, chemotaxis and intracellular matrix synthesis, all of which are needed in effective wound healing and tissue regeneration. Two kinds of platelet-rich plasma are available – activated platelet-rich plasma and non-activated platelet-rich plasma. Activation of platelet-rich plasma essentially aims to bring about the degranulation (or activation) of platelets in order to release bioactive compounds that initiate the healing cascade in damaged tissues. Three methods are widely used to activate platelet-rich plasma – the addition of calcium products like calcium gluconate, thrombin or type 1 collagen. Studies have shown that activated platelet-rich plasma has more efficient therapeutic results than non-activated platelet-rich plasma.

Relying on these favourable properties, platelet-rich plasma concentrate injections have been used for many treatments including cosmetic procedures in dermatology and plastic surgery, as well as in the treatment of musculoskeletal injuries like arthritis and tendinitis. Platelet-rich plasma injections have also been used for promoting hair growth. Injections of platelet-rich plasma can be used on their own or as an adjunct to other hair loss treatment procedures like hair transplant. As with all hair loss treatment procedures, platelet-rich plasma (PRP) therapy is an elective procedure that is not required medically and can prove to be expensive.

  1. Preparation for PRP therapy for hair loss
  2. Procedure of PRP therapy for hair loss
  3. Contraindications for PRP therapy for hair loss
  4. Complications of PRP therapy for hair loss
  5. Other treatments of hair loss

When considering any hair loss treatment procedure, it is important to meet with a dermatologist or specialist to discuss one’s problems and goals. The doctor will begin by taking a thorough medical history, conducting a physical examination and running some laboratory tests. After diagnosing the underlying cause of hair fall, other treatment approaches may be tried first. The aim will remain to treat the causative disease first. If the hair loss does not improve after that or the patient wants it, hair loss treatment procedures are discussed. After choosing the hair loss treatment best suited for the patient, a date will be set and some preparation instructions will be given to the patient. It is advisable to follow your doctor’s orders, as advice may defer in each case; however, some common measures to take before a platelet-rich plasma (PRP) hair treatment include:

  • Inform the doctor about blood thinner medications, beta-blockers or other prescription medication you’re on. These may need to be stopped, have doses altered or substituted, depending on the case.
  • Anti-inflammatory drugs like NSAIDs (non-steroidal anti-inflammatory drugs) need to be stopped up to one week before the treatment as the success of the procedure lies on effective inflammatory reaction. The doctor must be informed in case of preexisting long-term therapy.
  • Some dietary supplements may need to be stopped leading up to the procedure. Generally, iron and vitamin D are safe to take.
  • Sun exposure of the area being treated should be avoided for at least one week prior to the treatment.
  • Minimise or avoid alcohol up to three days before the treatment.
  • Avoid smoking for at least three days before the procedure as it can impede the healing process.
  • In general, it is okay to continue other hair growth treatments (like minoxidil/rogaine) before the platelet-rich plasma therapy unless advised otherwise by the treating doctor.
  • Maintain adequate hydration the day before the procedure. It would be beneficial to slightly increase water intake as well.
  • Remove any hair extensions, weaves or wigs the morning of the procedure.
  • It is recommended that patients wash their hair thoroughly with regular shampoo on the morning of the procedure.
  • Hairstyling products (like sprays or gels) should not be applied before the procedure.
  • Patients should eat normally as they do. Heavy greasy meals should be avoided before the treatment.
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Typically, three sessions, 4-6 weeks apart, are needed for PRP therapy for hair loss. However, maintenance sessions can be required every 4 to 6 months. Platelet-rich plasma (PRP) therapy for hair loss is conducted in three steps.

  • Step 1: Blood is withdrawn from the patient, usually from a vein in the arm, and placed in a centrifuge machine. The machine separates the different complements of the whole blood.
  • Step 2: Within ten minutes of placement in the centrifuge, the whole blood components separate into:
    • Platelet-poor plasma
    • Platelet-rich plasma
    • Red blood cells

Platelet-rich plasma is extracted and activation products may be added to it. Activated platelet-rich plasma (PRP) is created by inducing the degranulation of platelets and release of biochemicals by adding calcium compounds, thrombin or type 1 collagen.

  • Step 3: The activated or non-activated platelet-rich plasma is taken up in a syringe and then injected into areas in the patient’s scalp that need hair growth. A local anaesthetic like lidocaine is used prior to the injection.

Aftercare would involve the following:

  • Bruising, redness, itching, swelling and/or soreness that may last for 2 to 5 days following treatment is normal and expected. Paracetamol can be taken for relief from these symptoms.
  • NSAIDs and anti-inflammatory drugs should be avoided.
  • Hair should not be wet for three hours following the treatment.
  • Hair should be washed with a pH balanced shampoo for the next three days.
  • Hair products should not be applied for at least six hours following the procedure.
  • Icing the injection sites should be avoided as it can have an anti-inflammatory action and reduce the effects of the PRP treatment.
  • A hot shower and thorough shampooing in the evening following the procedure would enhance the effects of the therapy and is recommended.
  • In the rare case an infection ensues, a course of antibiotics may be prescribed by the doctor.

The results of platelet-rich plasma therapy for hair loss have been found to be variable. While some patients benefit tremendously, others have had less fruitful results. Overall, though, a positive outcome is reported.

Although relatively risk-free and thought to have an overall positive outcome, platelet-rich plasma therapy may not be suitable for all patients. Some factors that could render therapy avoidable include:

As the patient’s own blood is being used after processing, there isn’t a risk of contracting a communicable disease. However, some minor complications associated with injections and local anaesthesia can occur. Possible side effects of PRP therapy for hair loss include, but may not be limited to:

  • Injury to blood vessels or nerves
  • Infection
  • Calcification at the injection points
  • Scarring
  • Temporary bleeding at injection sites
  • Itching
  • Headaches
  • Scalp tend
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Usually, hair fall does not require specific medical therapy, but if significant loss is present the underlying cause should be investigated and, after arriving at an accurate diagnosis, treated adequately. Hair replacement therapy can be opted for by patients for cosmetic reasons to boost their self-esteem and confidence levels but is an expensive elective procedure that is not considered medically necessary. While platelet-rich plasma treatments for hair loss are a new novel means of promoting sustained hair growth that has become popular, many of the following hair fall treatments can also be pursued:

  • Medical treatment of underlying causes: In the cases where hair loss is caused by an underlying medical condition, appropriate treatment consists of targeting the disease first. Examples of such therapy include, but are not limited to:
    • Disease-modifying antirheumatic drugs (DMARDs), corticosteroids or other immunosuppressive agents: These medicines are used to treat autoimmune causes of hair loss.
    • Antifungal therapy: Oral or topical antifungal agents are needed to treat fungal infections that cause hair fall. Common antifungal conditions that lead to hair loss include ringworm of the scalp and dandruff. Ketoconazole (2%) shampoo is used very commonly upon a dermatologist’s advice.
    • Alternate medicines: Some medicines are known to cause hair loss. While not all of these medications can be replaced, sometimes if a suitable alternative is available and the hair loss is particularly distressing, other drug options can be considered. For example, ACE inhibitors used for the treatment of hypertension have a known history of inducing hair loss.
    • Dietary supplements: Although a healthy balanced diet cannot be substituted to attain good hair health, sometimes malnourishment states can necessitate the use of external nutritional supplements to overcome deficiencies.
  • Medication to promote hair growth: Certain medicines are used solely for the purpose of promoting hair growth. While some of them are available over-the-counter, some may need a prescription from a dermatologist. All medicines should ideally only be used after assessment and advice from a doctor. Examples:
    • Minoxidil: Also known as rogaine, it is applied on the scalp to prevent hair from becoming visibly thinner and promote hair growth in both men and women.
    • Finasteride: Also known as propecia, it is available with a doctor’s prescription and is used to treat androgenic alopecia (male pattern baldness) in men. It is also used to treat benign prostate hyperplasia (BPH).
  • Hair fall treatment procedures: If medications are ineffective at curbing hair loss, following treatment procedures can be sought.
    • Hair transplant: Two types of hair transplants – Follicular Unit Transplantation (FUT) or Follicular Unit Strip Surgery (FUSS) and Follicular Unit Extraction (FUE) – are available. Although the method of extraction of viable hair follicles for transplantation from the donor site varies in both methods, the underlying principle remains the same. Healthy hair follicles harvested are transplanted into suitable recipient sites in the body for hair replacement.
    • Scalp reduction: It is a surgical procedure in which a patch of bald scalp is removed with a scalpel and the edges are closed with sutures.
    • Scalp flaps: Similarly, another surgical procedure can be done where a bald patch on the scalp is covered by a flap created from neighbouring scalp tissue.
    • Scalp tissue expansion: It is a two-step surgical procedure in which devices, called tissue expanders, are inserted into a part of the scalp that has hair and is adjacent to a bald spot to be covered. After a month or so, the scalp tissue with the device inserted expands and, in a second surgery, is placed to cover the neighbouring bald patch on the scalp.

(Read more: Hair loss prevention and natural remedies)

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