Category Archives: Platelet-Rich Plasma

Does PRP for Hair Loss Work?

This post was first published in March 2014. I have now updated it and added links to more recent studies at the bottom of this post. Note that even the respected Mayo clinic recently found PRP to work to temporarily regrow hair in women.


Platelet-rich-plasma (PRP) injections will not grow robust plentiful hair in the vast majority of hair loss sufferers. PRP will almost never grow lengthy new hair in areas of the scalp that have been totally bald for many years. If you ever decide to get this procedure, you should go in with modest expectations.

However, there now exist over 50 studies from around the world that have shown PRP to grow at least some hair. More often, PRP therapy will make existing hair thicker. Platelet-rich plasma contains numerous growth factors, many of which are well known to benefit hair growth.

PRP hair growth and pigment change
PRP and ACell hair growth and color change. Source: Dr Jerry Cooley.

Scroll down to the bottom of this post in order to see the updated list of PRP and hair loss studies. Most of them have detailed patient statistics on success and failure rates. Also make sure to read my post on PRP sometimes making hair darker.

Introduction

As I mentioned earlier, PRP will almost never regrow hair in completely bald areas of the scalp. In most best-case scenarios, PRP treatment will thicken and seemingly improve the density of existing scalp hair. If you are really lucky, it will make recently miniaturized hair grow back stronger and lengthier. Even if effective, PRP is not a permanent solution to your thinning hair loss problems.

Numerous people on online hair loss forums have been disappointed with their PRP treatment results. In stark contrast, on local TV programs in the US, doctors have frequently presented real life patients who claim to be very pleased with their PRP hair growth results. They always show impressive before and after photos and videos as evidence. In most cases, they are likely presenting their absolute best case outcomes.

On realself, as of May 2020, an astounding 87 percent of patients have voted their PRP hair growth results to be worth the expense and effort. I am extremely skeptical about this success rate number. Some great before and after PRP hair loss treatment photos can be found in those realself reviews.

I have not done any research on the reliability and accuracy of these testimonials. On sites such as Yelp, you can find numerous fake ratings and reviews. Youtube also has many videos on PRP and hair loss treatment before and after experiences.

PRP Treatment for Hair Loss

Platelet-rich plasma (PRP) is the concentration of platelets that are derived from the plasma portion of one’s own blood. PRP contains various growth factors, cytokines and other bioactive factors. Because the plasma is autologous (i.e., extracted from a patient’s own blood), there is minimal possibility of any significant adverse side effects.

To obtain PRP, a small amount of blood is first extracted from a patient. This blood is then spun in a centrifuge that leads to separation into three layers:

  1. Platelet-poor plasma (PPP).
  2. Platelet-rich plasma (PRP).
  3. Red blood cells.

The whole procedure typically requires one or two spins of the centrifuge and takes less than 15 minutes. The concentration of platelets in PRP is usually around five times as much as in normal blood. This PRP is then injected into a patient’s scalp in order to try and improve his or her hair.

Platelet-Rich Plasma Growth Factors

The key benefit from platelet-rich plasma seems to arise from various growth factors. The main growth factors in PRP that are relevant to hair growth include:

  • Platelet-Derived Growth Factor (PDGF)
  • Fibroblast Growth Factor (FGF)
  • Insulin-like Growth Factor 1 (IGF-1)
  • Vascular Endothelial Growth Factor (VEGF)
  • Epidermal Growth Factor (EGF)
  • Nerve Growth Factor (NGF)
  • Transforming Growth Factor Beta (TGF-β)

Interestingly, a number of other hair loss treatments that I have read about over the years also target one or more of the above growth factors. Among these, the most impressive one is include Shiseido’s Adenosine based products. Adenosine is thought to increase FGF-7, FGF-2, IGF-1, and VEGF.

A company named Follicept was working on a widely touted product to deliver IGF-1 to the scalp. However, it seems to have ceased operations in 2016 after the demise of one its main researchers.

On an important note, it is interesting that one of the ways in which Minoxidil works to grow scalp hair is via the upregulation of VEGF.

Related to this subject matter, a 2017 small-scale study from Spain looked at something called plasma rich in growth factors (PRGFs), and found it to have significant benefits towards hair growth.

Treatment Guidelines

PRP therapy typically consists of three injection sessions spread across a 4-8 week period. Thereafter, maintenance treatments are recommended every 4-6 months. PRP injections are not particularly painful or uncomfortable for most patients. Their nonsurgical nature with negligible chances of side effects is also appealing to many people. Make sure to see this great pre- and post-care instructions resource page.

Among the reasons that PRP results can vary so much include: the significant variance in techniques; equipment used; and concentrations of platelets in the final product. Centrifuge quality, in particular, differs substantially depending on manufacturer.

If you are contemplating getting a platelet-rich plasma treatment on your scalp, it is imperative to choose a reputable doctor. Many hair restoration surgeons have significant experience in the use of PRP for hair growth purposes. Clinics and plastic surgeons that specialize in many different cosmetic procedure are often less preferable to hair experts.

Note that initial shedding after platelet-rich plasma treatment is a common side effect. The bald truth talk forum section on PRP is worth a visit to read about patient experiences and reviews.

PRP and Hair Transplants

If I was undergoing a hair transplant procedure today, I would seriously consider the addition of PRP to the procedure. Even if the benefits are not always guaranteed. An increasing number of hair transplant surgeons are adding PRP to the procedure in the belief that the growth factors improve yields and donor area healing. Some are certain about the benefits. It remains to be seen if this is just a revenue making scheme or a scientifically sound add-on.

Platelet-Rich Plasma Hair Loss Treatment Cost

The cost of PRP for hair loss varies drastically. In the US, the lowest price that I have read about is $500 per treatment. The highest has been $2,500 per visit. The latter is ridiculous, since most people will require a few sessions for optimal results. And the results will often not last for more than a year.

On the realself website that I mentioned earlier, the average cost of PRP treatment for hair loss is $2,125 as of 2020. Most health insurance plans will not cover cosmetic treatments such as PRP for hair growth.

PRP for Hair Loss Clinical Studies

A number of recent studies on platelet-rich plasma have shown favorable outcomes (often when used in conjunction with ACell) on hair growth. I really like the fact that these studies are coming from all over the world rather than from just one country such as the US. This limits the potential for any kind of sponsor-influenced or self-interest-driven fraudulent “findings”.

United States, 2020 — PRP effective treatment for hair regrowth in female AGA, but not as good as minoxidil. Interestingly, patients preferred their PRP results and quality of life after treatment.

Syria, 2020 — PRP Injections for Men with AGA Show Positive Effect on Hair Density.

Turkey, 2020 — Positive Data on PRP and AGA.

Pakistan, 2020 — Combined SVF-PRP Therapy Benefits Hair Growth more than PRP Alone.

Italy, 2020 — Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia. Only 17% of analyzed studies reported that PRP was not effective in treating AGA.

India, 2020 — PRP and Minoxidil Combination Superior to Either Treatment Alone.

Canada, 2020 — Small Clinical Trial Suggests PRP Hair Growth Varies Depending on Growth Factor Concentrations.

Italy, 2020 — Autologous Activated Platelet-Rich Plasma (AA-PRP) and Non-Activated (A-PRP) in Hair Growth.

China, 2020 — Sonicated PRP Promotes Hair Follicle Stem Cell Activation and de novo Hair Follicle Regeneration.

Sri Lanka, 2020 — PRP Injections Have a Positive Therapeutic Effect on AGA Without Major Side Effects.

India 2019 — PRP Gives Superior Results to Minoxidil in Treating Androgenetic Alopecia.

Netherlands, 2018 — Platelet-Rich Stroma: Platelet-Rich Plasma and Stromal Vascular Fraction (SVF) Combined Treatment of AGA.

Turkey, 2018 — Comparison of the Efficacy of Homologous and Autologous Platelet-Rich Plasma for Treating Androgenic Alopecia.

Pakistan, 2018 — Effect of Platelets-Rich Plasma on Scalp Hair Diameter.

Egypt, 2018 — The Effect of Autologous Activated Platelet-Rich Plasma Injection on Female Pattern Hair Loss.

USA, 2018 — Platelet-Rich Plasma for the Treatment of Female Pattern Hair Loss: A Patient Survey.

PRP Hair Loss Results
PRP hair growth in a female

Spain, 2017 — A Proposal of an Effective Platelet-Rich Plasma Protocol for the Treatment of Androgenetic Alopecia. Image on the right is one of several included in this paper, and shows the patient’s scalp and closeup view of the hair via magnification.

Italy, 2017 — Correlation Between Individual Inflammation Genetic Profile and Platelet-Rich Plasma Efficacy in Hair Follicle Regeneration.

India, 2017 — Platelet-Rich Plasma with Microneedling in Androgenetic Alopecia along with Dermoscopic Evaluation.

India, 2017 — A Split Head Study of Efficacy of Placebo versus Platelet-rich Plasma Injections in the Treatment of Androgenic Alopecia.

Italy, 2017 — Valuation of Not-Activated and Activated PRP in Hair Loss Treatment: Role of Growth Factor and Cytokine Concentrations Obtained by Different Collection Systems.

Spain, 2016 — Randomized Placebo-Controlled, Double-Blind, Half-Head Study to Assess the Efficacy of Platelet-Rich Plasma on the Treatment of Androgenetic Alopecia.

Italy, 2015 — The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial.

Thailand, 2015 — At the 9th Congress for Hair Research, Dr. Ratchathorn Panchaprateep from Thailand presented favorable findings regarding combination therapy treatment of hair loss using PRP and Non-Ablative 1,550 nm Erbium Glass Fractional Laser in 9 patients.

India, 2015 — PRP is Effective in the Treatment of Androgenic Alopecia, with no Side Effects.

South Korea, 2015 — Therapeutic Efficacy of Autologous Platelet-Rich Plasma and Polydeoxyribonucleotide on Female Pattern Hair Loss.

Greece, 2014 — Study of Platelet-Rich Plasma Injections in the Treatment of AGA over a 1-year Period.

Italy, 2014 — Platelet-Rich Plasma for Androgenetic Alopecia: A Pilot Study.

Italy, 2014 — The Effect of Autologous Activated Platelet Rich Plasma (AA-PRP) Injection on Pattern Hair Loss.

India, 2014 — Platelet-Rich Plasma in Androgenic Alopecia: Myth or an Effective Tool.

France, 2013 — Platelet-Rich Plasma: a Therapy for Hair Growth.

Taiwan, 2013 — Promotional Effect of Platelet-Rich Plasma on Hair Follicle Reconstitution in Vivo in Mice.

Brazil, 2012 — Follicular Unit Megasessions and Platelet Growth Factors.

South Korea, 2012 — Autologous Platelet-Rich Plasma: A Potential Therapeutic Tool for Promoting Hair Growth.

Key Growth Factors in Platelet-Rich Plasma

I have mentioned platelet-rich plasma (PRP) in a dozen or so posts on this blog over the past three years. The positive effect of PRP on hair growth is somewhat controversial. However, there is no controversy when it comes to the fact that PRP contains numerous concentrated growth factors (GFs). And many of these growth factors are known to at least modestly benefit hair thickness as well as hair quantity.

PRP Growth Factors
Platelet-Rich Plasma (PRP) Growth Factors.

In the past I have briefly discussed some of the key growth factors that are highly concentrated in PRP. I think it is worth having a separate post here that discusses all of them in a bit more detail. There is a good chance that I am still missing things, so any corrections and suggestions are welcome via the comments.

It should be noted that even many non-PRP related hair loss products target one or more of the below listed growth factors in order to stimulate hair growth. There is a good chance that both PRP as well as hair loss products that contain some of the below growth factors make existing hair stronger. It is probably unlikely that such products ever bring back hair that has been lost for a long time.

Growth Factors in Platelet-Rich Plasma

The key growth factors in PRP that are supposedly beneficial to hair growth are:

  • Insulin-Like Growth Factor 1 (IGF-1).
  • Fibroblast Growth Factor (FGF).
  • Platelet-Derived Growth Factor (PDGF).
  • Vascular Endothelial Growth Factor (VEGF).
  • Epidermal Growth Factor (EGF).
  • Transforming Growth Factor Beta (TGF-β).
  • Nerve Growth Factor (NGF).

IGF-1

I start with the growth hormone insulin-like growth factor 1 (IGF-1) because I have already covered it a few times before.

  • Promotion of IGF-1 expression is one of the main considerations behind Shiseido’s bestselling adenosine based products.
  • US-based Follicept was targeting IGF-1 delivery in its hair loss product, prior to the company’s demise.
  • Adipose-derived stem cells (ADSCs — an exciting recent development in the hair loss world) are rich in various growth factors, including IGF-1.
  • Last year, an important and widely publicized study found that topical application of oleuropein (derived from the leaves of olive drupes) induces hair growth in mice. According to the study findings, oleuropein-treated mouse skin showed substantial upregulation of IGF-1.

FGF

I list fibroblast growth factor (FGF) next because I have also covered it many times on this blog before. There are 22 types of FGFs numbered FGF-1 through FGF-22. A significant number of these influence hair growth. I may write an entire detailed post on FGFs at some point in the future. I have covered some of the key ones on this blog before, in particular FGF-5, which discourages hair growth and has to be inhibited. Australian company Cellmid’s Evolis line of products claims to inhibit FGF-5.

Note that PRP does not inhibit growth factors. So it is more relevant for the purposes of this post to discuss some of the FGFs that promote hair growth. It seems like the main ones are FGF-1, FGF-2, FGF-7, FGF-9 and FGF-10. Evidence for three of those (FGF-1, FGF-2 and FGF-10) and their positive effects on hair is found in an important 2014 study from China. Fibroblast growth factors stimulate hair growth through β-Catenin and Shh expression.

Note that “hair cell regeneration” or variations of that term are mentioned a number of times in this study, even if in mice.  PRP is said to increase FGF-2 concentration levels. Interestingly, when I interviewed Dr. Malcolm Xing last year, he mentioned that FGF-2 is the preferred growth factor used at this clinic for his work purposes.

FGF-9 has become an especially important growth factor in large part due to the work of the renowned Dr. George Cotsarelis, who holds a patent titled “Fibroblast growth factor-9 promotes hair follicle regeneration after wounding“. Dr. Cotsarelis is also a co-author of a 2013 paper that concludes: “The importance of FGF-9 in hair follicle regeneration suggests that it could be used therapeutically in humans“.

Finally, FGF-7 (also called keratinocyte growth factor, or KGF) is required for hair growth. The well known researcher Dr. Elaine Fuchs co-authored an important study on FGF-7, hair development and wound healing all the way back in 1995. Moreover, Histogen’s Hair Stimulating Complex product is focusing on KGF as one of the key growth factors to be injected in human scalps.

PDGF

Platelet-derived growth factor (PDGF) is a key growth factor involved in blood vessel formation. A 2006 study from Japan found that “PDGF isoforms induce and maintain anagen phase of murine hair follicles“. Adipose-derived stem cells (ADSCs) are rich in various growth factors, including  PDGF, and are increasingly utilized in the hair loss world.

VEGF

Besides hair growth, vascular endothelial growth factor (VEGF) is also involved in blood vessel formation. A 2001 study concluded that “normal hair growth and size are dependent on VEGF-induced perifollicular angiogenesis”. Note that Shiseido’s adenosine based shampoo also promotes the expression of VEGF. The previously discussed adipose-derived stem cells are also rich in various growth factors including  VEGF.

Also, one of the ways in which Minoxidil works to grow hair is via the upregulation of VEGF. Moreover, Histogen’s Hair Stimulating Complex product is focusing on VEGF as one of the key growth factors to be injected in human scalps.

A number of studies have examined natural and synthetic products that increase VEGF and their impact on scalp hair. For example, in 2018, Japanese researchers found that water-soluble chicken egg yolk peptides stimulate hair growth through induction of VEGF production.

EGF

Epidermal growth factor (EGF) promotes cell growth, proliferation and differentiation. A 2003 study from Hong Kong concluded that EGF functions as a biological switch that is “turned on and off in hair follicles at the beginning and end of the anagen phase of the hair cycle“.

TGF-β

Transforming growth factor beta (TGF-β) is a cytokine protein growth factor. From the brief research I did, it seems like TGF-β actually adversely impacts hair growth!  e.g., see here, here and here. So I am not sure if this growth factor in PRP benefits hair.  Will update this if I find out more.

NGF

There seem to be mixed opinions on the impact of nerve growth factor (NGF) on the hair cycle in any significant manner. A 2006 study suggests both anagen-promoting and catagen-promoting effects of NGF on the hair cycle. Another study, also from 2006, seems to also find different effects of NGF on the hair cycle.