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DETAILS | 28 SEPTEMBER 2014 | MedEsthetics By Garry R. Lee, MD, and Gordon H. Sasaki, MD, FACS PRP for Hair Loss Using PRP nonsurgically to stimulate hair growth in early androgenetic alopecia. Your patients who are losing their hair may be enticed by the Platelet-Rich Plasma (PRP) concept. After all, it seems so simple: They have their blood drawn; it is centrifuged to concentrate growth hormones and platelets; then a hair restoration physician injects it right back into their own scalp to stimulate hair growth. Though the premise seems too good to be true—and there remains a paucity of published data on using PRP to treat baldness—we have treated patients with early androgenetic alopecia (AGA) in our practices and seen good results. Following is some background on PRP and hair loss and the protocols we use to treat our patients. PRP BASICS "PRP is blood plasma containing a concentration of platelets many times greater than normally found in blood," as defi ned by the International Society of Hair Restoration Surgery. Concentrated growth factors are stored in the platelets' alpha granules, including platelet-derived growth factor, transforming growth factor beta, vascular endothelial growth factor, epidermal growth factor, insulin-like growth factor and fi broblast growth factor 2. Upon being activated with thrombin or calcium chloride, platelets degranulate, releasing growth factors that bind to transmembrane receptors for adult mesenchymal stem cells, fi broblasts, endothelial cells and epidermal cells. This triggers a pathway leading to cellular proliferation, matrix formation and collagen synthesis—thus stimulating growth and healing. PREPARING PRP While the U.S. Food and Drug Administration (FDA) has accepted a few automated devices for the "safe and rapid preparation of platelet poor (and rich) plasma and platelet concentrate from a small sample of blood," there is not yet any FDA-approved indication for PRP. Therefore, the use of PRP for hair growth is strictly off-label. Physicians may use PRP on patients, so long as it is not specifi cally marketed or promoted to patients for this indication. TREATING AGA WITH PRP We focus on using PRP to treat early AGA, the most com- mon cause of hair loss, which affl icts 70% of men and 40% of women. AGA in men begins at the temples and at the vertex of the scalp. In women, AGA presents with diffuse thinning without hairline recession. In theory, PRP helps patients with early AGA by stimulating the proliferation and differentiation of stem cells in the hair follicle bulge area. Surgical hair transplantation, minoxidil and fi nasteride are currently the treatments of choice. Published data on PRP for hair growth is limited. Among the research, in 2006, Uebel et al. 1 , kept follicular grafts in a PRP solution for 15 minutes before implantation. Seven months after follicular unit transplantation (FUT), the © GETTY IMAGES