Patrick Yam, MD

If the PRP is formulated properly, it can help with biofilm and associated microbial colonization. Several studies (Gilbertie 2020, Pall 2023, Schuldt 2021), have shown that PRP has anti-microbial and antibiofilm properties. The PRP should be high concentration, e.g. a platelet concentraiton of at least 1 million/µL and low in leucocytes and red blood cell contamination. The only way to ensure high concentration, dose and proper composition is through PRP testing and analysis of each treatment. PRF would have a similar benefit. Over time, such treatments could help with the biofilm and with volume loss through tissue regeneration.

In order to know if PRP will be effective for hair loss, it's far more important to ask about the concentration and dose of the platelets in the PRP that you received. Low concentration PRP will not work for hair loss, and could actually cause more hair loss. Even though this effect is likely temporary, it won't help in the end. The only way to know the concentration is to test each time using a hematology analyzer, since every sample will be different. Good PRP platelet concentration should be at least 1 million/µL and the dose should be at least 6 billion per treatment. If you had this, and the PRP was injected under the skin, it will diffuse into the surrounding area and get to the follicles. They are actually not as deep as 4-6 mm, but they are deeper than 1.0mm. We usually inject around 2-3 mm deep, but also leave more shallow boluses of PRP to absorb and diffuse into the local area around each injection site. We use manual injection for better control and no product wastage which can occur with injection guns. For comfort, we use a nerve block with lidocaine in a separate area, away from the PRP injections. Good luck!

Sorry to hear about your ITP diagnosis. At our clinic, we've done thousands of PRP procedures. More importantly, we use a hematology analyzer to check the platelet count of the patient's blood at the beginning of the procedure, and the PRP that is produced just before we use it. If the platelet count is not high enough, we won't use the PRP, because it lacks enough of the active ingredient, the platelets and their growth factors and signalling proteins. Preparing good PRP is a delicate process, especially when the starting count is low (i.e. less than 200k/µL). It's very easy to lose all the platelets. It could still be possible to prepare good PRP from low platelet counts, but we often need to start with a much larger blood sample, adjust the settings of the centrifuge, do double-spin process, and carefully check the platelet concentration along the way to be sure that the PRP has the right concentration and dose for the purpose it's being used for. Even by itself, microneedling will rejuvenate the skin and stimulate collagen. I wouldn't add the PRP unless the concentration is tested and known during the procedure.
Best wishes, Patrick Yam MD PRP Medical Aesthetics

Not all PRP is the same, and not all patients are the same. There are many reasons and types of hair loss. Androgenetic alopecia is the most common type of non-reversible hair loss in both men and women, and PRP has been shown to be a very effective treatment, but it needs to be the right type of PRP. Platelet concentration and dose are very important. Different PRP systems can produce very different levels of concentration and dose of platelets delivered in a single treatment. For example, some systems might deliver 89k/µL while others could be 1500/µL or more and this is very common. Using a typical amount of 6mL of PRP injected, the first system will give the patient 534,000 platelets, while the higher concentration PRP would give 9,000,000,000 platelets, which is a difference of around 1700%!

The concentration and dose is important because some studies have shown that using low concentration PRP could actually result in a loss of hair counts and density several months after the treatments. At our clinic, we check the concentration and quality composition of every PRP sample just before we use it. If it doesn't meet our standards, we won't use it and we stop the procedure. Concentration and dose are especially important when treating hair loss or joint and muscle problems such as arthritis or sports injuries.

A proper consultation prior to thinking about PRP is also very important, as PRP won't work very well if there is an underlying condition such as iron deficiency or hypothyroidism. We often hold off on treating patients who want PRP for hair restoration while we work on fixing their hormones or nutritional deficiencies first.

Best wishes, Dr. Patrick Yam, PRP Medical Aesthetics

Thanks for the great question. Shock loss is very rare from injections, especially if you're using good quality PRP. I agree with injecting 'blebs' or deposits under the surface which would diffuse into the surrounding tissue.

Interval is important, and you don't want to go too long between treatments. Ideally 2 - 4 weeks, with closer intervals seeming to show more benefit in a recent systematic review of the scientific literature.

Even MORE important than interval is the quality of the PRP you are receiving, including the PLATELET CONCENTRATION and DOSE. Different PRP systems give very different platelet concentrations, which can vary by 2000% or more. The only way to be sure about the platelet concentration is to analyze the PRP using a hematology analyzer, to analyze the final PRP just before injection. Generally for hair, we aim for a concentration of 1 million or more per microliter and a dose of 6 billion or more for the scalp. This may vary if using PRFM (platelet rich fibrin matrix), instead of PRP. If you use low concentration PRP, it could work against you and cause more hair loss, as shown a 2017 study by Gentile et al.

Finally, it sounds like you have had a great consultation to obtain a proper diagnosis, but for the benefit of anyone reading this, any hair loss should be reviewed with proper consultation and labs if needed to look into the cause. PRP may not help much if there is an underlying nutritional deficiency (e.g. iron), or hormone problem (e.g. hypothyroidism). One the signs of hypothyroidism can be loss of the later part of the eyebrow hairs. Best wishes, Dr. Patrick Yam PRP Medical Aesthetics.