Risk of shock loss from ‘ blebs’ in PRP administration?

When PRP is injected correctly (even as small “blebs” into the superficial dermis at follicle depth), it does not carry a clinically significant risk of shock loss, unless there is:
- significant trauma from injection (too deep, too large boluses, or too many passes),
- a compromised vascular supply in the area,
- or it is done into actively inflamed tissue (e.g. seborrheic dermatitis flare, infection).

Thank you for your question. PRP is generally safe and effective for hair restoration, but technique and volume are important to minimize the risk of temporary shedding or shock loss. The "blebs" technique, where small amounts are injected just under the skin at follicular depth, is commonly used. If the injections are evenly distributed and not overly concentrated in one area, the risk of stress on the follicles is low.

Given your history of stress, TE, and resolved SD, it’s important to ensure your scalp is healthy and inflammation-free before starting PRP.

The concern you're raising about PRP (Platelet-Rich Plasma) injections for hair regrowth, particularly the risk of shock loss or hair shedding due to over-injection in one area, is a valid one. PRP therapy involves injecting concentrated plasma into areas where hair loss has occurred, stimulating hair follicles and promoting regrowth. Shock loss, or temporary shedding, can sometimes happen after hair restoration treatments, including PRP, as existing weak hairs may fall out before stronger regrowth occurs.
When it comes to "blebs" or small bubbles of plasma being injected under the skin at follicle depth, this technique is often used to ensure that the PRP reaches the target area without causing trauma to the surrounding tissues. The likelihood of shock loss typically depends on factors such as the patient's condition, treatment protocol, and the interval between treatments. A careful and experienced practitioner would ensure that the injection volume and distribution are managed to reduce the risk of hair shedding.
In general, any shedding from PRP is usually temporary, and the hair regrowth process should resume in a few weeks.

In my opinion, shock loss from plain PRP does not occur if injected using the Rapaport subdermal depo technique. Possible causes of shock loss are excessive intradermal injections or using a extracellular matrix such as Acell. These put pressure on the follicles. The same holds true for Eyebrow and beard injections. Find a PRP expert.
Jeff Rapaport MD FAAD
Realself Hall of Fame

While it's true that some individuals may experience hair shedding or shock loss after getting PRP injections, the risk of this occurring can be reduced by ensuring that no more than the recommended amount of plasma is injected into one site, and by spacing out treatments appropriately. It's also important to find an experienced and knowledgeable practitioner who can help minimize any potential risks. However, it's important to note that while PRP has shown promise in promoting hair regrowth in some individuals, its effectiveness may vary between individuals and may not work for everyone.

Hi there Reliable213! In my experience, injecting PRP superficially into the dermis, closer to the level of the hair follicles, tends to produce better results than deeper, subcutaneous injections. I have not seen issues with shock loss when using this approach, even when small blebs form under the surface.
For optimal results, I recommend a series of monthly PRP treatments during the initial growth phase, then moving to quarterly sessions for maintenance.
It’s also worth considering combination therapies. Treatments like exosomes, nanofat, smooth threads, and even Keravive can enhance results by improving follicle health, boosting collagen, and optimizing the scalp environment for regrowth.
Best wishes,Frank Soto León, MDImagen Body Sculpting & Cosmetic CenterOmaha, NE

Microneedling with just PRP should not cause any shock loss. Combining/stacking PRP with other agents will have a higher risk

It’s important not to think for even a moment that we really understand how to administer PRP for the eyebrows or even how effective it truly is. We can not as a society of hair specialists even agree where PrP fits in in the algorithms of treating scalp hair loss let alone eyebrows. Surprising, I know, but that’s the reality. Sure PrP can cause hair loss as well as sometimes helping. We have no good understanding of really what works best and if other options like minoxidil, bimatoprost, etc are superior (better) than PRP. What we have in the present age is opinions on PRP - and that is just fine. But one must always remember these are opinions not usually backed up by very rigorous evidenced based scientific study. The treatment of eyebrow loss requires addressing the root cause. Telogen effluvium and other eyebrow issues are often temporary and so if issues remain it may reflect that the root cause is not, in fact, being addressed. If the root cause is not addressed, PRP may be a lifelong treatment. If eyebrow loss is due to other inflammatory issues, PRP may or may not be the first line option. The issue in my mind expands far from whether blebs or no blebs are given. it centers around what is the diagnosis and what other issues are possibly being missed and what options are on the table to consider.

PRP and PRFM are your own body product and to not stay in one place very long. Your body will disperse the PRP or PRFM into the area surrounding where it was injected. It is highly unlikely to get shock loss from such an injection. Shock loss occurs during hair transplantation and many leaders in the field, Like Jack Fisher MD, have recommended using PRP or PRFM as a bath for the hair follicles until they are transplanted. Unfortunately, no peer reviewed studies exist to support this very good idea.

Hello I'm Dr. Wipawan Vathananai, a co-worker of Dr. Kulakarn Amonpattana, from BHI Clinic, Bangkok, Thailand. As far as I know, PRP is not a standard treatment for eyebrow regrowth after stress, cover TE or even SD (if you meant seborrheic dermatitis). Also, it is quite unusual to lose eyebrow hairs. I would recommend you to see a dermatologist to get the right diagnosis which could either be alopecia areata, frontal fibrosing alopecia, lichen planopilaris, ulerythema ophryogenes, etc.