When applying PRP for hair loss, is there evidence regarding whether it is better to use injection, or micro-needling?

When applying PRP for hair loss, is there evidence regarding whether it is better to use injection, or micro-needling? I noticed that some doctors advertise both, and some only one or the other.

Doctor Answers 4

While microneedling can be sometimes be used in hair loss treatment, there are reasons why injections are preffered

Thank you for your question. You didn’t submit a photo but you’re asking what’s the best method of delivery of PRP in hair loss treatment, and if there is evidence to support if PRP with microneedling or PRP with injection is better.

I can share with you my perspective on both of these methods, as well as the application of PRP for hair loss in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I’m also the founder of TrichoStem™ Hair Regeneration Centers, which is a technology we developed in our practice using PRP in addition to Acellular matrix and other ingredients we developed over the course of several years as a non-surgical solution for hair loss. I can tell you how I made these determinations in the development of this treatment which I feel, in my experience, is actually much more effective than PRP whether it’s microneedled or injected, and I’ll explain why.

Let’s first understand a bit the rationale behind these methods. Back in 2007, an article was published by a famous, well-respected dermatologist/researcher about an injury model on mice that resulted in new hair formation.The concept was that if a particular biochemical pathway is manipulated, you can actually create hair. The understanding is when skin is injured, it can generate new skin which originates from hair follicles, and it is often observed with microneedling that you can grow very fine hair. In fact, we have patients come to us who told us that they would routinely microneedle their scalp, and would feel there’s a very fine fuzz of hair growth - the problem is the fine fuzz is as far as it goes. This is the type of hair known as vellus hair, or lanugo hair which is very fine hair -when we say our bodies are covered by fine hair, that’s exactly it. You can’t really see this hair, but under a microscope, you can actually see it. For those hairs to continuously keep growing as a response to injury, you have to keep microneedling.

We developed Hair Regeneration at a time we were doing several hair transplants a week, among the other cosmetic surgeries I performed. We noticed periodically when we were using PRP with Acellular matrix to help the wound healing of the donor area and the hair grafts transplanted that thinning hair became thicker. I decided to develop a strategy to see if this treatment can be done independently from a hair transplant, using an injection of PRP and Acellular matrix. Briefly, Acellular matrix is also referred to as extracellular matrix which is derived from pig bladder that stimulates healing by duplication of cells in the injured tissues, so when you place it on muscle, you’re able to grow muscle. When we place it on skin, we are able to accelerate the healing process of skin, so I use it a lot in my facelift incisions, reconstructive procedures, grafts including skin grafts and tissue grafts, and I was really impressed with this material.

Ultimately, during the development, I was also thinking about the wound healing technology this material was originally used for, and came up with different methods of using microneedling. We found that microneedling has a role, but for the treatment of an individual patient with hair loss, we don’t use it consistently for everybody. I actually developed an algorithm which is the basis of our company TrichoStem™ Hair Regeneration so the dosing, method of delivery, factors of a person’s age, age of onset of hair loss, progression, gender, and various other factors go into how I dose and deliver. I use microneedling in very specific indications. Microneedling is also adjustable - it can be mild at half a millimeter, or deep up to 2.5 millimeters.

You have to think about why the doctor sees a benefit in microneedling versus injection. In our practice, when we do Hair Regeneration treatment, we use an injection in pretty much every patient we treat using PRP, Acellular matrix, and Vitamin D placed in a very specific way. We will occasionally do microneedling as part of this procedure, but in my opinion, delivering the active ingredients necessary for the hair follicle to function is better with injection. What we’re doing with Hair Regeneration is we’re stopping progression,inducing the shed of thinning hair for thicker hair to grow in its place, and inducing the regrowth of hair that’s not growing.

PRP does induce regrowth, but it doesn’t induce sustainable regrowth in my experience. What I have found is PRP, which we use in our practice for everything including under eye dark circles, for acne scars, for fine lines and wrinkles, is a remarkable material, but it cannot stop the progression of hair loss. Often, people need to go for consistent treatments - once a month, once every 3 months. There are a lot of different protocols colleagues have developed that they’re comfortable with, but in our practice, when we do this injection treatment, people do not need that type of schedule. We’ll do a treatment at a single point, and in select patients, we’ll do another treatment at around 15 months. We have data for over 5 years showing people have not had regression from a treatment that was done at a single time, or with a second treatment 15 months later which we refer to as a booster.

That said, I think if you had to choose between PRP by injection versus PRP with microneedling, I think of microneedling as a method designed more to help epidermal and dermal wound remodeling. Microneedling works very well for fine lines, wrinkles around the eyes, and acne scars, and we use PRP with microneedling routinely. When it comes to hair loss, my concern with aggressive microneedling is you can potentially cause inflammation of the glands associated with the hair follicles, and may traumatize the hair follicle themselves depending on the depth. At the minimum, you may be traumatizing the hair shaft and the elements of the hair that are more superficial, so you have to be mindful.

The rationale I think is if you microneedle and apply the PRP, you get a nice, uniform absorption, which I certainly believe in when it comes to skin rejuvenation of wrinkles and sun damage. If you had to make a choice, I would say the injection has an advantage. In terms of your own healing process, it’s actually easier to heal from the injection versus microneedling because you don’t have any rawness in the surface. Typically, in 24-48 hours microneedling injuries can heal very well. Aagain, putting aside your question about one versus the other, I would say you have an opportunity to know and learn about the technology and work behind Hair Regeneration which is PRP with Acellular matrix, and a protocol that has been very successful.  I hope that was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

PRP. Microneedling vs injection? ENGLEWOOD CLIFFS NJ

This is an excellent question. Although there have been multiple studies on the effects of PRP, there are no Comparison evaluations as to the best method to deliver PRP to the scalp. I prefer to use subdermal injections as the major circulation of the bulb is in this space.  Furthermore,  this allows diffusion into surrounding areas.It is also less painful.  Find a p r p expert. Ask to see photos. Hope this helps. Good luck. 

Jeffrey Rapaport, MD
Englewood Dermatologic Surgeon
4.6 out of 5 stars 40 reviews

For greatest hair growth effect, inject PRP at the level of the follicles under the skin.

While there is now good evidence in the literature for PRP influencing hair regrowth, the "evidence" regarding application technique is lacking.  Here are my anecdotal impressions after performing more than 1,000 PRP treatments for hair regrowth:  Unless you have a healing wound from a hair transplant, it is highly unlikely that a topical (surface of skin) application of PRP will have any effect whatsoever.  In my experience, best results are obtained with careful and precise intradermal (under the skin) injection of high concentration of platelets. Research in the literature shows that at least 1.5 million platelets per microliter is needed for recruitment of stem cells, new blood vessel formation.  If your "PRP doctor" is spreading PRP for hair growth on the skin topically, not injecting the PRP where the follicles reside, not testing their end-product PRP for platelet concentration, or worse, not applying local anesthesia so the PRP can be placed appropriately at the level of the follicle under the skin, these are RED FLAGS that indicate poor levels of understanding of the hair follicle anatomy, and a lack of understanding of proper protocols of PRP preparation, activation and application for hair regrowth.The idea of PRP for hair regrowth is to deposit the powerful concentration of growth factors near the weakened hair follicles. Microneedling at the surface of the skin in the area either before or after provides microtrauma which helps trigger release of the growth factors from the platelets (i.e., platelets 'see' a wound and will perform their duties of initiating tissue regeneration and repair by releasing their contents).  Some doctors may consider the injection of the platelets to be "enough" trauma, but it seems to me like the mechanical microneedling provides the most homogeneous microtrauma to the skin to create the desired effect.  There are many other "nuances" to the successful use of PRP for hair regrowth, so look for a physician who has experience and expertise in this area and who can accurately diagnose your situation, determine if you are a good candidate and accurately quantify/measure your results over time. Sincerely,Alan J. Bauman, M.D. 

Alan Bauman, MD
Boca Raton Hair Restoration Surgeon
1.0 out of 5 stars 2 reviews

PRP Scalp

Thank you for your question.  Injection of PRP in to the Scalp can be done in both ways.  In my practice we have had amazing results with injecting the PRP in to the area of hair loss in a grid pattern.  We no longer Micro-Pen the area as we use all the PRP during our injections. Be sure to find a Surgeon that is well trained in PRP and has an understanding of hair loss patterns.  Best of luck!

Shahin Fazilat, MD, FACS
Mountain View Plastic Surgeon
4.8 out of 5 stars 13 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.