Is it normal to not be numbed at all before receiving PRP injections in the scalp?

I recently had PRP injections for a small bald area on my scalp. When it was time to inject the PRP into my scalp, I asked about the numbing. I had read on other websites that a numbing cream would be applied before injecting. He said they did not do numbing and that numbing would decrease the effectiveness of the shots. I am not afraid of needles or shots but I have to say that the shots were extremely painful. Is it normal to not be numbed at all?

Doctor Answers 8

PRP Injections

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Platet-Rich-Plasma treatments, also known as PRP. This procedure is done by drawing the patient’s blood, then centrifuging it to retrieve the patient’s own growth factors. We then inject the high concentrated growth factors directly into where we see the hair loss or volume reduction. To distract our patients we use our Zimmer Cryo, which cools the epidermis before injection by simply blowing -30 degree air. Mild tenderness can be expected post treatment but most patients can resume normal activity the following day. 

Irvine Dermatologic Surgeon
4.6 out of 5 stars 23 reviews

Hair loss injection treatments can be numbed with topical and injectable anesthetic, which do not affect results

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Thank you for your question. You are asking if it is normal not to be numbed before PRP injections, and describe that your physician who performed this treatment felt that the numbing would interfere with its effectiveness, You describe the experience as very painful.

I can certainly give you my experience with this type of treatment as we do hair loss treatment similarly in our practice every day. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I am also the founder of TrichoStem™ Hair Regeneration Centers that uses a system we developed which uses platelet-rich plasma (PRP) in addition to a material called Acellular matrix and other elements to help men and women from around the world with pattern hair loss. I’ve been in practice for over 20 years, and we use platelet-rich plasma (PRP) for hair loss in our practice every day so I am familiar with the treatment.

In our local area in New York City (we have an office in Manhattan) I’ve been made aware of colleagues who believe in doing this treatment without any anesthetic from the feedback we are getting from our patients. Many of our patients used to go monthly for platelet-rich plasma (PRP) injections and endured a fair amount of discomfort getting them. By around the 4th month, they questioned the justification of the pain against limited results, and where the endpoint would be.

I can tell you from my personal practice, style, and from my own philosophy that pain should be avoided as much as possible. Frankly, as a cosmetic surgeon, as a specialist who does everything from head to toe in the cosmetic field and with specialized areas beyond that, it has been my mission from day one to make my patients comfortable and to make cosmetic procedures less daunting, and more accessible. From the beginning of my career I proved that lower and upper eyelid cosmetic surgery and face lifting surgery can be performed without general anesthesia, but rather under local anesthesia with LITE™ IV sedation. I evolved many procedures in a way so our patients, whether they are sedated or wide awake, are completely comfortable.

Hair Regeneration is a system we developed based on a technology for wound healing using platelet-rich plasma (PRP) and Acellular matrix. We are able to help patients with 99% successful outcomes, meaning stopping the progression of hair loss, reactivation of hair that is not growing, and inducing shedding of thinning hair so thicker hair can grow - all with a single treatment session. In some cases of advanced hair loss a second treatment at around 15-18 months later is done. However, our data shows patients have continued to benefit from a single session even after more than 5 years.

With that said, I can see how it is pretty daunting to go back for platelet-rich plasma (PRP) treatment without any anesthetic. I am familiar with this practice, but I don’t know exactly what the justification is.  We get pretty amazing results, even with numbing the scalp. We first use a topical anesthetic applied around the scalp in the perimeter of the planned area of treatment, then let the anesthetic work for a while. We then do what’s called a ring block like in a hair transplant so the top of the scalp is completely numbed, and then I do the actual injection treatment. In a treatment process where we numb the scalp, we’ve had tremendous success with this treatment.

I understand that every doctor has their justification, but I think it is reasonable to ask why the  is pain necessary. From my experience, pain is not necessary for this process. Once the top of the scalp is numbed, I am not saying it is painless from the beginning - a few local anesthetic injections are going to be uncomfortable, but we use the tiniest needles after application of topical anesthetic. That said, Hair Regeneration has been extremely successful for us, so I think you need to figure out what is right for you. Like I said, a lot of people come to us once they got tired of feeling uncomfortable with the platelet-rich plasma (PRP) injections without anesthetic. Learn more and make some decision so you can feel better about treating your hair loss. I hope that was helpful, I wish you the best of luck and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Numbing before PRP injections

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We use a small amount of lidocaine before the PRP and with this our patients feel absolutely no pain. It does not affect the result of the PRP treatment at all. If you have any concerns I would suggest asking your doctor why they do or do not use any form of anesthesia. 

John Kahen, MD
Beverly Hills Hair Restoration Surgeon
5.0 out of 5 stars 30 reviews

Pain of #PRP injections

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Dear Allie5000:We are now mixing a little lidocaine with the PRP in the syringe. This makes the procedure nearly painless, a huge improvement over the prior protocol. This has not interfered with the response to treatment in any way.  All the best,  Dr. Clark

Sheryl D. Clark, MD
New York Dermatologist
4.7 out of 5 stars 10 reviews

PRP Injections and Numbing

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Thank you for your question!  Different offices have different protocols for PRP injections.  We provide injections of local anesthetic prior to the PRP injections.  This makes for a much better experience for our patients.  As always, be sure to consult with your hair expert about your concerns.  Best of luck to you!

PRP treatment should be comfortable

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Hi.  We routinely offer topical numbing cream and/or local anesthetic injections to patients and have not seen any interference with the hair growth.  There are other techniques that provide comfort that do not include a cream or injection, so before your next treatment, ask your plastic surgeon what else they can offer.  Being more comfortable, a more thorough treatment will be possible.

PRP for Hair Loss --- Combine with Injectable Progesterone Monthly

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We do not numb the area, injections in the scalp are rarely painful at all if done with proper technique.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Topical Anesthetic prior to PRP? ENGLEWOOD Cliffs NJ

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In my opinion, using a topical anesthetic prior to injecting with PRP is optional. Approximately 20 to 25% of our patients decide to  have a topical anesthetic. We like to use a Zimmer chiller prior to injection. Patients are usually comfortable with this technique. There is great variation in the amount of pain with PRP injection. The difference is based upon the level of injection and technique used. Find a PRP expert. GOOD LUCK.

Jeffrey Rapaport, MD
Englewood Dermatologic Surgeon
4.7 out of 5 stars 42 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.