Will PRP bring my hair back or is a hair transplant the only option? (photos)

PRP is good for treating individuals that have thinning hair and not for individuals that have no hair. Based on your photo s you can benefit from PRP in the crown area of your scalp.

Prp is effective, but I have a very specific protocol, every 3-4 weeks for 6 months with prp therapy. I also add in progesterone to speed the healing process.  After that the injections are tailored down. You should also be on viviscal and other growth promoting ingredients. See an expert for a formal evaluation. Best, Dr. Emer

In  my opinion, PRP can regrow hair that has been lost less than three to five years. The follicles must be present. Most shiny bald areas will not respond. For this reason, I do not anticipate that your frontal hairline will respond to PRP. A transplant would be needed.  

We have not seen consistent results with PRP. Hair transplantation is likely the only option for restoring the hairline and increasing density in the crown. I would estimate from the photos using 2000 FUE grafts in the crown, and another 1500 FUE grafts for a conservative lowering of the hairline.

IMO you likely have androgenetic alopecia but you would be well advised to seek a specialist in hair loss to be sure. There are many approaches to treatment for this disorder because there is no one treatment that works for everybody. Having said that, only transplants will work on areas that have been bald for 5 years or longer as the hair bulb is presumed to be dead. The crown area is treatable. While there are testimonials for all sorts of treatments regardless if they are spurious, crazy, costly and in some cases harmful, you should be reassured that there are treatment options that will work for the majority of persons.   Some popular medications especially DHT blockers have serious side effects and should not be used, IMO, until after a trial of the following treatment approach:  Minoxidil (liquid), Low level laser light therapy, Vitamin D3 (4000 units) and PRP.  I recommend that all four treatment approaches be employed simultaneously and continued for six months before seeking alternative treatments. 

PRP is most effective in "awakening" the miniaturized hair follicles. You can benefit from PRP on your crown. Based on your pictures, you seem to have androgenetic alopecia. This type of hair loss does tend to progress. Lowering your hairline is not a good idea. You will benefit from a combination therapy using minoxidil, multivitamins, low level light therapy, and potentially finasteride or viviscal. Best wishes!
Razieh Soltani, MD. Board Certified Dermatologist.

PRP is only going to help areas of your scalp with hair follicles present.  It will not bring back hair follicles such as in your forehead.  The most important thing you can do is to decrease, preferably discontinue smoking which will only accelerate your hair loss and  limit the benefit of any hair loss treatment. 

Lowering a hairline as drawn in a 31 year old male who is at risk for being a class VI (or VII) is not really a great idea. Building density in the mid scalp could look quite nice. You need a long term plan. PRP is not going to bring things back significantly.

PRP is a process where your own growth factors that are contained in your blood are injected into the scalp to help promote hair growth. The PRP helps hair growth in most patients. The most important aspect of PRP is that it helps maintain hair, and hairs that are miniaturizing it may help stop and reverse that process. 

PRP is useful to improve hair loss when there is still hair follicles present. The aging hair follicle produces a thinner hair - miniaturization. This is what's happening in the crown area. Unfortunately, there are no viable hair follicle in the forehead area and you can expect very little improvement there. I use very concentrated PRP (5-9x) with at least 1.5 million platelets per ml. This is important to get best results and most PRP is much lower grade. If only 10cc are drawn, it most certainly is 2-3X and requires many more treatments. Adding extracellular matrix such as ACell or amniotic cells will improve results as well. MIcroneedling has shown some very mild benefits and is best when combined with PRP or PPP. A hair transplant is needed for the forehead area.