Are PRP + CRP injections for hair loss more effective than PRP alone?

Question

Jeff Rapaport, MD · Answer

Platelet rich plasma normally contains  both platelets and cytokines. CRP is cytokine rich plasma . If one is injecting  PRP , without red cells or  white cells ,  cytokines  will normally be in the plasma. If one chooses to separate them as a proprietary process, it is my opinion that there is no long-term advantage. I believe the key is to eliminate the red and white cells which may lead to potential adverse effects. Find a PRP expert. Ask to see photos.
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Amiya Prasad, MD · Answer

Thank you for your question. You’re asking if PRP with CRP more effective than PRP alone for hair loss.
I can help you get some perspective on a question like this as there are all kinds of competitive statements made by doctors trying to show one method being better than the other when treating hair loss. 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 am also the founder of TrichoStem™ Hair Regeneration Centers, a system we developed using PRP with a material called extracellular matrix, a wound healing technology we originally used to help people during hair transplant. 
In the past 7-8 years, I have been very aware of different innovations to try to find the optimal way to help people with male or female pattern hair loss. As I said earlier, we developed a treatment using a wound healing material called extracellular matrix which is derived from pig bladder that stimulates adult stem cells to heal an injured area. How that became a benefit to hair loss was an accidental discovery when we were using this material to help the donor area from hair transplant heal better, and  to improve the survivability of hair grafts. 
At this point, I’m feeling very vindicated because we were first developing this and doing this treatment and we were showing preliminary results, a lot of my colleagues, particularly in the hair transplant world, wanted nothing to do with it, and were very dismissive, even from dermatology and aesthetic medicine. Move the clock forward, people started to see that it was working very well, and started to compete by using terms like “more concentrated PRP,” and “better PRP,” and now with CRP or cytokine-rich plasma.
There is a lot to be learned about differentiations between these methods. It takes some truth, standardization, and very large numbers of patients who are appropriately randomized in what’s called double blind control studies to make these distinctions. 
From my experience in treating patients from all over the world, the Hair Regeneration system I developed over several years, which I continuously look at critically to make sure that we are getting consistency and good results, we were able to make an algorithm, and also developed a classification system. 
When people are using platelet-rich plasma (PRP) whether it’s PRP or cytokine-rich plasma (CRP), there is a certain limit in longevity of effect. The reason is the response of the body to platelet-rich plasma can only last for so long. We can differentiate when it comes to a wound healing process. With platelet-rich plasma, the first group of doctors to use it were oral surgeons to facilitate the healing of dental implants, then came orthopedic surgeons who are now using it very commonly.
When it comes to hair loss treatment, we’re talking about physiologic effects which yet to be fully defined. From my experience with skin rejuvenation with PRP or CRP alone, the effect plateaus after a couple of months. With Hair Regeneration, using this wound healing material that has been really remarkable in its ability to help me in other areas of my practice when it comes incisions, regenerating tissues such as cartilage, and its uses in other areas of medicine has shown tremendous value in amplifying the potential of the body’s ability to repair. For example, the same material was used to restore an entire fingertip, and used healing bone, muscle, skin, and the nail. Yes, this is empiric data and is often criticized, but 80% of the practice of medicine is based on empiric data and clinical experience. 
When I do a treatment with Hair Regeneration, I’ve done a single injection session and have patients who were able to sustain improvement for over 5 years, but that doesn't apply to everybody as we’ve learned over time. We’ve looked at patients at very critical ways, and at specific demographic variables such as gender, age, age of onset of hair loss, rate of progression, degree of progression, and other medical variables including previous surgery, medical therapies, hormonal issues etc. We developed a classification system, and with that comes a treatment plan. I have been able to establish with a high likelihood of successful outcome based on individualized treatment plans. 
Right now, as is often the case with other things like laser, now with the PRP wars, doctors are competing by saying their PRP machine is better, and one PRP is more concentrated than the other. The first doctors to use PRP were oral surgeons, and their approach was very simple: just basic spinning and concentrating. I think it’s easy for patients to get confused when one doctor claims their machine, or their particular concentration are better. They can be very logical arguments, but can they be clinically proven?
What we’ve done over time is look at our data very critically. Although many different options come before me, and I certainly have the flexibility. I’m a cosmetic surgeon with multiple lasers and technologies in my offices. There is nothing I really can’t have in my practice, and I have yet to see any type of technology exceed the results we’ve been getting with platelet-rich plasma and extracellular matrix. It is important to understand that hair loss is not being cured, but being managed, so you have to use multiple tools. For males, we have a discussion, especially for younger males about the use of finasteride, a DHT blocker in combination with our Hair Regeneration treatment to maximize the longevity of the effect our treatment. The stimulatory effect of hair growth should be sustained as long as possible, so you want to use whatever tools you can. 
I’m always talking about customizing treatment and providing patients with an accurate prognosis and likelihood of success. It’s very easy to get lost in the war of terminology, but look at the experience of the doctor who is using whatever treatment they’re offering. Look to see how long can they look back at their patients, say how many years they were able to get benefit, how is it better than something else, which I think are important to ask whenever you do a consultation. I think there’s an opportunity for you to find the right doctor for your situation. I hope that was helpful, I wish you the best of luck and thank you for your question.

Baubac Hayatdavoudi, MD · Answer

PRP is more of restorative therapy and degree of reversal would really depend on how advanced traction alopecia has become.  If the follicles have become scarred enough, PRP unlikely to regrow cosmetically acceptable terminal hairs;  however during early stages, it does have the potential for reversal.

Are PRP + CRP injections for hair loss more effective than PRP alone?

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Are PRP + CRP injections for hair loss more effective than PRP alone?

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