Platelet-rich plasma (plasmolifting) to improve hair growth. Part 2

There are currently three main studies available regarding evaluations of the use of platelet-rich plasma in the treatment of androgenetic alopecia. Sorbellini and other scientists conducted a laboratory study involving 50 patients. 12 follicles were taken from each patient, 4 of which were placed in platelet-rich plasma, 4 – in Ringer's solution, and the remaining 4 – in normal saline. After that, the authors measured mitotic activity. The results showed increased mitotic activity and reduced apoptosis in the PRP group.

Takikawa et al.'s study aimed to determine if there was a difference between injections of conventional PRP and PRP with delteparin. 

Delteparin – it is a protein carrier for growth factors in platelet-rich plasma. The study was conducted on 26 volunteers with fine hair who underwent 5 topical treatments – half with platelet-rich plasma and delteparin, and half – with platelet-rich plasma without delteparin. Treatment evaluation was carried out over a period of 12 weeks. Experimental and control areas were photographed, digitally measured, and a biopsy was performed to assess histology. The interesting point of this article is that platelet-rich plasma increased hair density by 16% in 12 weeks. 

Greco and Brandt found that damaging the scalp and injecting growth factors into it reversed hair loss over a period of 8 months. 10 hair samples were taken from each patient; 5 patients were from the control group and 5 – from the treatment group. Hair diameter was measured with a Starrett micrometer. In the treatment group, 60 cm3 were taken. blood and processed 10 cm cube. platelet-rich plasma. The control group also had to take 60 cu. see blood, but it has not been processed. The scalp was traumatized in both groups with a 1 mm mesoscooter in order to trigger the movement of keratinocytes and wound healing. Then the treatment group was injected with platelet-rich plasma, and the control group – normal saline. After 4 and 8 months of treatment, the patients were evaluated and their hair diameters were measured.

The control group experienced a reduction in hair shaft diameter of 2.8% at 4 months and 3.5% at 8 months (this is a classic course of androgenetic alopecia). An increase of 9.7% in the diameter of the hair shaft after 4 months and 6.1% after 8 months was observed in the treatment group.

The author's study involved 60 patients (male and female) who underwent digital measurements (tattoos, density, thickness and anagen to telogen ratio), who were also photographed. As in the study by Greco and Brandt, 60 cm3 were taken. blood and using the MyCells kit, 10 cc were processed. see platelet-rich plasma. The scalp was first injured with a 1.5 mm mesoscooter. Patients underwent two treatment sessions with a 3-month interval. After 3 months, there was an 18.8% increase in hair density, as well as a decrease in average thickness (-2%), as the new hair is thin. After 9 months, the density increased by 29%, and the thickness – by 5%.

In this type of treatment, mesotherapy initiates the movement of keratinocytes, and growth factors improve the vascularization of the follicle, stimulate mitosis, prolong the anagen phase and slow down apoptosis.

Receding hairline: use of platelet-rich plasma

Another therapeutic application of platelet-rich plasma is in the surgical treatment of bald patches. Platelet-rich plasma can be used at different levels: to strengthen the weak donor site (stimulation is carried out 8-10 months before surgery), improve graft survival and minimize postoperative side effects at the donor site (reduced scarring) and the recipient site (less inflammation).

The use of platelet-rich plasma in hair restoration operations has shown excellent results when used as a medium for graft storage. In this case, it is necessary to activate platelet-rich plasma with calcium chloride or thrombin.

If platelet-rich plasma is injected directly into the dermis layer, it is traumatized and affects the production of adrenaline and calcium, which initiates an activation sequence. However, in this case, platelet-rich plasma is used as a storage medium without any damage, so it is necessary to "manually" activate platelet-rich plasma with calcium chloride or thrombin. Growth factors, immersed in platelet rich plasma, attach to stem cells in the convex zone of the cut follicular unit, increasing the usefulness of transplanted fresh follicles.

Webel and others observed a significant difference in the performance of follicular units compared to scalp control areas. The growth factors of the zones treated with platelet-rich plasma showed a result of 18.7 follicular units per square centimeter, and the control zones – 16.4 follicular units per square centimeter, 15.1% increase in follicular density. Among patients who used the experimental protocol, some experienced only a 3% increase in density, and some – by 52%.

Moreover, the introduction of platelet-rich plasma into the recipient zone increases the vascularization of transplanted follicular units, increasing the productivity and density of non-transplanted hair.

The use of platelet-rich plasma in alopecia areata 

A third field for the use of platelet-rich plasma is alopecia areata. This administration of platelet-rich plasma is difficult to assess. Therefore, this issue was unsuccessfully resolved throughout the year. Also, digital measurements are not accurate due to the fact that the regrowth zones are uneven. Macrophotography is the best way to assess this disease. Currently, only case reports of the disease are available, not standardized estimates.

Talk

In the author's assessment, in contrast to objective measurements, the subjective assessment of patients is evaluated. There is a big difference between objective measurements and patients' feelings. For example, a patient may be pleased with a small increase in hair growth (10%), or may be dissatisfied with a significant result (40%). Regarding the standardization of photography: many factors were considered, including color,  length, hairstyle and lighting. For these reasons, an objective parameter (i.e. phototrichogram) is very important to obtain suitable results.

Further guidelines for efficient analysis are those tools that enable authors to obtain the best phototrichogram possible (eg, tattooed dots, short haircut, and dye solution). Most authors also agree that 50 patients – this is the minimum figure required to obtain effective statistical results.

Once PRP has been shown to be effective in the treatment of hair loss, it will be interesting to compare the effects of different factors in further studies. For example, with and without a dermaroller, with or without activation, different volumes, as well as other hair pathologies such as alopecia areata and telogen effluvium. These studies are very important, since we have a very small arsenal of treatments at our disposal. The platelet-rich plasma protocol may be an alternative solution.

Conclusions

The use of platelet-rich plasma for the treatment of hair loss is promising. In the future, the authors hope to improve the protocol and show that platelet-rich plasma also has a preventive effect on hair problems. This method will not replace a hair transplant, but may be helpful in delaying such treatment and providing better results.  

Adapted from Prime magazine.