Platelet Rich Plasma – PRP

Hair loss is a common medical condition with significant cosmetic and psychosocial impact. A number of surgical and non-surgical treatment options have been developed over the years.

Platelet-rich plasma, derived from a patient’s own blood, has gained popularity over the years as a treatment for hair loss in men and women. In hair transplant procedures, hair follicles are harvested from the back of the head (occipital region) and transplanted onto the frontal scalp or vertex.

Three surgical modalities are currently in practice: Follicular unit transplantation (FUT), follicular unit extraction (FUE), and direct hair implantation (DHI). As a part of a surgical hair transplant, PRP is often used to speed up the healing process after implantation. Platelet-rich plasma procedure on its own is also a popular treatment option to promote hair regrowth.

What is PRP?

Platelets are well-known for their role in blood clotting. In addition, their alpha-granules contain a number of growth factors and other chemicals (chemokines) that have the potential to promote tissue healing. PRP, which stands for platelet-rich plasma, is an autologous product prepared by centrifuging a person’s own blood.

Normally, there are 150,000 to 400,000 platelets per microliter of blood. In PRP, platelets are highly concentrated, reaching up to 100,0000 per microliter or more. There are over 20 growth factors in PRP. They induce hair restoration by promoting the proliferation of hair follicles, improving their blood supply, and preventing the death of hair follicles.

The use of PRP to expedite tissue healing initially started in musculoskeletal and sports injuries in the 1990s. This was followed by its use in a wide range of medical and surgical fields including dermatology and plastic surgery. Since 2006, it has been increasingly considered a viable treatment option for hair regrowth in patients with alopecia (both androgenetic alopecia and alopecia areata). As a part of FUT or FUE, PRP injections are administered by dermatologists or plastic surgeons. Since the person’s own blood is used, there is minimal risk of infection transmission or allergic reactions.

Procedure and timeline

PRP for hair restoration is a relatively simple procedure. As a standalone procedure, PRP treatment is minimally invasive. When used in conjunction with hair transplant, the steps include donor and recipient preparation, follicle harvesting, and implantation, followed by PRP injections.

• Initial consultation and planning: The first appointment with your surgeon will involve a detailed discussion about the type of procedure most suitable for you, the expected number of sessions and probable timeframe, potential complications of the procedure, and post-surgery care.
• PRP injections: PRP is injected into the scalp just below the skin. Typically, 3 sessions are required, each session takes 4-6 weeks apart. To avoid recurrence of alopecia maintenance injections are required every 6 months.
• Donor site preparation & harvest: For hair transplant, the donor area is trimmed or shaved. After numbing the area with a local anesthetic, either an already marked strip of hair follicles is incised (in FUT) or individual hair follicles are punched out (in FUE) and placed in a holding medium.
• Recipient site preparation and implantation: The recipient site is prepared under magnification for implantation of hair follicles using needles or flat-edged surgical blades. The graft is then placed carefully and an emollient or antibiotic bandage is applied across the donor and recipient sites.
• Number of sessions and timeline: The number of hair follicles implanted in a session depends upon graft density and surgeon and patient preference. The average number is around 3000 follicles per session. A typical patient would require 3-4 sessions. A session usually takes 4-6 hours.

What does a PRP treatment cost?

An single injection of PRP costs £ 400 to £450 in the UK; the initial set of three sessions costing £ 1100-1200. The procedure is often not covered by private health insurers.

In comparison, a three-session set costs $ 1500 – 3000 in the US. In Turkey, a session of PRP costs on average € 250, though considerable variations exist between centers and cities. If you are traveling abroad for the procedure indirect costs can add up. The total cost of a package consisting of a hair transplant procedure, PRP, flight, and hotel stay ranges from £1500 to £ 2250 in Turkey.

For which hair loss types can PRP treatment be beneficial?

There are different types of hair loss. The most common is androgenetic alopecia (which may be male-pattern or female-pattern baldness) which is related to the normal aging process and affects up to 50% of men and at least half as many women.

In men, it starts above the temples and the hairline recedes progressively. Alopecia areata is another relatively common type, which results in discreet hairless patches or bald spots on the scalp, beard, or eyebrows. Telogen effluvium is a dramatic condition in which shedding of 20-50% of hair occurs over a short period of time. In the loose anagen syndrome, female patients experience thinning of hair due to diffuse hair loss and the hair becomes short and dull.

The most common indication for PRP or hair transplant is androgenetic alopecia and good success rates have been achieved. It is also successful in the treatment of bald spots. The experience for their use in other rare types of hair loss is limited. Regarding non-head transplants, FUE and platelet therapy have been used successfully to cover bald spots in the beard. In patients with alopecia areata affecting the eyebrows, PRP has shown promising results.

Clinics in United Kingdom VS Turkey

For a patient looking for PRP treatment nearby, a large number of qualified clinics offer their services in the UK. For those looking to cut costs on their treatment, Turkey offers a good alternative.

Turkey is one of the top destinations for medical tourism not only in Europe but across the globe. In 2018, before the Covid pandemic, more than 700,000 medical tourists visited the country. The main reason for its popularity is its affordable healthcare system without compromising on quality. It has the highest number of US accredited hospitals. Moreover, for UK residents, the cost of living is lower and exchange rates are favorable. Patients traveling to Turkey for a hair transplant or a PRP procedure can expect to save 60% – 70% on direct medical expenses compared to the UK.

Finding a suitable treatment facility abroad is not difficult but you will most likely need the services of a firm specializing in medical tourism. Another concern, not just for patients traveling for PRP but all health tourists, is the requirement to adjust to hotel life. Living outside your home and city, away from your loved ones, in the understandably anxious times of undergoing a PRP procedure may not be everyone’s cup of tea. While the quality of healthcare in Turkey is commendable, some patients may feel uneasy to be under the care of a foreign medical professional which they are meeting for the first time. Nevertheless, scores of foreigners regularly seek medical treatment in Turkey and return satisfied.

PRP compared to hair transplants

In addition to PRP, currently, available treatment options for hair loss include medications (Minoxidil, Finasteride) and surgical hair transplantation using one of the three procedures: FUT, FUE, and DHI. Medications results in moderate hair restoration but the effects often regress when treatment is stopped. Furthermore, medications their own set of undesirable adverse effects.

In FUT a single strip of scalp tissue is dissected and individual follicles are then harvested from it microscopically. FUT might be more suitable for patients with less hair in the donor areas and for those looking for more fuller, natural-looking hair. On the flip side, patients often find it a more uncomfortable procedure compared to FUE. Since a strip of skin is removed, this leaves a fine but occasionally noticeable linear scar at the donor area.

FUE is a relatively newer technique and the one more commonly used nowadays. Since follicles are harvested individually, there is little to no scarring of the donor area and recovery time is shorter. It is less painful than FUT for most patients. Another advantage of FUE over FUT is that it can be used to harvest hair from areas other than the scalp such as the chest and legs, in case the primary donor site is insufficient. Manual FUE procedures typically take longer than FUT as the process is more tedious. With the introduction of robotic methods, however, timing is of little consideration between the two.

PRP injections can be used as a standalone treatment option for patterned-baldness or as part of hair transplantation (FUT or FUE) to speed up the recovery process. When used alone, the success rate is around 60%.

Risks and considerations

This section will cover questions regarding PRP treatment like who is a good candidate for PRP and what are the common side effects of the PRP procedure.

Things to Consider before undergoing PRP or Hair transplant

• Hair loss pattern: PRP is more effective in those with mild to moderate hair loss, the hair loss is of recent onset and there are areas of weak quality hair growth on the scalp where hair follicles are still preserved.
• Other medical conditions and medications: Your doctor will need to know whether you have diabetes and how good is the glycemic control. If you are taking blood-thinning medications, they may need to be stopped a few days before the procedure.
• Donor and recipient area condition: For hair transplant both the donor and recipient areas need to be healthy. Active skin infection on either area needs to be treated first before the procedure can be done.

Risks and adverse effects:

PRP, FUT, and FUE are all safe procedures with little risk of long-term complications. Common side effects of PRP treatment include:

• Pain and swelling: These are signs of inflammation and commonly noticed in the first few days after the procedure. Application of a local anesthetic before the procedure and taking a pain-killer afterward will take care of the pain. Some doctors might inject steroids locally before the procedure to reduce the risk of inflammation.
• Infections: Serious infections are less likely with modern standards of surgical hygiene. Local antibiotics are commonly applied to reduce the risk further.

Recovery and Results

• 1-2 weeks: You might feel slight pain and the area may feel a bit swollen. Both are common reactions and easily controlled with pain medications. Bandages, if any, would be removed a day later and stitches a week to 10 days after. After a hair transplant, you should be able to resume your daily activities within a couple of days. For PRP, the recovery time is even shorter.
• 1-2 months: The scar would gradually heal and minor follow-up procedures (‘touch-ups’) may be done to achieve a more natural look. The implanted hairs fall out around 6 weeks post-surgery. This is normal and you don’t need to panic. After another 4-5 weeks, the growth of new hair can be noticed.
• 2-6 months: The rate of growth is on average half an inch per month. 6 to 9 months are required for the new hairs to grow.
• Result and success rate: For PRP alone, the success rate is around 60% although data from large-scale studies are lacking. FUT and FUE have shown good results with sustained hair growth in up to 90% of patients.