Questions for those of you that have done PRP with your surgery

[consequence]

A few questions for those of you had that have used PRP in conjunction with surgery:

• How has it been for you?
• Did you use adjuvant Acell or stem cells?
• What was the time frame of your use and how many treatments overall did you have?
• Any other relevant information such as other medications you're taking, age, Norwood, other medical conditions like diabetes/high blood pressure etc.
• Was your PRP activated or non activated? This one might be trickier to tell as most practitioners don't bother telling their patients and their staff usually doesn't even know. The way to find out is by googling the specific brand name of the PRP system your doc used and activation (ie. "AcCellerated Biologics +PRP +activation" or "Cellenis +PRP +activation")
• Was your PRP leukocyte enriched or leukocyte depleted? (similar to above)

It seems like practitioners are packing the PRP in Acell (ground up pig bladder) to make it stay in the scalp longer. I guess this makes sense, but there are no studies in the peer reviewed literature that I can find on this point, just "case reports" from individual surgeons' websites which are essentially worthless. Hair caliber and follicle density need to be objectively measured and quantified. You can't do this with pictures from 3 feet away.

Also, when using it with surgery, I'm not sure have having pig protein sitting in your scalp while your hair follicles are trying to sprout is a good idea -- would a gunky mesh of protein impede blood flow? Particularly at a time when the newly transplanted follicles are so delicate.

This is an interesting round table discussion about PRP in general from the ISHRS, with some of the names being pretty well recognized in the field. I favor the opinion of Bill Haber -- there's just a void of scientific information right now, particularly in the setting of surgery (literally 2 studies on all of Pubmed, one of them being cicatricial alopecia which is a very different process than androgenic). I disagree with Cooley's suggestion that the scientific method cannot be applied accurately to see if it actually works due to concomitant medication, bell shaped response curves, etc. Confounding variable and response curves are built into any scientific study. That's how the scientific method works. The real issues are funding and time. To do a large randomized double blinded trial would be expensive and time consuming. Until the market for the treatment can be shown to be more fertile, there's no large pharmaceutical company that will pay the millions of dollars it would require to push a randomized double blinded trial through. One thought is to do a large trial where half of the scalp with surgery is injected with PRP and the other half with saline, with the patient and surgeon both blinded to the results. But I don't see any study like that even remotely on the horizon.

And that leaves us caught in the middle, as is so often the case with cutting edge medicine. Of course the people that offer it will say "in my clinical experience, it works" but that's essentially worthless without the scientific method. Their wallet depends on what they're saying and they're only making judgments on pictures, not objective hair counts or caliber measurements. 

So with all that being said, I would like to know your experiences.  I had a single session without surgery and am on the fence as to whether or not to do it before my upcoming FUE. I had a minor improvement in density (perhaps between 1-5%) over the next few months though the effects seemed temporary. I'm not sure how this would translate into its impact on post operative healing or yield.

Edited April 12, 2023 by consequence
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[Melvin- Admin]

PRP is largely a question mark. Do I think it can help, yes. Marginally, some what like LLLT. My main issue with PRP is the cost is way too high for something unproven. Laser helmets are pretty expensive as well, but its a one-time purchase. PRP has to be done every 6 months. You’re better off doing dutasteride with mesotherapy.

[Gatsby]

PRP has been around for a long time in the sports industry. I have had PRP both times I had surgery admittedly one year apart. It was part of the package for surgery. Did it improve healing post op? Possibly but I will never know because I cannot be my own control group. Would I pay for PRP as a stand alone therapy for MPB? No for the reasons Melvin stated. The cost far outweighs any benefits in my own opinion. I would rather put that money towards meds, shampoos, hair cuts and surgery. But again that is just my opinion. All the best!

[A_4_Archan]

I dont know abt about results of prp during surgery ..bt i had prp sessions for my baldness and i got a positive outcome ...actually imo it helps well whn there is diffused pattern hairloss ...prp boost the existing grafts and make them more fuller and thicker and tht helps in coverage and than those grafts can be maintained well with the medication along with the prp..so i believe it complements well with medication...

As far as charges goes,in my country(india) it is very cheap, usually around 30usd per session so in my case benefits overweights the cost way better ...

[duckling]

Prp works well for healing post hair transplant and it works well for your miniaturized hair ( not a standalone treatment but along with minoxidil and finasteride).

Other than that it doesn't do anything. It cannot grow new hairs. 

[Mike10]

I have been doing PRP as a standalone treatment for 6 years. Maintenance once a year. I do not think it is on the same level as Fin/oral Minix. It is a 2nd line treatment.

[consequence]

15 hours ago, Melvin- Moderator said:

PRP is largely a question mark. Do I think it can help, yes. Marginally, some what like LLLT. My main issue with PRP is the cost is way too high for something unproven. Laser helmets are pretty expensive as well, but its a one-time purchase. PRP has to be done every 6 months. You’re better off doing dutasteride with mesotherapy.

That's kind of where I'm sitting with it. It also seems like some studies show activated to have more effect and others non activated.

I'm also not sure how it would affect the scalp in the setting of surgery. It's not just is there a benefit, but also could it hurt results? It seems like the surgery itself would induce a massive native PRP type response regardless.

By mesotherapy what do you mean specifically? Injecting dutasteride into the scalp? Or taking dutasteride and injecting something else?