Platelet-rich plasma (PRP), also commonly referred to as Dracula therapy, vampire facial, vampire facelift, S3, self-stimulated serum, liquid gold or vampire therapy, is not a new procedure. It has been around for many years but was catapulted into the media spotlight by Kim Kardashian when she famously had this procedure done and was featured on her reality TV show. The photos of her face covered in red blood cells raised discussions around the globe, but this is not a true representation of PRP.
Growth factors were first discovered by Stanley Cohen and Rita Levi-Montalcini in the 1950s, when their research opened the door for PRP. Subsequently, they were awarded a Nobel Prize for their work in 1986 (Villela et al, 2010).
Essentially, PRP allows the body to heal faster and more efficiently. It stimulates DNA repair, heals scars and makes dry, lacklustre skin look and feel younger (Ibrahim et al, 2015). Not only is it an effective anti-ageing treatment, but it also has wider uses within the medical profession, including treating hair loss and sports injuries (Amgar and Bouhanna, 2013).
What is platelet-rich plasma?
PRP is an autologous concentration of human platelets in a small volume of plasma, which is developed from autologous blood, meaning that it is inherently safe and is defined as a sample of autologous blood with concentrations of platelets in a given volume of plasma that is above the concentration found in the whole blood (Mishra, 2010; Sister, 2016).
» Platelet-rich plasma can be used as a standalone treatment or used in combination with other aesthetic medicine procedures, such as dermal fillers, mesotherapy, laser treatments, microneedling and polydioxanone threads «
Plasma, which comprises 55% of blood fluid, is mostly water (90% by volume), and contains dissolved proteins, glucose, mineral ions, hormones, carbon dioxide, platelets and blood cells. As PRP is a concentration of platelets, it is also a concentration of the seven fundamental protein growth factors proved to be actively secreted by platelets to initiate all wound healing. These growth factors include the three isomers of platelet-derived growth factor. All of these growth factors have been documented to exist in platelets, but the platelets need to be activated. On activation, they will release alpha granules, within which those growth factors are stored (Kim et al, 2011).
Additionally, the activated thrombocytes have a multitude of signal molecules on their surface: CD9, CD-W17, CD41, CD42a-d, CD51, CD-W60, CD61, CD62P, CD63. As these concentrated platelets are suspended in a small volume of plasma, PRP is more than just a platelet concentrate, it also contains the three proteins in blood known to act as cell adhesion molecules for osteo-conduction and as a matrix for bone, connective tissue and epithelial migration. These cell adhesion molecules are fibrin, fibronectin and vitronectin (Everts et al, 2006).
According to Ibrahim et al (2015), PRP allows the body to heal faster and more efficiently. It does this by stimulating DNA repair, which can heal wounds and remodel scars, as well as making lacklustre skin look and feel younger (Cervelli et al, 2009).
Platelets are the first responder to trauma in the body. By injecting these directly back into the site requiring treatment, the treatment ‘tricks’ the body into thinking that a trauma has occurred, and the growth factors present will start to work immediately to stimulate and rejuvenate, aiding the body's healing and repairing process (Everts et al, 2006; Wei, 2012).
By injecting platelets directly back into the site requiring treatment, it ‘tricks’ the body into thinking that a trauma has occurred
How platelet-rich plasma works
PRP is prepared by first taking blood from the patient, then placing the blood in a centrifuge, which spins the blood at a high speed to separate the platelets from the red blood cells. There are three layers: PRP, platelet-poor plasma (PPP) and red blood cells. The resulting small volume of fluid after the centrifugation process contains approximately five to seven-times the normal volume of platelets.
After spinning, the PRP and PPP are taken from the tube and placed in a syringe. The red blood cells are discarded, as they are never injected. The PRP is then injected into the patient into the area that requires treatment. Following a PRP treatment, results are noticeable within 3–4 weeks, and, often, only one procedure is required. However, this is dependent on the kit used, the area that is treated and whether the PRP is activated prior to injecting (Sister, 2016).
PRP is an effective treatment for rejuvenation, as it is non-surgical, natural and relatively safe. It also provides results that can last up to 12 months. As the platelets are autologous, there is no risk of infection or rejection.
There are a number of different PRP harvesting kits available, but some contain thrombin and, therefore, the end product cannot be categorised as autologous. Others use a chemical buffer to separate the plasma and red cells, and do not deliver pure PRP as a result. This can often lead to a difference in results and will, in the author's opinion, require further studies and research. Activation of the platelets is required for the release and enmeshment of growth factors, but the method of activation may influence the resulting matrix, growth factor availability and healing (Sommeling et al, 2013).
As previously mentioned, PRP is used to treat a variety of medical indications. Aside from sports injuries and orthopaedics, the treatment of alopecia is also hugely popular, and there is much research and many case studies that support this, as opposed to facial rejuvenation, which does not appear to have as many. PRP can be used as a standalone treatment or used in combination with other aesthetic medicine procedures, such as dermal fillers, mesotherapy, laser treatments, microneedling and polydioxanone (PDO) threads.
Platelet-rich plasma and hair loss
PRP is now a very active field of research. Studies are being published on an almost daily basis (there are over 18 000 on PubMed and 39 000 on Wiley Online Library), and they cover many fields of medicine, including hair loss. There are several papers published that have reviewed the literature and protocols for treating hair loss, and this is the focus of this article.
Further studies and controlled trials need to be carried out on platelet-rich plasma use
Androgenic alopecia (AGA) is a common chronic hair loss disorder. It is characterised by progressive hair loss, affecting both sexes. It affects up to 80% of white men and 40% of women. (Gkini et al, 2014). By the age of 60 years, 45% of men and 35% of women develop AGA (Stevens et al, 2018). It is known to advance with age and menopause (Rogers and Avram, 2008). Treatment options include minoxidil, finasteride, spironolactone, nutritional supplementation, low-level light therapy and hair transplantation surgery.
In an effort to improve hair density and stimulate follicular growth following hair transplant surgery, Uebel et al (2006) conducted an experimental study using platelet plasma growth factors. The study enlisted a group of 20 participants with male pattern baldness. The authors evaluated the effects of treatment of PRP during surgery. The results showed a significant improvement in hair density due to the stimulation of the hair follicles using PRP pre-surgery. The authors also considered that the platelets stimulated the stem cells in the area of the hair follicle, stimulating the development of new follicles.
Additionally, a randomised, double-blind, placebo- and active-controlled half-head study, carried out by Trink et al (2013), evaluated the effects of PRP on alopecia areata (AA), a common autoimmune condition that causes inflammation induced hair loss. The authors had seen preliminary evidence that suggested PRP may have a beneficial role in hair growth, and, so, conducted a study with 45 patients with AA. The study was randomised, and patients received intralesional injections of PRP, triamcinolone acetonide (TrA) or placebo on one half of their scalp. The other half of the scalp was not treated. Each patient was given a course of three treatments with intervals of 1 month. The results showed that PRP had increased hair regrowth significantly (Trink et al, 2013).
Schiavone et al (2014) explored the clinical benefit of injecting platelet-derived growth factors into the scalp of patients using a specific autologous blood concentrate. The study enrolled 64 patients, and each had two injections of a leukocyte PRP (L-PRP) with the addition of concentrated plasmatic proteins, which were administered at baseline. The results showed some improvement in all cases for the treatment of male and female pattern baldness.
Another study, conducted by Khatu et al (2014), looked at the safety, efficacy and feasibility of PRP injections in treating AGA. The study included 11 patients suffering from hair loss due to AGA and who were not responding to a 6-month treatment with minoxidil and finasteride. A total volume of 2–3 ml of PRP was injected into the scalp using an insulin syringe. The treatment was repeated every 2 weeks, for a total of four treatments. The results were reviewed after three treatments and showed a significant reduction in hair loss between the first and fourth injection.
There are many other published research papers available that show promising results for PRP in treating hair loss. Further studies are still required, and other factors will also need to be taken into consideration, including the activation (or not) of the platelets prior to injection, the centrifuge settings, the PRP kits used and the protocol for treatment, whether it is a standalone treatment or used in combination with other modalities.
Conclusion
Hair loss can have a considerable psychological and emotional effect on both men and women with a decreased quality of life for some. Developing a safe and effective treatment modality can greatly benefit patients and, apart from the current treatment options, PRP can now be added as a natural regeneration therapy.
The initial research into PRP is promising, but, as the authors of these studies indicated, further studies and controlled trials need to be carried out.
The author has conducted several hair loss procedures in their clinic over the past 8 years. Although good clinical results have been seen following one or two procedures, there have been some patients for whom PRP did not give an expected result. PRP can be effectively used as a standalone treatment, as well as in combination with other modalities to achieve good results.
PRP is a is a safe and natural procedure, as the platelets are taken from the patient's own blood, thus posing no risk of infection or rejection. The injection is a simple, cost-effective and feasible treatment option for AGA, with high overall patient satisfaction.