What is the protocol for Platelet-Rich Plasma (PRP) scalp treatment?

PRP Scalp Treatment Protocol for Androgenetic Alopecia

For androgenetic alopecia, perform 3-5 PRP sessions spaced 1 month apart during the treatment phase, injecting 5-7 mL of PRP per session at 0.05-0.1 mL/cm² into affected areas, followed by maintenance sessions every 6 months after the initial year. 1

PRP Preparation Specifications

• Use a manual double-spin centrifugation method to prepare PRP for androgenetic alopecia 1
• Target platelet concentration: 1 to 1.5 million platelets per microliter in the final preparation 1, 2
• Do NOT activate PRP before injection—non-activated PRP shows superior results with 31% greater increase in hair density compared to activated PRP 1
• Process 9-10 mL tubes of peripheral blood without anticoagulants 2

Treatment Phase Protocol

Pre-Treatment Preparation

• Patient must shampoo and detangle hair before the session 1
• No hair products (wax, gel, hairspray) should be applied 1
• Map and mark areas of hair loss before injection 1
• Position patient to allow scalp access from all angles 1
• Take standardized before-and-after photographs 1

Injection Technique

• Use 30G × 4 mm needles for all injections 1
• Apply topical pharmaceutical-grade numbing cream before injection due to significant pain associated with the procedure 1
• Inject at 90-degree angle to scalp surface 1
• Depth: 2-4 mm (full bevel of needle) 1
• Spacing: 1 cm apart between injection points 1
• Volume per session: 5-7 mL total PRP 1
• Dose: 0.05-0.1 mL/cm² of affected scalp 1

Treatment Schedule

• Initial phase: 1 session every 4-6 weeks for 3 sessions total per year 1
• Minimum of 3-5 sessions required for adequate treatment 1
• Evaluate results after one year of treatment 1
• Maintenance phase: 1 session every 6 months after initial treatment series 1, 2

Combination Therapy for Optimal Results

PRP combined with topical 5% minoxidil demonstrates the highest efficacy for androgenetic alopecia, showing superior results compared to either treatment alone 1, 2. The Indian Association of Dermatologists framework indicates that complex therapy (PRP with minoxidil) is more effective than monotherapy 1. Consider adding:

• Topical minoxidil 5% applied twice daily to both treated and untreated areas 1
• Background therapy with finasteride and multivitamin supplements may enhance outcomes 1, 3

Expected Outcomes and Monitoring

Clinical Response Indicators

• Increased hair density: Expect approximately 20 hairs/cm² increase after 3 sessions 4
• Improved hair shaft diameter: 14.3-fold increase reported with combination therapy 1
• Decreased telogen hair proportion: 9.3-fold reduction 1
• Patient satisfaction scores: Average 7.29/10 reported in clinical studies 5
• 25% improvement in hair density at 2 months predicts sustained response at 6 months 1

Assessment Methods

• Standardized photography at each visit 1, 2
• Trichoscopy for hair density and diameter measurements 2, 5
• Hair counts per cm² 2
• Patient self-assessment questionnaires 2, 5

Critical Pitfalls to Avoid

Low platelet concentration, inadequate injection volume, or insufficient treatment frequency are the primary causes of treatment failure 2. Specifically:

• Do not use fewer than 3 sessions—minimum 3-5 required for efficacy 1
• Do not space sessions more than 1 month apart during treatment phase 1
• Do not inject less than 5 mL per session—inadequate volume leads to poor results 1, 2
• Do not activate PRP—this reduces efficacy by 31% 1
• Prepare all equipment before blood withdrawal, as timing is critical especially for PRF variants 1

Safety Profile

PRP for androgenetic alopecia demonstrates excellent safety with no serious adverse events reported in clinical trials 5, 4. The treatment is autologous, eliminating risk of allergic reactions or disease transmission 5, 6. Pain during injection is the primary complaint, managed with topical anesthesia 1.

Evidence Quality Considerations

The Indian Association of Dermatologists task force reviewed 30 articles to establish these recommendations 1. While evidence supports PRP efficacy, studies show high variability in protocols, and the evidence base would benefit from larger randomized controlled trials with standardized protocols 1. For best results, initiate combined therapy protocol as early as possible in the disease course 1.