What is the treatment protocol for Platelet-rich plasma (PRP) therapy for hair loss?

PRP Treatment Protocol for Hair Loss

For androgenetic alopecia, administer three intradermal PRP injections spaced exactly one month apart (months 0,1, and 2), using nonactivated PRP at 5-7 mL per session, combined with topical minoxidil 5% (1 mL twice daily) throughout treatment and beyond, followed by maintenance PRP injections every 6 months to sustain results. 1

Blood Collection and PRP Preparation

• Draw autologous blood and process immediately using manual double-spin centrifugation method 1
• Target platelet concentration of 1.0-1.5 million platelets per microliter 1
• Use nonactivated PRP only—activation should be avoided as nonactivated PRP demonstrates 31% greater increases in hair count and total hair density compared to activated PRP 1

Treatment Administration Protocol

Initial Treatment Phase

• Deliver 3 treatment sessions spaced exactly one month apart (month 0, month 1, month 2) 1
• Inject 5-7 mL of PRP per session using 30-gauge × 4 mm needles 1
• Use point-by-point injection technique at 90-degree angle, 2-4 mm depth 1
• Space injections 1 cm apart across mapped areas of hair loss 1
• Apply pharmaceutical-grade topical anesthetic before injection to minimize pain 1

Concurrent Pharmacotherapy

• Prescribe topical minoxidil 5% at 1 mL twice daily starting with first PRP session and continuing indefinitely—combination therapy is significantly more effective than either monotherapy 1, 2
• Consider adding oral finasteride and multivitamin supplements as background therapy 1

Maintenance Phase

• Administer maintenance PRP injections every 6 months after completing initial 3-session protocol 1
• Continue topical minoxidil 5% twice daily indefinitely 1
• Discontinuation of treatment results in loss of gains within months, making continuous therapy mandatory 3

Expected Timeline and Outcomes

Early Response (2-3 Months)

• Initial improvements in hair density become visible at 2-3 months 1
• A 25% improvement in hair density at 2 months predicts sustained response at 6 months 4, 1

Peak Response (6 Months)

• Hair density increases by 1.74 times baseline 1
• Hair diameter increases by 14.3 times baseline 1
• Telogen phase hair decreases by 9.3 times 1

Long-Term Maintenance

• Some patients report progressive hair loss 12-16 months after last treatment if maintenance injections are not continued 5
• Re-treatment with maintenance protocol restores benefits 5

Patient Selection and Prognostic Factors

• Mild to moderate androgenetic alopecia responds most favorably to PRP treatment 1
• More severe grades show variable results 1
• Male pattern hair loss demonstrates consistent positive response in controlled trials 5

Comparative Efficacy Evidence

The triple combination (PRP + minoxidil + finasteride) represents the most effective evidence-based approach, with superiority demonstrated in this hierarchy 3:

• Triple combination > PRP + minoxidil > minoxidil alone > PRP alone > placebo 1, 6
• Combination PRP and minoxidil increases hair density by 32%, hair shaft diameter by 26%, reduces vellus hair by 30%, and reduces telogen hair by 39% 6

Safety Profile and Common Pitfalls

Expected Side Effects

• Pain during injection is the primary complaint, managed with topical anesthetic 1
• No major side effects reported in controlled trials 5

Critical Pitfalls to Avoid

• Do not use activated PRP—it produces inferior results 1
• Do not space treatments closer than 1 month or further than 1 month during initial phase 1
• Do not omit concurrent minoxidil therapy—monotherapy is significantly less effective 1, 6
• Do not fail to schedule maintenance injections every 6 months—gains will be lost 3, 1

Emerging Alternative: Platelet-Rich Fibrin (PRF)

• PRF is emerging as a potentially superior alternative with theoretical advantages including lower cost, easier preparation, and similar efficacy 1
• PRF demonstrates clinical efficacy in androgenetic alopecia with comparable safety profile to PRP 4, 1
• Consider PRF as an alternative when cost or preparation complexity is a barrier 1