What is the role of Platelet-Rich Fibrin (PRF) therapy in treating alopecia?

Role of Platelet-Rich Fibrin (PRF) in Alopecia

PRF is a safe, cost-effective, and clinically effective treatment for androgenetic alopecia that should be administered as three intradermal scalp injections spaced one month apart, ideally combined with topical minoxidil 5% twice daily for superior outcomes. 1

PRF vs PRP: Key Advantages

PRF offers theoretical advantages over traditional PRP, including lower cost, easier preparation, and similar or superior clinical efficacy without requiring platelet activation. 1, 2, 3

• PRF demonstrates significant clinical efficacy across all ages, genders, and severity grades of androgenetic alopecia, with particularly strong responses in mild-to-moderate cases 1
• Patient satisfaction scores average 7.42 out of 10, with visible improvements on clinical photographs and dermoscopy 1
• PRF is especially valuable as an adjuvant to hair transplant surgery, showing beneficial effects on hair follicle numbers 1

Treatment Protocol

Initial Treatment Phase

• Administer three intradermal scalp injection sessions spaced exactly one month apart (months 0,1, and 3) 1, 2
• Map areas of hair loss and inject point-by-point at 90-degree angle, 2-4 mm depth, with injections spaced 1 cm apart 1
• Use 30-gauge × 4 mm needles for administration 1
• Apply pharmaceutical-grade topical anesthetic before injection to minimize discomfort 2

Concurrent Therapy

• Combine PRF with topical minoxidil 5% at 1 mL twice daily throughout treatment and beyond for maximal efficacy 1, 4, 2
• Consider adding finasteride and multivitamin supplements as background therapy 1, 2
• PRF with microneedling can be performed in four sittings, two weeks apart 1

Maintenance Phase

• Administer maintenance PRF injections every 6 months to sustain long-term results 4, 2
• Evaluate treatment response after one year 1

Expected Outcomes and Timeline

Early Response (2-3 Months)

• Significant increases in hair density index become visible at 2-3 months post-treatment 1, 2
• A 25% improvement in hair density at 2 months predicts sustained response at 6 months 1, 4, 2

Peak Response (6 Months)

• Hair density increases by 1.74 times compared to baseline 1, 2
• Hair diameter increases by 14.3 times 1, 2
• Telogen phase hair decreases by 9.3 times 1, 2
• Significant improvement on Global Photographic Assessment (GPA) scale across all ages and genders 1

Preparation Considerations

PRF does not require platelet activation before injection—nonactivated preparations demonstrate 31% greater increases in hair count and total hair density compared to activated versions. 4, 2, 3

• While optimal centrifugation protocols remain under investigation, most studies favor low-speed centrifugation with shorter centrifugation times 5
• A horizontal centrifuge may be preferred over fixed-angle centrifuge due to higher platelet yield and less cellular trauma 5
• Target platelet concentration should be 1.0-1.5 million platelets per microliter 2

Clinical Efficacy Evidence

Combination Therapy Superiority

Complex therapy combining PRF with minoxidil is significantly more effective than either monotherapy alone. 1, 4, 3

• PRF increases proliferative activity of hair follicle cells and improves hair morphology in androgenetic alopecia patients 1, 3
• All cases in clinical studies showed improvement in hair growth with liquid PRF 1

Best Candidates

• Mild-to-moderate androgenetic alopecia responds most favorably to PRF treatment 1, 2
• More severe grades show variable but still statistically significant improvements 1
• PRF is effective across both male and female patients 1

Safety Profile

• PRF is safe with no major adverse events reported in clinical studies 1, 6
• Pain during injection is the primary complaint, manageable with topical anesthetics 2
• PRF is generally well-tolerated with high patient satisfaction 1, 7

Critical Clinical Pitfalls

Treatment Continuity

Continuous treatment is required to maintain benefits—discontinuation results in loss of gains. 4, 2

• Maintenance injections every 6 months are essential for sustained results 4, 2
• Treatment must be initiated as early as possible for best outcomes 1

Evidence Limitations

• Current evidence for autologous platelet concentrates in alopecia remains somewhat controversial due to highly variable study protocols, preparations, and treatment intervals 1
• Standardized approaches are still evolving, with need for larger randomized controlled trials comparing PRF directly to PRP 1
• Optimal preparation methods, treatment frequency, and long-term durability after therapy termination require further investigation 1, 5

Monitoring Treatment Response

• Use standardized before-and-after photographs for objective assessment 4
• Employ trichoscopy to evaluate hair density and diameter changes 4
• Utilize patient self-assessment questionnaires for subjective outcomes 4
• Perform hair pull test before each treatment session and at follow-up 7