What is the recommended treatment protocol for Platelet-Rich Plasma (PRP) therapy for hair loss?

PRP Therapy for Hair Loss: Evidence-Based Treatment Protocol

Administer three intradermal PRP injection sessions spaced exactly one month apart (months 0,1, and 2), combined with topical minoxidil 5% applied twice daily, followed by maintenance PRP injections every 6 months to sustain results. 1, 2

Treatment Protocol

Initial Treatment Phase

• Three treatment sessions delivered at precisely one-month intervals (baseline, month 1, month 2) 1, 2
• Injection technique: Point-by-point delivery at 90-degree angle, 2-4 mm depth, spacing injections 1 cm apart across mapped areas of hair loss 1
• Volume per session: 5-7 mL of PRP using 30-gauge × 4 mm needles 1
• Concurrent therapy: Topical minoxidil 5% at 1 mL applied twice daily throughout treatment and beyond 1, 2

PRP Preparation Specifications

• Use nonactivated PRP only—activation before injection should be avoided as nonactivated PRP demonstrates 31% greater increases in hair count and total hair density compared to activated PRP 1, 2
• Target platelet concentration: 1.0-1.5 million platelets per microliter using manual double-spin centrifugation method 1
• Process autologous blood immediately after collection 1

Maintenance Phase

• Maintenance injections every 6 months are mandatory to sustain results, as discontinuation results in complete loss of gains within months 1, 3
• Continue topical minoxidil 5% twice daily indefinitely 2

Expected Outcomes and Timeline

Early Response Indicators

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

Six-Month Results

• Hair density increases by 1.74 times baseline 1, 2
• Hair diameter increases by 14.3 times baseline 1, 2
• Telogen phase hair decreases by 9.3 times 1
• Mean hair density increases from approximately 34 hairs/cm² to 50 hairs/cm² 4
• Terminal to vellus hair ratio improves in 60% of patients 4

Combination Therapy Superiority

The combination of PRP with topical minoxidil 5% is significantly more effective than either monotherapy, and both monotherapies are superior to placebo. 5, 1, 2

• PRP with minoxidil demonstrates the highest treatment efficacy and patient satisfaction scores compared to either treatment alone 5, 6
• For maximal efficacy, the triple combination (PRP + minoxidil + finasteride) represents the most effective evidence-based approach 3

Patient Selection and Response Prediction

Best Candidates

• Mild to moderate androgenetic alopecia responds most favorably to PRP treatment 1, 2
• More severe grades show variable results 1
• Both male and female pattern hair loss respond to treatment 7, 4

Monitoring Treatment Response

• Use trichoscopy to evaluate hair density and diameter 2
• Standardized before-and-after photographs 2
• Patient self-assessment questionnaires 2
• Hair pull test (becomes significantly negative in 83% of patients after treatment) 5

Safety Profile and Adverse Effects

• Pain during injection is the primary complaint, though generally well-tolerated 5, 1
• Apply pharmaceutical-grade topical anesthetic before injection to minimize discomfort 1
• No serious adverse effects reported in clinical studies 7, 4, 6, 8
• Minoxidil is better tolerated than PRP in terms of pain, but PRP avoids systemic side effects 5

Critical Clinical Pitfalls to Avoid

Common Errors

• Do not use activated PRP—this reduces efficacy by 31% compared to nonactivated preparations 1, 2
• Do not skip maintenance injections—results are not permanent and require ongoing treatment every 6 months 1, 3
• Do not use PRP as monotherapy—always combine with topical minoxidil 5% for superior outcomes 5, 1, 2
• Do not expect results before 2-3 months—early discontinuation due to perceived lack of response is a common mistake 1, 3

Treatment Discontinuation Consequences

• Continuous treatment is mandatory to maintain benefits 1, 3
• Discontinuation results in complete loss of gains within months 2, 3
• Relapse of androgenetic alopecia occurs 12-16 months after stopping treatment 8

Emerging Alternative: Platelet-Rich Fibrin (PRF)

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

Patient Satisfaction Data

• Average patient satisfaction score: 7.29/10 7
• Clinician satisfaction score: 6.46/10 7
• Likelihood of recommending treatment to friends: 8/10 7
• Reported improvements: hair density (64%), new hair growth (57%), less hair loss (48%), increased thickness (38%) 7