What is the recommended protocol for Platelet-Rich Plasma (PRP) hair administration in a patient with hair loss or thinning?

PRP Hair Administration Protocol

For androgenetic alopecia treatment, administer 5-7 mL of PRP prepared by manual double-spin method, injecting 0.05-0.1 mL/cm² at 1 cm intervals into the scalp at 90-degree angle and 2-4 mm depth, with 3-5 sessions spaced 1 month apart during the treatment phase, followed by maintenance sessions every 6 months. 1

PRP Preparation Protocol

Preparation Method:

• Use a manual double-spin centrifugation method for optimal platelet concentration 1
• Target platelet concentration of 1 to 1.5 million platelets per microliter 1, 2
• Draw 9-10 mL of peripheral blood without anticoagulants 1
• Centrifuge at 700-2000 RCF for 8 minutes in a horizontal centrifuge 1
• No activation of PRP is required when used for androgenetic alopecia 1

Critical Pitfall: Digital centrifuges with large-sized sodium citrate tubes and low centrifugation speed (900 rpm) produce higher platelet counts, though clinical outcomes appear similar across preparation methods 3. The key is achieving the target platelet concentration of 1-1.5 million/μL 1, 2.

Pre-Treatment Preparation

Patient Instructions:

• Patient must shampoo and detangle hair before the session 1
• No hair products (wax, gel, hairspray) should be applied 1
• Prepare all equipment before blood withdrawal, as timing is critical especially for PRF variants 1

Clinical Setup:

• Take standardized before-and-after photographs 1
• Map out and mark areas of hair loss 1
• Comb through the treatment area before injection 1
• Position patient to allow scalp access from all angles 1

Injection Technique

Equipment:

• Use 30G × 4 mm needles to minimize injection pain 1
• Apply pharmaceutical-grade topical numbing cream, as injections are associated with significant pain 1, 2

Injection Protocol:

• Inject at 90-degree angle perpendicular to scalp 1
• Depth: 2-4 mm (full bevel of needle) 1
• Spacing: 1 cm apart in a point-by-point pattern 1
• Volume: 5-7 mL total PRP per session 1
• Dose: 0.05 to 0.1 mL/cm² of affected scalp 1

Treatment Schedule

Initial Treatment Phase:

• Perform minimum of 3-5 sessions 1
• Space sessions 1 month apart (can extend to 4-6 weeks if needed) 1
• Complete 3 sessions total per year during treatment phase 1

Evaluation:

• Assess response 1 month after the final treatment session 4, 5
• Formal evaluation after one year of treatment 1
• Use trichoscopy, hair counts, and standardized photography to document response 2, 6

Maintenance Phase:

• Administer 1 session every 6 months after completing initial treatment series 1, 2
• Critical consideration: Relapse may occur 12-16 months after last treatment, requiring re-treatment 5

Expected Outcomes and Response Monitoring

Clinical Efficacy:

• Mean increase of 33.6 hairs in target area with 45.9 hairs/cm² density improvement after 3 sessions 5
• 64% of patients report improved hair density, 57% report new hair growth 4
• Combination with topical minoxidil 5% shows highest efficacy rates 1, 2, 7

Response Indicators:

• 25% improvement in hair density at 2 months predicts sustained response at 6 months 1
• Increased hair shaft diameter and decreased telogen hairs indicate positive response 2
• Patient satisfaction averages 7.29/10, with clinician assessment at 6.46/10 4

Safety Profile and Side Effects

Common Side Effects:

• Pain during injection is the primary complaint, resolving after treatment completion 7
• No major adverse effects reported in controlled trials 5
• Treatment is considered safe with autologous preparation 4, 8, 7

Combination Therapy Considerations

Optimal Treatment Strategy:

• Initiate complex combined therapy as early as possible for best results 1
• Combine PRP with topical minoxidil 5% for highest hair density increases 1, 2, 7
• Consider background therapy with finasteride and multivitamin supplements 1
• PRP can serve as adjuvant to hair transplant surgery, improving graft retention 1

Important Caveat: While evidence supports PRP efficacy, optimal protocols remain under investigation, with variability in preparation methods, treatment intervals, and injection volumes across studies 1. The protocol outlined above represents consensus recommendations from the Indian Association of Dermatologists task force based on review of 30 articles 1.