Best hair loss treatments for 2021
Platelet-rich plasma (PRP) is a concentration of platelets. Platelets have two functions. When the body is cut, platelets clump to help stop the bleeding. As platelets clump, they release growth factors to initiate the healing process. In the late 1990s, the dental field and orthopedic surgery field decided to concentrate the platelets and use them in dental procedures and orthopedic injuries. PRP spread from these fields to plastic surgery and later to hair restoration procedures. In 2005, Dr. Ubel put PRP in hair transplant grafts prior to transplanting them to the scalp. He found that the survival rate of hair was 15% higher if the grafts treated with PRP. Subsequent to this, physicians began injecting PRP into the scalp during a hair transplant and to regenerate hair in people with hair loss.
When blood is spun with a centrifugal force, the cells will fall into layers based on weight. The red blood cells are the heaviest and lie at the bottom. Then there is a layer of white blood cells called the buffy coat. Above the buffy coat are the lighter platelets. Above the platelets is the serum with still lighter anions and cations of sodium, potassium, chloride, calcium, etc. PRP is further concentrated platelets. The normal concentration might be 150,000 to 250,000 per milliliter in the whole blood. Concentrating the platelets up to 5X increases them often over 1 million platelets per milliliter. These concentrated platelets have much higher concentrations of growth factors.
There is high-quality PRP and low-quality PRP. It is possible to prepare PRP in a very inexpensive way by spinning a tube of blood and drawing off the platelet fraction. However, this is usually a 1X concentration (150,000 to 250,000 per milliliter) of platelets with lower concentrations of platelets. Concentrating platelets up to 5X requires much more expensive equipment and supplies. However, there is also a difference in the quality of the PRP even with equipment that is more expensive. Thus, you need to know the specific cell counts of the equipment you are using. These cell counts include monocytes and granulocytes. Monocytes are positive, while granulocytes are negative. Then there also appears to be a difference between the quality of the platelets that is seen only by evaluating the growth factor concentration profile of the equipment you are using. The physician needs to know all of this. Higher concentrations of growth factors are optimal. Better quality platelets and higher concentrations of platelets will lead to a higher concentration of growth factors.
A comparison of good quality PRP and poor quality PRP for hair density and follicular unit density.
After preparing the PRP, the platelets can be injected without activation (not activated PRP) or with activation of the platelets. Not activated PRP has the lowest concentration of growth factors and is least desirable. Platelets can be induced to clump by adding a 1:10 concentration of calcium gluconate or calcium chloride just prior to injecting them into the area of hair loss. This means of inducement produces similar concentrations as activating the platelets with thrombin and is acceptable. Bovine thrombin cannot be used on humans due to the risk of hypernasality, disease transmission, or transfer of plasmids. Recombinant thrombin made from bacteria may be used but adds to the cost and offers no benefit over calcium gluconate.
Dr. Cole has studied this extensively and found that different PRP preparation systems produce different concentrations of growth factors. Furthermore, studies show that dermal papilla proliferation is greater when the concentration of growth factors is higher. The response of dermal papilla is dose dependent.
PRP Vs. CRP
For this reason, Dr. Cole performed a study where he lysed the platelets using high energy sound waves that costs over $23,000.00 to purchase. He studied different protocols of lysis and found that subjecting platelets to sound energy in 30 second increments while chilled in a bath at 4 degrees Celsius for a total of 30 minutes of sonication produced 5X the concentration of high molecular weight growth factors. Higher concentrations of growth factors are desirable. Preparing PRP from the blood draw to the injection of the platelets requires about 2 hours using Dr. Cole’s method. Lysis of the platelets is preferred due to the higher concentration of platelets. Other methods can be completed in less than one hour, but do not produce similar results. Because this method of lysing platelets is much different other forms of PRP on the market, Dr. Cole called this method cytokine rich plasma (CRP).
Dr. Cole further studied the impact on hair loss following injection of the PRP. Dr. Cole found that with PRP prepared by the Angel System (hematocrit set at 2% and platelets set at 5X), the hair density increased by 50% at 6 months. Using the Regen system and a 5X concentration of platelets, hair density decreased by 25% at 6 months. Thus, the system of preparation produces different quality of platelets, as well. Again, no product will grow hair on bald skin so do not use these methods to treat bald skin. You can protect areas where you are thinning from the aging process, but at this time, only hair transplants will grow hair on bald skin.
