Questions for those of you that have done PRP with your surgery


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A few questions for those of you had that have used PRP in conjunction with surgery (or even just PRP in general):

  • How has it been for you?
  • Did you use adjuvant Acell or stem cells?
  • What was the time frame of your use and how many treatments overall did you have?
  • Any other relevant information such as other medications you're taking, age, Norwood, other medical conditions like diabetes/high blood pressure etc.
  • Was your PRP activated or non activated? This one might be trickier to tell as most practitioners don't bother telling their patients and their staff usually doesn't even know. The way to find out is by googling the specific brand name of the PRP system your Doctor used and activation (ie. "AcCellerated Biologics +PRP +activation" or "Cellenis +PRP +activation")
  • Was your PRP leukocyte enriched or leukocyte depleted? (similar to above)
It seems like practitioners are packing the PRP in Acell (ground up pig bladder) to make it stay in the scalp longer. I guess this makes sense, but there are no studies in the peer reviewed literature that I can find on this point, just "case reports" from individual surgeons' websites which are essentially worthless. Hair caliber and follicle density need to be objectively measured and quantified. You can't do this with pictures from 3 feet away.

Also, when using it with surgery, I'm not sure have having pig protein sitting in your scalp while your hair follicles are trying to sprout is a good idea -- would a gunky mesh of protein impede blood flow? Particularly at a time when the newly transplanted follicles are so delicate.

This is an interesting round table discussion about PRP in general from the ISHRS, with some of the names being pretty well recognized in the field. I favor the opinion of Bill Haber -- there's just a void of scientific information right now, particularly in the setting of surgery (literally 2 studies on all of Pubmed, one of them being cicatricial alopecia which is a very different process than androgenic).

I disagree with Cooley in the above discussion -- that the scientific method cannot be applied due to concomitant medication, bell shaped response curves, etc. Confounding variables and response curves are built into any scientific study. That's how the scientific method works. The real issues are funding and time. To do a large randomized double blinded trial would be expensive and time consuming. Until the market for the treatment can be shown to be more fertile, there's no large pharmaceutical company that will pay the millions of dollars it would require to push a randomized double blinded trial through.

One thought is to do a large trial where half of the scalp with surgery is injected with PRP and the other half with saline, with the patient and surgeon both blinded to the results. But I don't see any study like that even remotely on the horizon, especially as most hair restoration is out of pocket and patient's most likely will not want to f around.

And that leaves us caught in the middle, as is so often the case with cutting edge medicine. Of course the people that offer it will say "in my clinical experience, it works" but that's essentially worthless without the scientific method. Their wallet depends on what they're saying and they're only making judgments on pictures, not objective hair counts or caliber measurements.

So with all that being said, I would like to know your experiences. I had a single session without surgery and am on the fence as to whether or not to do it before my upcoming FUE. I had a minor improvement in density (perhaps between 1-5%) over the next few months though the effects seemed temporary. I'm not sure how this would translate into its impact on post operative healing or yield.