Jun
22
2013

Baldness Can Be Treated With Platelet Rich Plasma

Baldness can be embarrassing to the person who has it. Often it runs in families, as there is a genetic factor that can be passed on from mother’s and father’s side. It can even jump one generation. I have reviewed hormonal factors and the treatment with minoxidil under Ref. 1 and 2.

One particularly embarrassing form of baldness is a spotty hair loss (medically known as “alopecia areata”), which can occur spontaneously after a period of severe stress. It is due to an autoimmune phenomenon as explained here.

Recently a randomized trial was published where one half of the head was treated with either platelet rich plasma injections (PRP), corticosteroid injections or placebo injections. Each person of the 45 volunteers got three treatments in monthly intervals and they were followed for 1 year. Only the PRP treatment group had successful regrowth of hair in the bald spots. This study has caught the attention of the media.  Images of vampires drinking blood were circulating in the press, but nothing could be further from the truth. Unfortunately a story like this just instills fear in the public, but does nothing to clarify what was done in this clinical trial.

Baldness Can Be Treated With Platelet Rich Plasma

Baldness Can Be Treated With Platelet Rich Plasma

Let me explain what the authors of the above baldness study actually did and why.

PRP has been shown in the past to contain various growth factors that support stem cells. So, in order to stimulate the stem cells in the baldness spots to renew hair growth blood was drawn from the same patient (there are no incompatibility issues with regard to transplant rejection). The blood sample was then placed in a centrifuge to separate the red blood cells, which go to the bottom of the test tube, from the other cells. The portion of the blood just above the red blood cells contains platelets and fibrinogen. This is called PRP or platelet rich plasma (blood without red blood cells is called plasma).

The plasma is enriched more than 4 times from the original concentration of platelets in blood. Platelets are special blood cells, which take part in the clotting process. They also contain a lot of growth factors that are all-important for the survival of the stem cells in the baldness spots. The PRP helps the dormant hair follicles in the bald spots to regrow hair. In the past PRP has been extensively researched for the treatment of musculoskeletal injuries.

With respect to treatment of baldness according to this website PRP injections alone help only in about 30% of patients to slow down hair loss and to rejuvenate hair growth. This link also contains a “before and after” picture of a PRP treated scalp. Note that this patient did not receive a hair transplant, just PRP injections. What happened here is that the PRP injections transferred platelets with growth factors from the patient’s blood. Some of the hair growth was from stimulated dormant hair follicles that were still in the patient’s scalp at the bald spot; however, other hair follicles likely developed from mesenchymal stem cells that were situated in the scalp, but activated by PRP (like grass seeds that would grow grass when put in fertile soil and watered).

Here is a YouTube video, which explains stem cell therapy for thickening of thinned hair with the use of something called Acell and PRP.

In this 2011 paper it was describes that PRP and other factors can stimulate hair growth, in some cases histology proof was even obtained showing that hair follicles had grown to a normal size following the stimulation from PRP and other factors. One important such other growth factor is the so-called Acell, which is a special application of extracellular matrix: With the help of this acellular material that functions as a matrix for hair follicles to grow the success rate of Acell and PRP injections has vastly improved. Estimates are that there are 70% to 80% success rates with this form of treatment (Acell and PRP). Here is a website where this type of treatment is also discussed.

Conclusion

In those cases of baldness where minoxidil and bioidentical testosterone replacements fail, treatment with the patient’s own PRP and augmented by the use of Acell material as a matrix can be an alternative form of treatment. Although so far only one randomized trial has shown good results, other trials from different centers will likely soon confirm this treatment modality.

References regarding hormone aspects (lack of testosterone) of baldness

1. Overview of hair loss: http://www.nethealthbook.com/articles/hairloss.php

2. Testosterone for male menopause: https://www.askdrray.com/testosterone-for-male-menopause-andropause/

3. More info on PRP: http://link.springer.com/article/10.1007/s12178-008-9032-5#page-1

Last edited April 30, 2014

Jan
01
2006

Face Transplants For Disfigured Patients

Patients with severe burns to their face have been treated with skin transplants in order to help them cope with common body functions which the average person takes for granted, like opening and closing of eyelids or breathing. Patients have to undergo numerous skin grafts, where skin is transplanted from other body areas. The process can take years, as multiple surgeries are needed. Facial skin is also more tender and pliable, making it different from the type of skin in other areas of the body, and plastic surgeons are working to make the facial appearance of the patient less mask-like. The journey to recovery becomes a long and difficult one, which can be likened to an emotional roller coaster: there is surgery and the time to heal, after which more surgery is required.
The possibility of a face transplant sounded like a futuristic item till a short time ago, but French doctors have used new techniques to restore the facial features of a 38-year-old woman, whose face had been mauled by a dog. The partial transplant was done using the mouth, nose and chin of a brain dead donor.
Maria Siemionow, the director of plastic-surgery research at the Cleveland Clinic states, that facial transplant can only be considered as a treatment for severely disfigured patients who have exhausted all conventional options. The procedure itself remains controversial and risky. It involves harvesting the face from a brain-dead organ donor in a 4 to 6 hour surgery. In the following 10 to 15 hour procedure the face is draped over the bones and muscles of the recipient. Following surgery the transplant patients needs to take medication to prevent the rejection of the transplant. Even though the risk is not any different than the risk, which goes along with a kidney transplant, there is the possibility of transplant rejection and of side effects from immunosuppressants. Patients, who take this medication that will cost about $2000 per month, are more susceptible to infection, cancer, metabolic disorders, and liver and kidney damage. The psychological impact on the patient will also be significant, as there could be a feeling of having a different identity. Dr. James Zins, chairman for plastic surgery at the Cleveland Clinic, insists that there are no races to be won and the approach to this new option should be methodical and slow.

Face Transplants For Disfigured Patients

Before and after face transplant

Not all potential candidates for the surgery are willing to take the risk of life-long immuno-suppressants and it is only a consideration for physical as well as psychologically suitable patients who are willing to take the risk of receiving a new face after devastating accidents.

Reference: December 12, 2005 issue of Newsweek, pages 60-61

Last edited December 6, 2012