Why PRP Alone is Not Enough to Stabilize Hair Loss, and Why 20s is Too Young for Hair Transplant

By: Amiya Prasad, M.D.

Thank you for your question. You submitted several photos and you state in your question that you’re 23-years-old and that you’ve been undergoing PRP or platelet-rich plasma treatments and it appears that your hair loss has been stabilized. And you’re specifically concerned about the temples, particularly the right temple in an area where you have observed a cowlick that has become more visible. And you’re asking is it appropriate for you to consider hair transplant although you are still young if you were to continue doing PRP every 6 to 9 months moving forward. Well, I can certainly share with you how I address this type of question in my practice which we deal a lot with.

A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Hair transplant and hair loss treatment has been a major part of my practice. And I’m also the founder of TrichoStem™ Hair Regeneration Centers. This is a system we developed starting about 7 years ago to help men and women of all ages treat hair loss non-surgically. And this is actually using PRP as well as Acellular matrix something I’ll discuss further momentarily. So I would like to explain to you few things about your situation that still makes me hesitant to ever consider a hair transplant for someone your age. To begin with, you have to understand that hair loss is a progressive condition.

And the age of onset and rate of progression are the most important variables when it comes to strategizing a surgical intervention. So what does that mean? When you think about it, there’s a concept called the Rule of Decades. And the Rule of Decades basically is that when you are in your 20s, 20% of men have hair loss while 80% do not.

And as you get older, 40s and 50s, it gets closer to 50%. So when we think of hair loss, I like to think, especially when we’re doing what we do in our practice a treatment called Hair Regeneration, when I look at patients in a way retrospectively over the many years we’ve been doing this and essentially, I’ve categorized people into different levels of risk in terms of progression and a relative aggressiveness. So when you think about someone your age group starting to lose hair, essentially by definition, your hair loss is more aggressive. This is in distinction to a man who comes in who is in his 40s or 50s who has a similar appearance. In that situation, the hair loss is less aggressive. Now the aggressiveness of hair loss can be variable. For younger people, people in their 20s, men, I have observed that essentially, you can have a progression that is very rapid or where you can practically be bald or not bald by your early to mid-20s as well as moderately progressive in terms of the time that it goes on so that you can be well into your late 20s and early 30s and still have a decent amount of hair. Now the challenge is in categorizing people in a way so that you can develop an appropriate prognosis but unfortunately, the appearance can be very similar in the more aggressive as well as in the moderately aggressive situations at any given point of time when people come in essentially for consultation.

Why PRP Alone is Not Enough to Stabilize Hair Loss, and Why 20s is Too Young for Hair Transplant

So when we think about the technology of PRP and what we’ve done in our practice with Hair Regeneration, PRP which is now becoming much more well established as an intervention for hair loss is still a treatment that is in effect, slowing down progression. It’s not stopping progression. When you think about hair loss treatment as it stands today, whether it’s medical such as the drug finasteride, whether it’s PRP, whether it’s Acellular matrix, platelet-rich plasma combination that we’ve developed called Hair Regeneration as well as transplant, what are you essentially doing? We’re essentially managing hair loss progression.

You’re not curing. So when we developed Hair Regeneration and it’s something that may be worthwhile considering in your research and learning about this technology, what we’ve learned is that the effects of combination of Acellular matrix and platelet-rich plasma (PRP), formulated and injected in a particular way depending on an individual’s particular hair loss characteristics, we’re able to establish significant prolongation of growth as well as reactivation of the hair that isn’t growing as well as thickening hair that was previously thinning. Now something to also be mindful is whether or not it is worthwhile for you to consider being also on a DHT blocker such as finasteride. When I look at people in terms of this relative aggressiveness model, I think a lot about their relative DHT sensitivity.

Now DHT is not the only cause of hair loss. We know this because when people are on finasteride and they’re on finasteride for 15 years or more, a lot of the patients are still progressively losing hair. But what I would suspect is that they have more hair than they otherwise would have. What’s happened is that progression has slowed down.

So again, when you think about this concept, with Hair Regeneration, what we have done is we’ve developed a system where we can do an injection, a single injection. And in the right candidate, we can extend that lifespan of that hair and see improvement for more than 5 years. We have a subgroup of younger people who have more aggressive patterns who it appears that we can extend only to three years. There’s a distinction there even if it’s as effective as our treatment. So the take home message here is, with the PRP, the PRP may appear to have stabilized your hair loss because you’re not losing hair currently. But what you don’t know how long this effect is going to last. There is no treatment that stops hair loss for the rest of your life. It is still about managing hair loss.

So in your situation, you’re only 23, you don’t know whether this PRP treatment will be as effective 2 years from now, 4 years from now. And what I recommend to my younger patients is do everything you can to avoid a hair transplant for as long as possible. Hair transplant is not the answer to everything. Hair transplant is limited. It’s limited by the amount of hair you can get from your donor area and just getting a natural full volume appearance.

For example, if you want to treat your temples, just think about what would happen if you got the transplant and then the temple hairs that were present currently receded then all you would have will be transplanted hair and that doesn’t look very good. So I would recommend that you wait for as long as possible. Certainly, continuing the PRP treatments seems to make sense in your situation. Learn about Hair Regeneration, PRP, Acellular matrix which we developed from a wound healing concept. And also consider a DHT blocker like finasteride. As I said, wait as long as possible before considering hair transplant and I would recommend probably not until your 30s. So I hope that was helpful, I wish you the best of luck and thank you for your question.

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