Thank you for
your question. You submitted your question with several photos.
And you’re asking your question, can PRP work for diffuse androgenetic alopecia. You
state that you have had 2 sessions of PRP and that your hair is still shedding although
you note that the shedding has decreased by half.
Well, I can certainly share with you my approach to treating androgenetic alopecia in women
in my practice. 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. I am also the founder of TrichoStem™ Hair
Regeneration Centers, a system we developed using PRP but also using a material called
extracellular matrix. And we developed a system for both men and women who we treat from around
the world for mostly androgenetic alopecia. So I can share with you a little bit about
the strategy that I use when I evaluate patients like yourself.
So to begin with, it’s important very much to distinguish androgenetic alopecia which
is the progressive thinning of hair from something called telogen effluvium which is hair shedding
which is often associated with an acute stressful event preceded by 2-5 months where an event
occurred, a major stressful event such as general anesthesia or a family type of event.
And then 2-5 months later, there’s a lot of shedding.
Further, there’s also a condition called chronic telogen effluvium. And this is a condition
where it’s typically more associated with women that will have chronic hair shedding.
Now that’s important because when we see women who fall in the more classic category
of androgenetic alopecia, we’re looking at generally middle aged women and it’s
very common whether it’s age 50 or so, 50% of women over the age of 50 have hair loss.
Now that leaves a significant number about 30% under the age of 50.
Further, in the work that we have been doing and we started much of this work back in 2011,
we have seen that a large number of younger women, women in their 20s and 30s can also
have androgenetic alopecia. As younger women came into our practice, I would often have
to do or feel compelled to do biopsies to confirm the diagnosis of androgenetic alopecia
to differentiate from other conditions that can be causing hair loss. In fact, in our
youngest patient we treated was a woman who was 16 and she has the same condition that
her mother has of a very early onset androgenetic alopecia.
So to answer the question about PRP, well what we developed in our practice evolved
out an effort to help our hair transplant patients to heal better. We wanted the donor
area to heal better and we wanted the hair grafts to survive better. And so we used a
material called extracellular matrix or Acellular matrix and we combined that with platelet-rich
plasma (PRP). A side-effect, a benefit that we saw was that thinning hair became thicker.
Over the course of several years, we took it upon ourselves to really work on systems
to be able to more predictively treat people with hair loss whether it’s men or women.
Further at this point, I’ve developed a classification system for both men and women
who come to our practice based on their gender, age, age of onset of hair loss, rate of progression,
rate of progression and if indicated, some other medical issues as well as the possible
need for confirmation diagnosis with scalp biopsy.
So when it comes to the management of a patient, of female pattern hair loss patient using
Hair Regeneration or TrichoStem™ Hair Regeneration, I generally tell our female patients that
after one injection treatment, we can expect that on average that improvement will be seen
about 9 months. Improvement being defined by regrowth of hair that was not growing and
that is a classic part of androgenetic alopecia where the growth cycles are getting shorter,
the anagen phase gets shorter and the resting phase, telogen phase, gets longer. Which means
at any given time, a certain percentage of hair is actually not growing that’s more
than is typical than someone who’s not experiencing androgenetic alopecia. So regrowth of hair,
strengthening of thinning hair and essentially prolongation of the growth cycles such that
there’s ultimately more hair on the scalp and we can see that by looking at the hair
part and we can look at areas where there may be thinning such as the temple.
Now a lot of times, we see our patients improving sooner than that. We’ll see them at 3-6
months and notice that the temple areas have started to fill in and I always explain that
if you see it there, then it’s affecting the entire scalp.
Now depending on the profile of the patient, we also consider doing called a booster injection
and that’s generally done somewhere around 15-24 months after the first injection. But
the sustainability of our treatment has exceed for many patients 5 years. And so it depends
on the patient profile. And this continuous evolution of our treatment as we have treated
so many people of wide range of ages and clinical profiles that I basically developed treatment
plans that is specific to the patient’s profile.
I think it’s important that you discuss with your doctor what the expectations will
be. I think that at the current time, people are doing the best they can. I am proud of
the influence our work has had in the world of hair loss treatment. We’ve gone from
people dismissing it or perceiving that PRP and Acellular matrix was not really something
that can work to the point where lots of doctors are offering PRP and PRP with Acellular matrix
with their own approach. But I find that much of what I see is essentially a shotgun approach
and people are seeing what kind of results they get. And currently, a lot of doctors
are saying that PRP works 50% of the time but that is pretty non-specific so we can’t
say 50% on exactly who, on what kind of profile or is it just a broad average and kind of
you have a 50% chance. I think that the work that we have done with Acellular matrix and
PRP and following our patients closely, getting a certain amount of experience that comes
from treating so many patients come from a different perspective.
So I think the questions that I would ask is how certain are you with the diagnosis
of androgenetic alopecia? I would say that also that one of the ways that I distinguish
androgenetic alopecia from telogen effluvium is based on the degree of hair shedding. Generally
speaking, androgenetic alopecia is more of a slow insidious process with minimal amount
of significant hair shedding while telogen effluvium is marked by significant hair shedding.
Now that’s just one point. Yes, people who have androgenetic alopecia, their growth cycles
get shorter therefore there can be more hair that can shed. And they’ll say that they
notice more hair in their brush and that they notice that compared to 3 years prior, they
have significantly less hair. But it is always about the diagnosis before you start a treatment
strategy. So first confirm the diagnosis. Discuss with
your doctor what’s the strategy with PRP. What are the expectations. What kind of schedule
is necessary to sustain the growth cycles. If you have androgenetic alopecia, you have
to understand also that this is a condition that’s hardwired in your genetics and everything
that we do is about management. So what you want is an optimal strategy for management
of your hair loss. So I hope that was helpful, I wish you the
best of luck and thank you for your question.