Why PRP treatment needed only once – or twice?A very frequent question I get in consultation is why my PRP treatment for hair loss is effective without doing it three or four times, as is commonly performed in most offices. To begin with, it is important to note that the answer to this question is not based on any clinical study with comparison of the results of different methods (such studies do not exist); rather it is based on my experience over the last nine years of treating patients with PRP. Most doctors who have started doing PRP for hair loss have only recently started doing so.

My technique involves microneedling, PeRP, and ACell. All three components are important to the success of the procedure. I also assess every patient to determine candidacy. Patients with significant miniaturization of hair are better candidates. The procedure is performed once and an evaluation follows 3-4 months later, very occasionally we try a second “booster” PRP if we feel the response has been weak. If it doesn’t work at that point, we don’t recommend continuing. A positive response is not seen in every patient. As with minoxidil and finasteride, some patients do not respond. Patients who have had a good response, usually repeat the PRP every 9-15 months.

Back to the question at hand, why do I not perform PRP 3-4 times to see an effect, and why is it generally only repeated once a year, when other doctors tend to favor a much more frequent schedule? In general, the earliest time at which we can see some change in hair volume, in response to any treatment, is approximately 3 months. I started doing PRP on patients who were coming for surgery and evaluated them post-operatively at various intervals. After only one PRP treatment, I was seeing improvement more often than not.

I then started treating patients with PRP as a stand-alone treatment. These patients had either been taking minoxidil or finasteride for more than two years, and continued usage. Or they were not taking any other treatment for hair loss, because of failure of treatment or contra-indication. I specifically evaluated PRP treatment alone, to avoid any confusion regarding which treatment was responsible for what effect. At three months after treatment, the vast majority of patients showed improvement. Therefore, I never saw the need to do more treatments.

Over the years, I modified and improved my procedure and found that very occasionally, patients with a minimal or no response after one treatment, did respond after a “booster” PRP 3-6 months after the first.

Patients with alopecia areata, that has not responded to first line or second line treatments, will sometimes opt to try PRP treatments. The schedule for these patients is 3-4 PRP procedures once a month. This is because the autoimmune process needs more aggressive treatment.

PRP, as performed in my office, is usually successful after one procedure and is repeated every 9-15 months. Perhaps this is because of my specific technique, which is definitely more aggressive than other approaches. It is definitely not a “lunchtime” procedure…