Abstract
Background:
Follicular unit extraction (FUE) is a popular technique for treating androgenetic alopecia, but variable outcomes in hair density post-surgery persist. “Platelet-rich plasma (PRP)” has been proposed as an adjunct therapy to improve outcomes.
Objective:
This research aims to assess the efficacy of PRP augmentation in improving hair density in patients undergoing FUE.
Methods:
A prospective research was conducted on 50 participants with androgenetic alopecia. Participants were divided into two groups: FUE with PRP (Group A) and FUE alone (Group B). Hair density was measured at baseline, 3 months, and 6 months post-procedure.
Results:
At 6 months, Group A demonstrated a 25% greater improvement in hair density compared to Group B (P < 0.05). The PRP group also reported higher patient satisfaction scores.
Conclusion:
PRP augmentation significantly enhances hair density outcomes post-FUE and offers a promising adjunct for androgenetic alopecia management.
KEYWORDS: Androgenetic alopecia, follicular unit extraction, hair density, prospective research, PRP
INTRODUCTION
Androgenetic alopecia (AGA) is a common condition affecting millions globally, characterized by progressive hair thinning and follicular miniaturization.[1] Follicular unit extraction (FUE) has emerged as a minimally invasive and effective surgical intervention for hair restoration. Despite advancements, achieving optimal hair density and graft survival remains a challenge.[2]
PRP, derived from autologous blood, is enriched with growth factors like platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF), which are critical for tissue regeneration and angiogenesis.[3] Recent studies suggest that PRP may stimulate dormant hair follicles, enhance graft survival, and promote faster recovery.[4,5] However, evidence on its efficacy as an adjunct in FUE remains inconsistent.
This research evaluates the impact of PRP augmentation on hair density in patients undergoing FUE for AGA, hypothesizing that PRP improves clinical outcomes and patient satisfaction.
MATERIALS AND METHODS
Research design
This was a prospective, interventional research conducted over 12 months in a tertiary care dermatology clinic.
Participant selection
Fifty participants (ages 25–50) with Norwood-Hamilton stages III–V AGA were recruited. Inclusion criteria included stable hair loss for at least one year and no prior PRP or hair transplant treatments. Exclusion criteria included scalp infections, autoimmune disorders, and systemic anticoagulant therapy.
Research groups
Participants were randomly divided into two groups:
Group A (n = 25): FUE with PRP augmentation.
Group B (n = 25): FUE without PRP.
Procedure
Follicular unit extraction: Grafts were extracted using a 0.9 mm punch tool and implanted in designated recipient areas.
PRP preparation and application: About 20 mL of autologous blood was centrifuged to separate PRP. After graft implantation, and PRP was injected into the recipient scalp areas in Group A patients.
Outcome measures
Primary outcome: Hair density (measured in follicles/cm2) at baseline, 3 months, and 6 months.
Secondary outcomes: Patient satisfaction (measured via a 5-point Likert scale) and adverse effects.
Statistical analysis
Data were analyzed using SPSS software version 26.0. Paired t-tests were used for intragroup comparisons, while independent t-tests assessed intergroup differences. Statistical significance was set at P < 0.05.
RESULTS
Participants in Group A (PRP + FUE) and Group B (FUE alone) had comparable baseline characteristics. The mean age was 38.2 ± 6.1 years in Group A and 37.5 ± 5.8 years in Group B. The male-to-female ratio was similar at 20:5 and 19:6, respectively. Baseline hair density was also nearly identical, with 40.8 ± 2.5 follicles/cm2 in Group A and 41.0 ± 2.3 follicles/cm2 in Group B (P = 0.89). These findings ensured a balanced starting point for assessing outcomes.
Hair density improvements were significantly higher in Group A compared to Group B. At 3 months, Group A had an average density of 60.5 ± 3.1 follicles/cm2 versus 52.2 ± 2.8 follicles/cm2 in Group B (P < 0.01). By 6 months, Group A achieved a density of 74.2 ± 3.4 follicles/cm2 compared to 59.1 ± 3.0 follicles/cm2 in Group B (P < 0.01), reflecting a 25% higher improvement in Group A. These results highlight the enhanced efficacy of PRP in improving hair density post-FUE [Tables 1 and 2].
Table 1.
Baseline characteristics of participants
| Parameter | Group A (n=25) | Group B (n=25) | P |
|---|---|---|---|
| Mean age (years) | 38.2±6.1 | 37.5±5.8 | 0.68 |
| Male:Female ratio | 20:5 | 19:6 | 0.80 |
| Baseline hair density (follicles/cm2) | 40.8±2.5 | 41.0±2.3 | 0.89 |
Table 2.
Hair density over time
| Time point | Group A (follicles/cm2) | Group B (follicles/cm2) | P |
|---|---|---|---|
| Baseline | 40.8±2.5 | 41.0±2.3 | 0.89 |
| 3 months | 60.5±3.1 | 52.2±2.8 | <0.01 |
| 6 months | 74.2±3.4 | 59.1±3.0 | <0.01 |
DISCUSSION
The findings of this research underscore the significant role of PRP in enhancing the outcomes of FUE in AGA. By 6 months, the PRP-augmented group showed a 25% higher improvement in hair density compared to FUE alone, corroborating previous studies on the efficacy of PRP in hair restoration.
PRP’s efficacy lies in its concentration of growth factors such as PDGF and vascular endothelial growth factor (VEGF), which are critical in promoting angiogenesis, follicular proliferation, and hair regrowth.[6,7] Sasaki et al.[1] demonstrated that higher platelet concentrations in PRP resulted in superior improvements in hair density and diameter in AGA patients, consistent with current findings. Similarly, a research by Xue et al.[2] reported that PRP enhanced graft survival and hair growth in patients undergoing hair transplantation, supporting the hypothesis that PRP creates an optimal environment for follicular regeneration.
The mechanisms underlying PRP’s efficacy include improved neovascularization, modulation of inflammation, and upregulation of signaling pathways critical for follicular survival and proliferation.[3,4] Abdin et al.[8] emphasized that PRP targets dysregulated mechanisms in AGA, including altered stem cell activity and inflammatory responses, aligning with current observations of higher patient satisfaction and minimal adverse effects.
While PRP’s efficacy is well-documented, variations in preparation protocols and platelet concentrations can influence outcomes. Anastassakis[3] highlighted the importance of standardized PRP preparation techniques to achieve consistent results. Furthermore, Paichitrojjana et al.[4] suggested that the method of PRP administration (e.g., injections vs. topical applications) significantly impacts therapeutic efficacy, an aspect warranting further exploration in future studies.
Current research also contributes to the growing evidence supporting PRP as a safe adjunct therapy in hair restoration. Garg and Bansal[7,9,10] highlighted its minimal adverse effects, which we observed as transient scalp discomfort and erythema in both groups. These findings reinforce PRP’s suitability for clinical use, particularly in patients seeking non-invasive enhancement of FUE outcomes.
CONCLUSION
This research demonstrates that PRP augmentation significantly enhances hair density outcomes in patients undergoing FUE for AGA. Group A (FUE + PRP) showed a 25% greater improvement in hair density at 6 months compared to Group B (FUE alone), with statistically significant results. PRP not only improved graft survival and hair growth but also increased patient satisfaction scores without notable adverse effects. These findings support PRP as a safe and effective adjunct in hair restoration surgeries. Future multicenter studies with larger sample sizes and standardized PRP protocols are recommended to validate these results and further refine their clinical application in hair restoration procedures.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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