PRP Hair restoration:
In the recent year there has been an explosion in the wealth of knowledge in the field of regenerative medicine. One of the fields that has benefited the significantly from the advances made in regenerative medicine is aesthetic medicine and anti-aging medicine. You can learn more about Skin and face Rejuvenation as well as sexual health in the following pages. Here we will concentrate on using PRP and/or Stem cells for Hair restoration.
We may not realize what we have until we lose it. This holds true for many of our health and well being issues. However, hair is on the top of this list. Hair has always been and will continue to be a symbol of youth and vitality. We even use it as a media for our self-expression. What kind of hair cut we get, how we comb our hair, and what color we give it are just a few examples of how we express ourselves through our hair. It can even communicate personal feelings. Think about it! When we are sick our hair stands out one way, when we wake up or when we are tired our hair stands out another way. When we are happy, sad, or feeling festive, our hair is done in different ways.
There are several different types of baldness, which we will discuss later. However, just to get your attention: the most common type is known as the Androgenic baldness. It is also known as Male Pattern Baldness (MPB) and Female Pattern Baldness (FPB). This type alone affects 50 million men and 30 million women across United states.
We cannot talk about hair loss without understanding how hair grows and how it falls. Furthermore, we cannot treat any condition that we do not understand. Therefore, in this section we will talk about the anatomy and physiology of normal hair growth and how it applies to our decision making in choosing a treatment.
Hair consists of Follicle and Shaft. Shaft is the visible part which is above skin line. At the base of the follicle is the hair bulb. This is where the cells divide and grow to form the hair shaft.
The most unusual characteristic of the hair follicle is that it is self-regenerating. This is of significant importance for hair restoration through regenerative medicine.
A little further up from the follicle is a particular feature called the Bulge. This is where the follicle Stem cells live. Once these stem cells receive the appropriate signal, they start dividing and renewing the follicle cells.
Another peculiar aspect is the way these Stem cells divide. In most tissues each cells divides into 2 halves and each half is transformed into the new cell which keeps splitting and developing. The Stem cells in the bulge of the hair follicle split into 2 halves. 1 half stays stem cell for future regenerations. This way future growth is guaranteed in perpetuity.
Hair shaft does not have any live cell. It consists of a protein called Keratin which is produced by the cells in the bulb.
Surrounding the follicle is an area called the Papilla. It contains the tinny blood vessels (capillaries) that bring food and oxygen to feed the cells. It also transports hormones and growth factors that regulate the growth and structure of the hair.
Typical Hair growth cycle goes through 5 stages. These are as follows:
- Anagen: This is the growth phase of the hair. It starts with a signal telling the Stem cells in the bulge to regenerate. Then the papilla sends a signal to the hair matrix cells in the bulb. These cells grow rampantly and give rise to the keratin which is pigmented and becomes the hair shaft. About 90% of the hair cells are in this stage at any given time.
- Exogen: The new Hair shaft pushes the old hair shaft out of the skin. The old hair falls. This is the stage that causes shedding.
- Anagen Finished: The hair shaft grows beyond the skin surface and fully matures.
- Catagen: The lower two third of the Follicle atrophies and it is destroyed. The Papilla remains in place, attached to the regressing follicle.
- Telogen: The regressed Follicle is in the resting phase. It awaits a signal telling it to start Anagen.
Each hair Follicle produces hair for about 2-6 years (Anagen phase). Then rests for several months (Telogen phase). Shedding is a normal part of the hair cycle and one can shed 50-100 hairs a day.
There are about 100,000 follicles in the scalp. However, at any given time follicles are in different phase of their growth cycle. Therefore, hair loss is usually not noticeable. Once there is disruption of the normal growth and shedding cycle, hair loss becomes noticeable.
Another possibility is that the hair follicle is totally obliterated in the Catagen phase and it is replaced by scar tissue.
As we will learn further down, the signaling to start Anagen phase and preventing the Telogen phase are the target of the regenerative medicine. Also PRP has anti-inflammatory and anti-scar properties which helps prevent total obliteration of the hair Follicle.
Common Hair Loss Problems:
1. Androgenic Alopecia: This is the most common type of alopecia. It is thought to be cause by Testosterone and its byproducts (DHT), thus called Androgenic. It is the typical male pattern baldness which we all relate to aging man. However, it can start at any age and it can affect female as well. The possibility raises with age. As previously mentions 50 million men and 30 million women in USA have this type of baldness.
The male pattern starts with an M-Shaped receding hair loss which could eventually involve the entire front and vertex of the head. The back of the head and the sides of the head hairs remain in place. This is because the hair in these areas are not sensitive to Testosterone; but the hair on top and front of the head are sensitive to the male hormone.
Female Pattern is different in that it typically involves the center of the head (the split of the hair line in the middle). It is associated with thinning of the hair all over the head.
This baldness pattern happens because the Anagen phase gets shorter. The Telogen phase gets longer. Therefore, it will result in thin, short hairs and many Follicles empty of hair shaft.
To treat this condition time is of the essence. Using PRP or stem cells before the all the follicles die, can send the proper signal to the Follicle to push it into the Anagen phase and prevent prolonged Telogen phase which can endanger the hair Follicle.
2. Telogen Effluvium: This simply means increased hair shedding. For various reasons many of the hair Follicles enter the Exogen phase all at once. This is a self limiting condition and the hair almost always grows back in a few months.
3. Chemotherapy-Induced Alopecia: Chemotherapy generally targets cells that are growing fast, such as cancer cells. Hair cells are also fast growing cells; so they will be the target of chemotherapy agents. The hair Follicle is forced into Catagen phase. The Shaft does not develop properly so it breaks and falls out.
This type of hair loss is usually reversed once the chemotherapy is discontinued.
4. Alopecia Areata: This is an inflammatory condition in which the person’s own immune system attacks the hair bulb and forces it into Catagen phase. The Hair breaks and falls out. The hair loss usually is patchy across the scalp, which gives it the name Areata.
A more severe form of this condition is called Alopecia Totalis. This is also an autoimmune inflammatory condition. It starts in a patchy pattern but it progresses to cause total head baldness.
The conventional treatment for this conditions is immunosuppressants and local steroid injections. These treatments are not very effective and they are associated with a very high side effect profile.
PRP is an effective treatment for majority of the cases of both Alopecia Areata and Alopecia Totalis. The local immunomodulatory and anti-inflammatory properties of the PRP are major role players in its efficacy for these conditions.
Available treatments range from various medications such as Minoxidil (Rogaine), Finasteride (Propecia), to herbal and natural supplements, and finally hair transplant. The most successful of these treatments is the hair transplant. Let’s talk about these options one by one.
1. Hair Transplant:
Transplant is an invasive surgical procedure and it comes with many potential complications and side effects. It is also limited in the number of hairs that can be transplanted. Furthermore, not everybody is a candidate for hair transplant. If the remaining hair on your head is thin and not strong enough, you cannot have a transplant.
Hair transplant is indicated mostly for Androgenic Hair loss. Hair is harvested from the back of the head because of Testosterone insensitivity. Then the harvested hairs are transplanted to the top and front of the head, where needed.
This is a very operator dependent procedure. Where and how the hair is transplanted, and the methods used to do the procedure, dictate the outcome and how natural the hair looks.
Possible complications are infection, rejection, and reverse hair growth (similar to an ingrown hair but all over the head).
Best results are seen when transplant is followed by PRP treatment.
Commonly known and Rogaine. Minoxidil was developed as a blood pressure medication. It is from the family of Beta-Blockers. Other members of this family are Propranolol, Atenolol, and Metoprolol. The one side effect that set Minoxidil apart was hirsutism or hair growth.
It is effective to some degree. It mostly helps make the hair on your head thicker and stronger. In general it does not stimulate new hair growth on a bald head.
Side effects include low blood pressure, dizziness, Orthostasis (dizziness upon standing), and in some cases fainting.
Commonly known as Propecia. Finasteride is a Testosterone blocking agent that was developed for prostate cancer. Its effect is commonly referred to as chemical orchiectomy (castration). It was later approved for Androgenic hair loss and baldness. The thought process was to block the Testosterone so that it does not force the hair Follicles into Telogen.
Propecia helps maintain the hair and lessen hair loss to some degree. However, it comes with many side effects relating to lowering the effects of Testosterone in the body. These include loss of libido, erectile dysfunction, fatigue, muscle pain, depression.
Another medication in this family is Dutasteride (Avodart). This is also a prostate medication. It is not FDA approved for Alopecia but used frequently.
These medications are not effective for female pattern baldness.
4. PRP and Stem cell Hair restoration:
PRP and stem cells contain the messaging mechanisms needed to activate the Stem cells in the bulge of the Follicle and subsequently stimulate the cells in the Bulb to grow and produce new hair. In other words it forces the hair Follicle into Anagen phase. This automatically shortens the Telogen phase. Now the balance in hair growth cycle is shifted towards new hair production (Anagen) rather than shedding and rest phase (Catagen and Telogen).
It is a very effective treatment to maintain and promote new hair growth and even new follicle formation. The limitation to this treatment for Androgenic baldness is that the treatment should be started as soon as possible. This is because if all the Follicles have died off, there is nothing left to regenerate or force into Anagen.
It is effective in both men and women alike.
Because it is a totally natural treatment and patient own blood or Stem cells (from fat or bone marrow) are used, there are no side effects.
Possible complications are bruising, bleeding, and infection. These are simply the possible complications of any injection.
PRP can also be used very effectively in Alopecia Areata and Totalis. As previously mentioned PRP has immunomodulation properties. This helps regulate the immune system so that it does not attack the hair Follicles. It also promotes regenerative inflammation by releasing growth hormones such as Epidermal Growth Factor (EGF), Vascular Endothelial Growth Factor (VEGF), and Platelet Derived Growth Factor (PDGF).
These growth factors hold the key to the healing properties of the body. They promote new blood vessel formation (Neo-angiogenesis) for delivery of more Oxygen, nutrition, and hormones that are needed for a growing tissue. They also promote activation of local Stem cells and finally regeneration of the missing or damaged tissue. This phenomenon leads to reduced tissue injury, increased tissue repair, thus reduced inflammation and autoinflammation.