Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.
The acronym PRPHT stands for “Platelet Rich Plasma Hair Therapy”. It is a therapeutic medical technique that falls within the field of “regenerative medicine”; it is based on the principle that stem cells, which have been demonstrated to be present in the hair bulb, are equipped with growth factor receptors.
The platelet concentrate, rich in growth factors, is injected into the scalp with very thin needles and then a massage is performed to facilitate its distribution. The patient may return to his/her normal life after just a few hours. Hair growth starts to show 2-4 months after the first session, and reaches its peak after 6 months. Then, some call-back sessions are generally performed 3-4 times per year, according to the severity of the case.
This clinical protocol is innovative in the field of hair loss treatments, while PRP has already been used for several years in orthopaedic, oral & maxillofacial and eye surgery, in the treatment of chronic ulcers, in the field of cosmetic surgery for biorevitalization and skin rejuvenation and to stimulate adipose stem cells in autologous lipofilling.
We can therefore exploit the very complicated system of growth factors capable of healing injuries in many organs of the body. Each organ is controlled by specific growth factors, and those of the skin are IGF-1, FGH, and VEGH.
Platelets are bodily cells that circulate in the blood and are active in the blood coagulation process for wounds and bleeding. They are actually among the first cells to trigger the repair and regrowth process of damaged cells; as soon as tissue is damaged, the platelets are “activated” by various natural chemical factors (inflammatory processes, cytokines, macrophages, etc.) and stimulate the cells to “repair themselves”.
Either after hair transplants or following the injection of PRP directly into the scalp suffering from hair loss, it is possible to stimulate the bulb with an autologous substance, rich in growth factors. Since PRP is a natural substance taken from the patient, there are no side effects such as possible allergies or intolerances. It is non-toxic and stimulates biorepair and regenerative processes. It stimulates angiogenesis and tissue revascularization. It stimulates the proliferation of mesenchymal cells and, in particular, adult mesenchymal stem cells. It stimulates the formation of collagen. PRP is therefore a source of Growth Factors that derive from the platelet granules of the patient.
PRP is obtained by concentrating the autologous platelets of the patient. A small quantity of blood is drawn (usually 20cc) from the patient, by collecting it in sterile single-use suction tubes with anticoagulant. The tubes are centrifuged for a few minutes, at a specifically scheduled number of turns.
The blood does not come into contact with the environment or with the operator, let alone with the instrument. At the end of the centrifugation, the samples are analysed in two phases: the lower sediment part features red and white blood cells. The upper part features plasma and platelets with growth factors. By using a special pipette, the PRP is suctioned and a chemical activator is added to degranulate the platelets, facilitating the outflow of growth factors. The prepared PRP may then be injected into the scalp by using a sterile syringe.
The operations must be consecutive, given that the platelets have a short lifespan. The blood must be drawn from the individual who is to be treated. The preparation, which lasts around 45 minutes, is carried out by specialized clinical personnel or hematologists. Thus, no risks are present in this treatment. The centrifugation does not alter the blood cells and is used solely to separate them. If the entire procedure carried out by qualified personnel is conducted in a designated environment, there is no risk of contamination.
As far as results in hair loss treatments are concerned, the growth factors stimulate the bulb cells (of the dermal papilla, matrix and melanocytes) to keep the anagen phase active, produce the hair shaft, reduce inflammatory processes in the skin and reduce cellular death. Moreover, the extremely high concentration of natural growth factors is able to stimulate stem cells in the remaining bulbs to once again generate a hair bulb. Thus, in the case of pattern hair loss, this procedure can lead to the regrowth of a number of hairs (obviously not quantifiable beforehand), especially in the early stages of the illness (in particular from stages I to IV of the Hamilton scale and in stages I to II of the Ludwig scale).
According to scientific literature, significant growth is seen in 60-70% of cases. On average, 2-4 sessions are performed over the course of 3 months; in alopecia areata (spot baldness), this may well be the most important treatment technique in terms of hair regrowth percentages in active patches. In scarring hair loss, it may have a significant effect on inflammation control and for decreasing the progression of active hair bulb death, especially in early forms. If residual hair follicle stem cells exist in the dermis, they may also be stimulated.
PRP therapy can be considered one of the most advanced and effective therapy techniques in the trichological field. Success depends, however, on the type of illness, on various concurrent situations and on the presence or lack of stem cells that may be activated. The most advanced theories now tend to use a treatment with PRP before, during or after the micro-autotransplant operation, in order to obtain:
– faster implantation of transplanted bulbs
– an increase in the bulb implantation percentage
– growth stimulation of silent bulbs
– faster healing of the scalp treated with the hair transplant.
The scalp is an ultra-specialized area of the skin, where hair is anchored. Like other hair, also the hair on the scalp originates from a hair follicle, called a bulb.
With the term Telogen Defluvium we mean a modest, not excessive, loss of hair in the telogen phase, but which tends to often be irreversible, with the precise characteristics of hair in decay or involution. The hair that falls out is usually short and fine, with bulbs that are undeveloped and reduced in size.
In the trichological field, with the passing of age hair whitening is seen to follow the greying process of the hair on the scalp (called grey hair). Hair becomes grey (white) following a natural biological aging process of the melanocytes, which are the cells tasked with coloring hair.
In the majority of people, the first grey hairs appear around 35/40 years of age in women and around 30/35 in men.
Psychogenic alopecia is a type of hair loss related to stress. Though not yet scientifically explained, this connection is well-known in the experience of those working with the problem. In addition to stress, other causes are personality disorders, states of anxiety and depression, all of which are conditions of acute or chronic stress.
Cures and surgery for baldness are related to the degree of hair loss, type of situation around the donation area and the patient’s expectations. Thus, no surgical treatment is guaranteed to work for all situations.
This is very short hair, between 1 cm and a maximum of 2 cm in length, which usually has insufficient pigmentation. This hair has a base structure that is quite large, almost like normal hair. It then tends to get smaller towards the end, thus taking on the form of a very pointed cone.
This hair has a strong tendency to fall out.
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