PRP Hair Therapy in Ukraine

Platelets do more than help blood clot. Their alpha granules contain growth factors: platelet-derived (PDGF), vascular endothelial (VEGF), transforming (TGF-beta) and insulin-like (IGF-1). In tissue they trigger the same processes as after a microtrauma: the growth of small blood vessels, cell division and the synthesis of the extracellular matrix.

The idea is to concentrate platelets from the patient's own blood to several times their baseline level and inject them into the scalp dermis, at the depth where the follicles lie. The expected effect is a better blood supply to the dermal papilla, a longer growth phase of the hair and thickening of hair shafts that have already become thinner.

The indications are fairly narrow: early and intermediate androgenetic alopecia, when the follicles have shrunk but are still alive; chronic telogen effluvium, as an addition to dealing with its cause; and support for the area after a hair transplant. In women the method is used on the same basis as in men, and there are no sex-specific restrictions.

What the method does not do is just as important. PRP therapy does not restore hair where the follicle has already died: in scarring alopecias and on areas that have long been bald there is no point injecting plasma. Nor does it replace minoxidil or finasteride: it is an addition to an evidence-based regimen, not an alternative to it.

MediUkraine is a service that finds and coordinates treatment; it is not a clinic. We select the medical centre and a doctor with the right expertise, agree the schedule of sessions and support patients, including those travelling from abroad. The decision on whether the procedure is appropriate is made by the doctor after an in-person examination and trichoscopy.

It all begins with venepuncture: 10–20 ml of blood is drawn, sometimes up to 30–60 ml if a large area needs treating. The blood goes straight into a tube with an anticoagulant, most often sodium citrate, which binds calcium and stops the platelets from activating prematurely. EDTA tubes are not used for this.

Tubes differ in more than the anticoagulant. Some systems have a gel separator, a dense gel that after centrifugation forms a barrier between the red blood cells and the plasma and makes it easier to draw off the required fraction. Other kits work without gel: the doctor takes off the plasma with a pipette, guided by the boundary between the layers. The system determines how many times the platelet concentration exceeds the baseline, from twofold to five- or sixfold.

Centrifugation can be single-stage or two-stage. One cycle, about 3–5 minutes, gives a less concentrated plasma with some white blood cells mixed in; two cycles give a denser platelet pellet, which is then resuspended in a smaller volume of plasma. The speed, the time and the number of cycles are set by the kit manufacturer, and this is where the protocols of different clinics diverge most.

Two more parameters are worth asking about: white blood cell content and activation. Plasma can be leukocyte-poor or leukocyte-rich; for the scalp the former is chosen more often, because white blood cells amplify the inflammatory response. Not every clinic activates the plasma with calcium chloride or calcium gluconate: some doctors believe that the collagen of the dermis activates the platelets without additional reagents. There is no single standard here, and that is the main criticism of the method.

The plasma itself is injected superficially, into the dermis at a depth of about 2–4 mm, at the level where the follicles lie. The doctor works along a grid with a spacing of about 1 cm, injecting 0.05–0.1 ml per point; small papules remain on the skin and resolve within a few hours. The thinning area is treated together with 1–2 cm of healthy skin around it. Some clinics combine the injections with microneedling, using the punctures as a delivery route; so far there is little evidence that such a combination is better.

Pain relief is usually not needed: the injections can be felt, but they are brief. If the patient wishes, a topical lidocaine cream is applied 20–30 minutes beforehand, or the skin is cooled immediately before the session. In total the visit takes 30–40 minutes, of which centrifugation takes 10–15 minutes and the injections themselves about 15.

The standard course is 4 sessions at intervals of 3–4 weeks. After that, if there is a response, patients move on to maintenance sessions every 3–6 months. There is no point assessing a course of one or two sessions: the hair cycle is measured in months, and changes physically do not have time to appear. If after the full course and six months of observation trichoscopy shows no change, it is not worth continuing.

Now to the evidence, which calls for honesty. Randomised trials and meta-analyses do show an increase in hair density compared with placebo in androgenetic alopecia, but the samples are mostly small, follow-up is short, and the protocols for preparing the plasma differ so much that the results are hard to compare. For this reason the method is not part of the core recommendations as a stand-alone treatment: its place is as an addition to minoxidil or finasteride, not a replacement for them. Some patients do not respond to the therapy at all, and this cannot be predicted in advance.

The comparison with scalp mesotherapy is what patients ask about most often, because technically the procedures are similar: the same grid of superficial injections, the same interval. The difference lies in what is injected. In mesotherapy it is a factory-made cocktail of vitamins, amino acids, peptides and trace elements whose composition varies from manufacturer to manufacturer, and systematic reviews describe small unblinded samples and conclude that there is not enough data for a recommendation. Plasma is the patient's own material, so there will be no reaction to a foreign substance, and there is noticeably more research on it in hereditary thinning, although the results are contradictory. The prices of the procedures are comparable, so the choice is more between "a little more data" and "less data" than between something that works and something that does not.

Finally, the limits of the method. Plasma does not work on areas where the follicle openings have already been lost: in scarring alopecias, on areas that have long been bald, in late stages of hereditary thinning. There a transplant is discussed, and plasma is considered at most as support for the transplanted area. A doctor who offers a course without prior trichoscopy is in effect selling the procedure blind.

Immediately after the session the scalp is red, small papules are visible at the injection sites, and sometimes there is swelling around the forehead. This is an expected reaction: the redness passes within a few hours, the papules sooner. Some patients feel a heaviness in the head or a mild headache on the first evening.

Washing your hair is usually allowed after 24 hours, with warm water and without vigorous massaging of the scalp. Saunas, swimming pools, intensive workouts and direct sun are put off for 2–3 days; hair colouring is postponed for at least a week. These restrictions apply to every session of the course, not just the first.

The effect cannot be assessed after one session, and the clinic should warn you of this before you pay. Hair responds on a scale of months: patients usually notice the first subjective changes, less hair on the comb and short new hairs appearing, after the third or fourth session, that is, 3–4 months after the start of the course.

An objective assessment means a repeat trichoscopy of the same areas after 6 months, with a phototrichogram where possible. Density and the proportion of thin shafts are compared, not the overall impression from a photo taken in the bathroom: lighting and styling change the picture more than any therapy.

The effect lasts for a limited time. Without maintenance sessions and without core therapy, density usually returns to its previous level within 6–12 months, because the procedure does not remove the cause of thinning: the follicles' sensitivity to androgens does not go away. That is why plasma is prescribed together with medication, not instead of it.

There are also patients who do not respond to treatment: after six months trichoscopy shows neither an increase in density nor thickening of the shafts. In that case the course is not continued, and the doctor goes back to the diagnosis and reviews the regimen. For patients from abroad, MediUkraine arranges a follow-up examination or a video consultation with the same doctor.