Platelet-Rich Plasma for Hair Loss

Standardized Informed Consent Form for Clinicians Administering Platelet-Rich Plasma

Introduction When it comes to medico-legal malpractice suits, lawyers and insurers tend to focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for the use of platelet-rich plasma (PRP) injections, which might cause problems. This study aimed to mitigate this concern through the development of a standardized informed consent document for PRP injections, grounded in evidence-based practices. Materials and methods An examination of databases was conducted to explore the medico-legal ramifications associated with PRP injections, as well as the broader topic of informed consent, with a particular focus on the context of PRP injections. Moreover, interviews were carried out with healthcare providers and individuals who had received PRP injections within the preceding year, utilizing a semi-structured methodology. Results We developed an evidence-based informed consent document tailored for PRP injections. To guarantee its legal validity, the document underwent review by a legal specialist. Subsequently, our institutions implemented the finalized form for PRP injection procedures over one year. Conclusion A legally valid and evidence-based informed consent form for PRP injections would ensure patient's rights, and encourage open communication and transparency between them and the doctor. Moreover, if a lawsuit were to arise, it would serve as a critical document in the doctor's defense and withstand scrutiny from lawyers and the judiciary.

Duo-role Platelet-rich Plasma: temperature-induced fibrin gel and growth factors' reservoir for microneedles to promote hair regrowth

INTRODUCTION

Alopecia concerns more than half our adult population. Platelet-rich plasma (PRP) has been applied in skin rejuvenation and hair loss treatment. However, the pain and bleeding during injection and the troublesome for fresh preparation of each action limit PRP's in-depth applying dedication to clinics.

OBJECTIVES

We report a temperature-sensitive PRP induced fibrin gel included in a detachable transdermal microneedle (MN) for hair growth.

RESULTS

PRP gel interpenetrated with the photocrosslinkable gelatin methacryloyl (GelMA) to realize sustained release of growth factors (GFs) and led to 14% growth in mechanical strength of a single microneedle whose strength reached 1.21 N which is sufficient to penetrate the stratum corneum. PRP-MNs' release of VEGF, PDGF, and TGF-β were characterized and quantitatively around the hair follicles (HFs) for 4-6 days consecutively. PRP-MNs promoted hair regrowth in mice models. From transcriptome sequencing, PRP-MNs induced hair regrowth through angiogenesis and proliferation. The mechanical and TGF-β sensitive gene Ankrd1 was significantly upregulated by PRP-MNs treatment.

CONCLUSION

PRP-MNs show convenient, minimally invasive, painless, inexpensive manufacture, storable and sustained effects in boosting hair regeneration.

PHAT Lips and PHAT Face: Platelet Hybridized Adipose Therapy for Superficial Musculoaponeurotic System and Dermal Rejuvenation

Platelet-rich plasma has been increasingly used for facial rejuvenation in conjunction with other modalities such as microneedling or on its own. Nanofat grafting to the face has also been utilized for skin quality improvements. Our group previously described the novel combined Platelet Hybridized Adipose Transplant (PHAT) technique for hair restoration. In this series, we describe our experience with the PHAT technique for lip and facial rejuvenation to improve the quality of facial skin and superficial musculoaponeurotic system, and enhancing surgical results.

Alopecia Areata: Current Treatments and New Directions

Alopecia areata is an autoimmune hair loss disease that is non-scarring and is characterized by chronic inflammation at the hair follicle level. Clinically, patients' presentation varies from patchy, circumscribed scalp involvement to total body and scalp hair loss. Current management is guided by the degree of scalp and body involvement, with topical and intralesional steroid injections as primarily first-line for mild cases and broad immunosuppressants as the mainstay for more severe cases. Until recently, the limited number of blinded, randomized, placebo-controlled clinical trials for this disease had made establishing an evidence-based treatment paradigm challenging. However, growing insights into the pathogenesis of alopecia areata through blood and tissue analysis of human lesions have identified several promising targets for therapy. T-helper (Th) 1/interferon skewing has traditionally been described as the driver of disease; however, recent investigations suggest activation of additional immune mediators, including the Th2 pathway, interleukin (IL)-9, IL-23, and IL-32, as contributors to alopecia areata pathogenesis. The landscape of alopecia areata treatment has the potential to be transformed, as several novel targeted drugs are currently undergoing clinical trials. Given the recent US FDA approval of baricitinib and ritlecitinib, Janus kinase (JAK) inhibitors are a promising drug class for treating severe alopecia areata cases. This article will review the efficacy, safety, and tolerability of current treatments for alopecia areata, and will provide an overview of the emerging therapies that are leading the revolution in the management of this challenging disease.

Platelet-Rich Plasma in Alopecia areata: A Case Report With a Mini Review of Literature

A 46-year-old patient with extensive patchy alopecia areata (AA) treated successfully with platelet-rich plasma (PRP) is presented. The therapy was used in three applications at monthly intervals. The treatment results were analyzed with clinical photography, quantitative assessment of scalp hair, digital trichoscopy, and evaluation of the patient's quality of life. Results of studies conducted with PRP therapy in alopecia areata are briefly presented. PRP injections in alopecia areata are a relatively effective, safe, low-pain, and minimally invasive treatment method.

An umbrella review of the use of platelet-rich plasma in the treatment of androgenetic alopecia

OBJECTIVE

To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of androgenetic alopecia, as well as establish an effective treatment protocol and optimal PRP preparation procedure.

METHODS

We searched the PubMed, Scopus, Embase, Cochrane, CNKI, and Wanfang databases from inception to October 29, 2021, using PROSPERO's International Prospective Register of Systematic Reviews (registration ID: CRD42022295921).

RESULTS

The original literature search revealed 215 reviews; after duplication removal, 89 papers were eliminated, 95 were eliminated after reading the titles and abstracts, and eventually, 28 articles were included after reading the complete text.

CONCLUSIONS

PRP treatment for androgenetic alopecia is effective, and we recommend the following: (1) a PRP volume of at least 0.05 ml/cm² , preferably 0.1 ml/cm² ; (2) at least three consecutive treatments at an interval of 1 month; (3) intensive therapy is beneficial and can be provided from 3 to 6 months after continuous treatment; (4) objective indicators such as hair diameter, hair count; (5) long-term follow-up.

A Comprehensive Review of Microneedling as a Potential Treatment Option for Androgenetic Alopecia

BACKGROUND

Microneedling refers to a minimally invasive technique that uses multiple fine needles targeted skin epidermis for mechanical stimulation to obtain therapeutic or cosmetic effects. It is suitable for the treatment of a variety of dermatological conditions, including androgenetic alopecia (AGA).

OBJECTIVE

This article aims to make a comprehensive review of the relevant studies on microneedling for the management of AGA.

METHODS

Extensive literature search was performed using PubMed, Web of Science, and EBSCO databases. 4 in vivo studies and 25 clinical trials were included according to the inclusion and exclusion criteria.

RESULTS

The effects of microneedling on AGA was investigated in animal experiments. Several clinical trials, including randomized controlled trials, strengthen the validity of the findings. Microneedling therapy showed some encouraging results with minor complications when used alone or in combination with topical products.

CONCLUSIONS

Microneedling appears to be a safe and effective therapeutic option for AGA. Larger and more randomized controlled trials regarding the role of microneedling in AGA are strongly recommended to provide more definitive evidence.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comparison of Efficacy of Platelet-Rich Plasma (PRP) With PRP Microneedling in Androgenetic Alopecia

Background Limited data are available on the efficacy of platelet-rich plasma (PRP) and microneedling versus PRP alone. In this study, we aimed to compare the efficacy of PRP and microneedling with PRP alone in androgenetic alopecia (AGA). Methodology This prospective, randomized, interventional study was conducted in Pak-Emirates Military Hospital, Rawalpindi, from September 2020 to December 2020. In total, 60 individuals suffering from AGA of up to Hamilton-Norwood grade 4 were randomly assigned to two groups, namely, PRP+microneedling versus PRP alone. A total of three sessions, each one month apart, were offered. Pre and post-intervention photographs, hair count (/cm²), hair-pull test, and physician's and patient's perception of hair loss were recorded. The data were statistically analyzed. Results A greater proportion of patients in the microneedling group achieved a negative hair-pull test and improved perception of hair loss compared to the PRP-alone group (82.1% vs. 51.9% and 88.0% vs. 73.9%, respectively). The percentage increase in mean hair count in the microneedling group (24.53 ± 9.49%) was significantly higher than the increase in the PRP-alone group (17.88 ± 10.15%) (p = 0.011). For grades 2 and 3 hair loss, microneedling+PRP caused a much greater increase in hair count than PRP alone. This difference was less pronounced for Norwood grade 4. No notable side effects were noted in any patient. Conclusions Combined PRP and microneedling is more efficacious than PRP alone in patients with AGA up to Hamilton-Norwood grade 4.

Platelet Rich Plasma Hybridized Adipose Transplant (PHAT) for the Treatment of Hair Loss: A Case Series

Background

Platelet-rich plasma (PRP) has long been used for the restoration of hair in conjunction with microneedling or on its own. Fat grafting to the scalp has also been utilized in the past to improve the quality of hair and the possibility of successful hair transplant. The novel therapy reported in this case series combines the natural progression of these two techniques and utilizes synergistic effects to improve the quality of hair, either in preparation for micrografting or without hair transplant.

Objectives

To demonstrate the principles behind the novel approach to restoration of hair and the rationale for its use.

Methods

A review of the evidence for PRP and fat transfer for non-scarring alopecia serves as the foundation for the combination treatment reported herein. Through presentation of three cases in this series, we provide examples of the utility of this approach for non-scarring alopecia. This report includes a female who suffered non-scarring alopecia following COVID-19 hospitalization and intensive care stay where she lost a large percentage of her hair, in addition to two male patients suffering from androgenic alopecia.

Results

Platelet-rich plasma-hybridized adipose transplant hair was shown in these three cases to improve both the quality and density of hair. It improved the density of hair in all patients and was characterized first by a short period of transient hair loss followed by new hair growth which develops starting at 4 weeks and was readily apparent at 12-week follow-up. Results were maintained at 6-month and 1-year follow-up.

Conclusions

PHAT hair offers a combination of beneficial effects—namely the unique healing properties and growth signaling provided by PRP, along with adipocyte angiogenic and growth signaling, which both work to improve scalp quality. The combination of these effects is better than previously characterized PRP injections alone in the hands of these individual practices. This may be due to synergistic interactions at a cellular level, but additional clinical studies are needed to better understand this novel treatment and the observed effects.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Opportunities and Challenges regarding Induced Platelets from Human Pluripotent Stem Cells

As a standard clinical treatment, platelet transfusion has been employed to prevent hemorrhage in patients with thrombocytopenia or platelet dysfunctions. Platelets also show therapeutic potential for aiding liver regeneration and bone healing and regeneration and for treating dermatological conditions. However, the supply of platelets rarely meets the rising clinical demand. Other issues, including short shelf life, strict storage temperature, and allogeneic immunity caused by frequent platelet transfusions, have become serious challenges that require the development of high-yielding alternative sources of platelets. Human pluripotent stem cells (hPSCs) are an unlimited substitution source for regenerative medicine, and patient-derived iPSCs can provide novel research models to explore the pathogenesis of some diseases. Many studies have focused on establishing and modifying protocols for generating functional induced platelets (iPlatelets) from hPSCs. To reach high efficiency production and eliminate the exogenous antigens, media supplements and matrix have been optimized. In addition, the introduction of some critical transgenes, such as c-MYC, BMI1, and BCL-XL, can also significantly increase hPSC-derived platelet production; however, this may pose some safety concerns. Furthermore, many novel culture systems have been developed to scale up the production of iPlatelets, including 2D flow systems, 3D rotary systems, and vertical reciprocal motion liquid culture bioreactors. The development of new gene-editing techniques, such as CRISPR/Cas9, can be used to solve allogeneic immunity of platelet transfusions by knocking out the expression of B2M. Additionally, the functions of iPlatelets were also evaluated from multiple aspects, including but not limited to morphology, structure, cytoskeletal organization, granule content, DNA content, and gene expression. Although the production and functions of iPlatelets are close to meeting clinical application requirements in both quantity and quality, there is still a long way to go for their large-scale production and clinical application. Here, we summarize the diverse methods of platelet production and update the progresses of iPlatelets. Furthermore, we highlight recent advances in our understanding of key transcription factors or molecules that determine the platelet differentiation direction.

Platelet-rich plasma for androgenic alopecia: A randomized, placebo-controlled, double-blind study and combined mice model experiment

BACKGROUND

Platelet rich plasma (PRP) has been accepted as a potential therapy for treating androgenetic alopecia (AGA).

OBJECTIVE

To fully clarify the underling molecular mechanisms of PRP action on hair growth and promote its clinical applications.

METHODS

In this study, we used mice models and protein biochip to explore the specific mechanisms of PRP regulating hair growth. Then, we performed a randomized, placebo-controlled, double-blind, half-head study of 52 AGA patients to verify the therapeutic efficacy of PRP in Chinese AGA patients.

RESULTS

The results confirmed that PRP treatment boosted hair regrowth, accelerated hair cycling, and the effect sustained for more than one hair cycle in mice. Protein biochip evaluation confirmed remarkably upregulated β-Catenin, PDGF, and AKT signaling and repressed p53 signaling in PRP injection group. Clinically, mean hair count, density, diameter, and anagen hair ratio in PRP group showed a significant improvement at 6 month comparing to control side.

CONCLUSIONS

Overall, we elucidated the specific molecular mechanism of PRP action on hair growth and proved the therapeutic efficacy and safety of PRP in Chinese AGA patients.

Lyophilized growth factor intralesional injection in female pattern hair loss: A clinical and trichoscopic study

Various therapeutic modalities have been tried for female pattern hair loss (FPHL) treatment. To our knowledge, no previous studies had evaluated the therapeutic effect of lyophilized growth factor (L-GF) intralesional injection in FPHL. The current study aimed to evaluate the efficacy and safety of intralesional L-GF injection in FPHL by clinical and trichoscopic evaluation. This study included 20 patients with FPHL. All patients received three treatment sessions of intralesional injection of L-GF 4 weeks apart. Patients were followed-up for further 3 months. The outcome was evaluated by trichoscopy, photography score, patient's satisfaction score and side effects were reported. Trichoscopic evaluation showed significant posttreatment increase in all hair parameters associated with a significant decrease in vellus hair count. Ludwig's grade II showed posttreatment significant differences in all trichoscopic parameters from the baseline. No significant differences were detected regarding all trichoscopic parameters between the two Ludwig's grades posttreatment. 80% of patients showed photography score improvement that was significantly higher in Ludwig's grade II than in grade I. 100% of patients showed improvement in patient's satisfaction score with insignificant difference between Ludwig's grades. Intralesional injection of L-GF is safe and improved various trichoscopic hair parameters and clinical scores in FPHL.

Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice

BACKGROUND

Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients.

OBJECTIVES

This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients.

METHODS

A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction.

RESULTS

We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations.

CONCLUSIONS

Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density.

LEVEL OF EVIDENCE: 4

Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options

Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.

Evaluation of platelet-rich plasma as a treatment for androgenetic alopecia: A randomized controlled trial

BACKGROUND

Platelet-rich plasma (PRP) shows promise as an androgenetic alopecia (AGA) treatment.

OBJECTIVE

To conduct a randomized placebo-controlled split-scalp study to investigate the effects of PRP on hair regrowth and thickness.

METHODS

Two 7.6-cm × 7.6-cm squares were tattooed on the scalps of 35 study participants with AGA. Areas were randomly assigned to intradermal injection with PRP or saline. Participants received 3 monthly treatment sessions with evaluation 3 months after the final treatment.

RESULTS

Hair density in the PRP-treated area was significantly increased compared with baseline at all visits. At the final assessment, hair density in PRP-treated areas increased from 151 ± 39.82 hairs/cm² at baseline to 170.96 ± 37.14 hairs/cm², a mean increase of approximately 20 hairs/cm² (P < .05). However, hair density in placebo-treated areas also increased from 151.04 ± 41.99 hairs/cm² to 166.72 ± 37.13 hairs/cm² (P < .05). There was no significant difference in hair density change between the 2 groups (P > .05). No serious adverse events were reported.

LIMITATIONS

Possible PRP diffusion due to split-scalp study design as well as microinjections causing microinjury to both sides.

CONCLUSION

PRP may have benefit in increasing hair density.

Platelet-Rich Plasma in the Treatment of Alopecia Areata: A Review

Platelet-rich plasma (PRP) is an autologous preparation of plasma with concentrated platelets containing various growth factors and cytokines that enhance the body's inherent capacity to repair and regenerate hair follicles. A few studies and case reports support the use of PRP for the treatment of alopecia areata (AA). Further large-scale studies are needed to evaluate the efficacy of PRP as monotherapy or in association with other therapeutic modalities for AA. Although PRP is relatively safe and potentially effective, there is no standardized protocol or recommendations for the number of PRP sessions required to treat and maintain hair growth.

Vivostat Platelet-Rich Fibrin® for Complicated or Chronic Wounds-A Pilot Study

Vivostat Platelet-Rich Fibrin^® (PRF) is an autologous platelet concentrate used for the local treatment of chronic or complicated wounds. Still, its application for this indication is not evidence-based. Therefore, we performed this monocentric retrospective pilot study investigating the clinical outcome of a local treatment of chronic or complicated wounds in 35 patients (23 male, 12 female, mean age 68.7 years) treated with Vivostat PRF^®. This study population is the largest among published studies analyzing the clinical efficacy of Vivostat PRF^® on chronic wounds so far. Using the perpendicular method we divided the wounds into three sizes (<10, 10–30, and >30 cm²). The clinical efficacy of the Vivostat PRF treatment was the primary endpoint and was divided into three groups of increasing degrees of wound improvement: (1) no improvement of the wound (wound area was not reduced > 10% under Vivostat PRF^® treatment), (2) improvement of the wound (reduced area > 10% under Vivostat PRF^® treatment) and (3) complete epithelialization (wounds that were completely re-epithelialized after Vivostat PRF^® treatment). We included patients’ diagnosis and concomitant diseases (peripheral arterial occlusive disease (PAOD)), chronic venous insufficiency (CVI)), diabetic foot syndrome (DFS)) in our data analysis in order to investigate their potential impact on the wound healing capacity of Vivostat PRF^®. Our results show that in the entire study population, 13 out of 35 (37.1%) patients experienced wound improvement and 14 out of 35 (40%) patients showed complete epithelialization of their wound under Vivostat PRF^® treatment. In summary, 77.1% of the treated patients benefited from the Vivostat PRF^® therapy. These positive wound healing effects were all observed within the first three to six Vivostat PRF^® applications. Subgroup analyses showed that Vivostat PRF^® appeared to be more efficient in patients without CVI in comparison to patients with CVI (p = 0.02). Moreover, Vivostat PRF^® treatment seems to be particularly efficient in PAOD-related wounds with a reduced crural arterial blood supply (p = 0.01). Additionally, we performed an experimental human in vivo study on ten male students where we artificially generated bilateral gluteal wounds and analyzed the influence of the Vivostat PRF^® treatment on the expression of two genes (human beta Defensin-2, ((hBD-2) and human beta-Defensin-3 (hBD-3)) in keratinocytes of resected wound specimens that are induced during wound healing. Interestingly, this analysis revealed that only seven of out ten individuals showed a relevant hBD-2 and hBD-3 gene induction after Vivostat PRF^® treatment. This led to the novel “key-lock-hypothesis”. With the goal of an individualized precision medicine approach with optimized wound treatment strategies in the future, this is an important observation that demands further experimental and clinical studies.

308-nm Excimer Laser Plus Platelet-Rich Plasma for Treatment of Stable Vitiligo: A Prospective, Randomized Case-Control Study

Purpose

308-nm excimer laser has a confirmed treatment effect on vitiligo. Platelet-rich plasma (PRP) is an autologous preparation which contains a variety of growth factors. The effect of 308-nm excimer laser combined with PRP on vitiligo has been rarely reported. This study investigated the effect of PRP combined with 308-nm excimer laser on stable vitiligo.

Patients and Methods

A total of 60 patients with localized stable vitiligo who received treatment at Beijing Friendship Hospital and Xi’an Vitiligo Specialist Hospital between May 2019 and January 2020 were consecutively enrolled. They were equally randomized into three groups according to different treatment methods: intradermal PRP injection (group I), 308-nm excimer laser alone (group II), and 308-nm excimer laser plus PRP injection (group III). All treatments lasted for 3 months. At 3 months after treatment, clinical assessments were performed in terms of the visual analogue scale (VAS) score, repigmentation response and side effects.

Results

The VAS scores showed significant differences among the three groups (P<0.001), with the highest score in group III, followed by group II and then group I. Repigmentation responses also showed significant differences among the groups (P<0.001), and the best effect was observed in group III. No side effects were reported in any of the groups.

Conclusion

The effect of PRP combined with 308-nm excimer laser on stable vitiligo is significantly better than that of PRP and 308-nm excimer laser alone. It is safe and satisfactorily tolerant.

Contemporary Management of Alopecia: A Systematic Review and Meta-analysis for Surgeons

BACKGROUND

The decision of surgical approach for hair restoration often involves evaluation of the type of alopecia; however, the impact of surgical hair restoration from existing techniques in specific population subsets has not been comprehensively investigated.

OBJECTIVES

The authors sought to systematically review the literature on micrografts, minigrafts, mini-micrografts, tissue grafts, tissue flaps and expanders, as well as evaluate graft survival and satisfaction within specific populations in a meta-analysis.

METHODS

PubMed and Scopus literature searches between 1980 and 2018 yielded 57 articles for systematic review and 34 articles for meta-analysis. Study design, mean patient age and gender, patient alopecia type, surgical hair restoration technique, number of treatment areas, mean follow-up, graft survival rate and satisfaction rate were extracted from each study, and a meta-analysis was performed.

RESULTS

The pooled rates of graft survival were 84.98% (95% CI 78.90-91.06) using micrografts and 93.11% (95% CI 91.93-94.29) using micrografts and minigrafts in nonscarring alopecia patients, as well as 88.66% (95% CI 80.12-97.20) using micrografts and 86.25% (95% CI 74.00-98.50) using micrografts and minigrafts in scarring alopecia patients. The pooled rates of satisfaction were 89.70% (95% CI 82.64-96.76) using micrografts and 97.00% (95% CI 92.48-100.0) using micrografts and minigrafts in nonscarring alopecia patients, as well as 97.80% (95% CI 94.59-100.0) using micrografts and 88.70% (95% CI 66.49-100.0) using micrografts and minigrafts in scarring alopecia patients. Dot plots depict rates of graft survival rate from micrografts and satisfaction from micrografts and minigrafts.

CONCLUSION

Surgical hair restoration for nonscarring and scarring alopecia yields high graft survival and satisfaction rates.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Efficacy of Platelet-rich Plasma for Treating Androgenic Alopecia of Varying Grades

BACKGROUND AND OBJECTIVES

Platelet-rich plasma (PRP) has received growing attention as a valuable therapeutic tool in androgenetic alopecia (AGA). However, knowledge regarding specific effectiveness and satisfaction of PRP for different grades of AGA in male pattern hair loss (MPHL) and female pattern hair loss (FPHL) is missing. This study aims to ascertain and compare the efficacy and safety of PRP treatment for different grades of AGA in males and females over 6 months.

METHODS

In this study, 51 MPHL patients with Norwood-Hamilton stage II-V and 42 FPHL patients with Ludwig stage I to III were enrolled for 6 monthly sessions of PRP injections. A longitudinal analysis was used to compare the hair density, thickness, and hair pull test over 6 months for MPHL and FPHL through generalized estimating equation (GEE) models. Phototrichograms of scalp inflammation and oil secretion, global photographs and overall patient satisfaction were also assessed.

RESULTS

Consequently, improvement of hair density, hair thickness, hair pull test, the level of scalp inflammation and oil secretion were observed with statistical significance in all stages for both MPHL and FPHL at 6 months. Noteworthy, lower level of alopecia (Grade II, III in MPHL and Grade I in FPHL) had better response to PRP, and also had a better tendency of increment of hair growth than that of high-grade patients with prolonged treatment.

CONCLUSIONS

PRP injections, as an efficacious and reliable therapy, can be recommended for Grade II and Grade III in MPHL and Grade I in FPHL.

Platelet-Rich Plasma: Principles and Applications in Plastic Surgery

Platelet-rich plasma (PRP) is an autogenously harvested liquid platelet concentrate extracted from a patient's peripheral blood that contains higher than baseline concentrations of growth factors and cytokines. This innovative new technology has demonstrated great promise in the field of plastic surgery, and its use has been evaluated in several clinical settings including wound healing, hair restoration, and skin rejuvenation. The goal of this article is to explain the biology behind PRP and to review the basic principles involved in its preparation. This will be followed by a discussion of some clinical applications of PRP in both aesthetic and reconstructive plastic surgery.

Fibroblast Growth Factors: A Controlling Mechanism of Skin Aging

Cutaneous aging is a complex and continuous biological process characterized by cellular and molecular alterations, with progressive reduction of the body's capacity to maintain the homeostasis, senescence, and/or apoptosis of the dermal cells. Fibroblast growth factors (FGF) have elicited studies to evaluate their role of repair and remodeling of the dermis during the skin anti-aging process, since they are regulatory proteins that mediate important signaling pathways and act on cell regeneration and repair processes. FGF acts primarily through binding to tyrosine kinase receptors through the autophosphorylation of their residues, promoting the phosphorylation of serine, threonine, and tyrosine residues of specific target proteins such as Raf-1, MAPK/Erk kinase, and extracellular signal-regulated kinase-1, which are part of the cascade of MAP kinases (mitogen-activated protein kinase). Then, FGF initiate signaling cascades inside the cell, where each kinase activates the following by phosphorylation, resulting in alterations of cellular functions. In addition, the FGF has a relevant role in anti-aging therapy because it is related to collagen and elastin synthesis activation responsible for skin resistance and elasticity, characteristics that are diminished with skin aging. Thus, the present article aims to review several scientific studies that demonstrated the cell signaling involved with the action of FGF on skin aging.

What's New in Hair Loss

The treatment of hair loss is a challenge for all dermatologists. New medications are needed due to lack of efficacy of many treatments or their side-effect profile. This article discusses the most recent literature updates on the use of retinoids in frontal fibrosing alopecia, platelet-rich plasma in androgenetic alopecia, and JAK inhibitors in alopecia areata.

The Use of Platelet-Rich Plasma in Aesthetic and Regenerative Medicine: A Comprehensive Review

INTRODUCTION

In recent years, platelet-rich plasma (PRP) has emerged as a promising autologous biological treatment modality for the use in aesthetic and regenerative medicine. PRP is a high concentration of platelets derived from whole blood which is isolated by centrifugation to separate and concentrate platelet-containing plasma from red blood cells. PRP comprises hundreds of bioactive proteins, including growth factors, peptides, and cytokines that stimulate healing of skin and soft tissues. Attractive features of PRP are the extended release of various growth and differentiation factors from activated platelets, tissue regenerative, and healing capabilities, as well as the lack of problems associated with immunogenicity. Because of the unique biological features of this whole blood-derived biological agent, multiple clinical uses for PRP exist for aesthetic and regenerative medicine.

EVIDENCE ACQUISITIONS

A comprehensive review of the literature regarding the use of platelet-rich plasma in aesthetic and regenerative medicine was performed.

EVIDENCE SYNTHESIS

Therapeutic applications of PRP including several methods for its clinical deployment in conditions related to aesthetic and regenerative medicine including wound healing, skin and facial rejuvenation, hair restoration, hand rejuvenation, breast augmentation, and musculoskeletal regeneration were reviewed.

CONCLUSION

PRP treatment has shown itself as a bright future for a safe and efficient cosmetic intervention. However, more studies are needed to better our understanding of limitations and benefits in clinical phases associated with the aesthetic use of PRP.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .