We’ve been preaching for years that not all PRP is created equal, and in fact most of what is being promoted both in the hair loss world and more recently in the mainstream cosmetic surgery space is completely worthless. IAHRS founding member, Miami hair transplant surgeon and hair loss expert, Paul T. Rose M.D., J.D. discusses his latest findings and exposes the unfortunate reality that many being treated for various conditions in the aesthetic space are simply throwing their hard earned money and hope down the drain.

Paul Rose, MD: One of the things I'd like to discuss with you, Spencer, is the use of platelet-rich plasma.

Spencer Kobren: Okay.

Paul Rose, MD: As you probably know, many people are advertising the use of platelet-rich plasma. We see it in everything from orthopedics to cosmetic surgery. 

Spencer Kobren:  I don't mean to cut you off or laugh, but when you say "everybody ..." It is like an epidemic here in Los Angeles. There are ... Honestly. I'm not even joking. There are vans parked on the side of the street promoting PRP for hair loss.

Paul Rose, MD:  I can believe it.

Spencer Kobren: Yeah.

Paul Rose, MD:  I can believe it. It's covering every part of your body from your joints to your genitalia.

Spencer Kobren: Yeah.

Paul Rose, MD: It's quite peculiar.

Spencer Kobren: Oh, yeah. There's a guy here in LA. He calls it the P-shot, making all kinds of claims. Believe me, there are guys who are willing to be injected down there. They think if they can get just a half an inch ...

Paul Rose, MD: Absolutely.

Spencer Kobren: Yeah.

Paul Rose, MD: The point I'd like to raise is that, while people use the same acronym, PRP, and we talk about platelet-rich plasma, the platelet-rich plasma from one institution to another institution or from one system, as there are many PRP systems, can be quite different. I actually did a small study myself where we tested about six or seven different systems. What we found was that some of the platelet-rich plasma systems actually did not even concentrate the platelets to any significant degree. People are injecting PRP and the patient has no idea what they're getting, nor does the clinician even bother to know what the patient is getting in terms of concentration of platelets and whether there are red blood cells, whether there are white blood cells. There are so many different permutations for the use of PRP that, unless we start talking about the same things, we're not going to really be able to compare results. 

My point is that we use a system that's been very reliable. As I mentioned, I tried six or seven of them. The system that we use seems to concentrate platelets anywhere from six to 12 times the normal concentration. We test every patient before we draw their blood, we know where their platelet concentration is. Then, we test the platelets once we have obtained them. The next day, if the patient wanted to, we could tell them what their platelet concentration actually was. I think that's important. We can tell them how many red blood cells, we can tell them whether there were white blood cells. That's a little different study, but we can do that.

Spencer Kobren: It's beyond just important. The one thing that I've always been saying, and I do believe in PRP therapy or treatment for hair loss, but not all PRP is created equal. Frankly, most of what people are offering, and now you have essentially been able to demonstrate this with this study, is complete bullshit. They're not helping anybody. They are just re-injecting a person's own blood back into their scalp. They're going through the process of having the blood drawn, they're going through the process of having all these needles injected into their scalp, and there's no benefit, and they're also probably on average of about $1500 out of their wallet for absolutely no benefit.

Paul Rose, MD: Yeah. That's ... You're absolutely correct. The thing becomes that patients really are just not aware of these variations that occur, and so it's quite possible that, as you mentioned, you could be getting nothing. That would account for some of the variability in the studies. You may know that, a few years ago now, I think Dr. Puig in Houston did a study for female pattern alopecia and they found that their results with PRP were very disappointing, that they didn't get much of a reaction. Then, you look at other people who've done studies and you get very nice results.

Spencer Kobren: Right.

Paul Rose, MD: In our hands, we were getting very nice results with the PRP but I would say, in almost all the studies, very few of these people are comparing the same systems, and, unless you're comparing the same systems and doing these counts, I think you're going to be far off. There are other considerations, as well. How deep do you inject? How much do you inject at each site? Is there an inhibitory concentration? We haven't answered these questions, let alone what protocol should we be using. Some people inject every week for a while, some people inject every month. There are variations all the way to once or twice a year. 

Spencer Kobren: Yeah, I was just ...

Paul Rose, MD: We don't have those answers yet.

Spencer Kobren: I was just at a conference where one dermatologist from Texas, and she gave a ... She actually gave one of the better talks, I'd say, from the talks that I actually was able to watch. Her protocol is start ... Kind of load patients up, do one procedure a month for the first three months, and then do it quarterly. In her practice, the claim is she's getting pretty consistent results, but, with that said, we have no idea. Is she using an open system or a closed system? Is it an FDA-approved system? Is it ... What exactly is being used?