Otolaryngologists Are Cautiously Optimistic about Platelet-Rich Plasma But Want More Evidence

Clinical Uses

Alopecia patients at Massachusetts Eye and Ear are treated with PRP as either a less invasive, stand-alone therapy or in conjunction with hair transplant, with a recommended series of three injection treatments four to six weeks apart. “Hair loss can be devastating for patients. Multiple studies have shown that both men and women who are suffering from hair loss are negatively affected and, conversely, benefit greatly after treatment to restore their hair,” said Linda N. Lee, MD, who co-authored a systematic literature review on PRP’s efficacy and safety for alopecia patients in 2018 (Facial Plast Surg. 2018;34:631-640). “Anecdotally, PRP holds a lot of promise as a hair loss treatment. There are so many individual stories about unbelievable patient results with PRP. However, as an evidence-based field, we wanted to evaluate data objectively and understand what the risks and benefits truly were.”

The review by Dr. Lee and colleagues analyzed eight randomized controlled trials and 16 prospective cohort studies, and excluded case reports. They found that 21 of the studies reported positive outcomes based on objective clinical criteria, while three suggested no clinical improvement. However, in two of those three studies, patients reported increased satisfaction with their results. PRP also appears relatively safe, said Dr. Lee: The only complications were transient edema or erythema, and the pain and headaches associated with the procedure.

PRP can promote axon regeneration, where you actually regenerate nerve tissues to switch back on these disrupted neural connections. It may have an anti-inflammatory effect and upregulate growth factors to regenerate these nerves. —Zara M. Patel, MD

Dr. Epstein also currently uses PRP to treat alopecia. “We utilize PRP in the treatment of hair loss in several indications. PRP is performed at the same time as a hair transplant. When injected into the scalp prior to making recipient sites, we believe it reduces the ‘shock’ hair loss and accelerates healing,” he said. “PRP is also done as a stand-alone therapy for the treatment of androgenic alopecia.” Dr. Epstein recommended that alopecia patients have repeat injections two months after the initial treatment, then every four to six months afterward.

Currently, Dr. Lee’s clinic uses PRP only for alopecia treatment, but she believes that PRP may also promote wound healing in patients with tympanic membrane perforations or after facial aesthetic surgeries. “Because of its possible benefits across multiple different indications, PRP has sometimes been referred to as ‘liquid gold,’ but it’s important that as physicians we carefully select the right candidates and accurately inform our patients of the evidence and realistic risks.”

Dr. Karimi believes that adding PRP or PRF injections increases success rates for fat transfer procedures, where fat is taken from the patient’s abdomen and applied to the face for either cosmetic or reconstructive treatment. “We’re using that patient’s own fat cells, or a fat graft, and you need the fat to perform well in its new environment. This hasn’t worked so well in the past,” he said. “When you add PRP or PRF, the take rates of fat can approach 50% to 70% of the volume injected. Patients see better results, and there are improved take rates for the fat.”

PRF is also helpful in rhinoplasty because it increases the blood supply to the grafts, added Dr. Karimi. “The platelets are the first cells to come to a wound to promote healing. They create a spider’s web of fibrin, and spin and signal growth factors to the wound,” he explained. “In rhinoplasty, most of the time we use cartilage grafts that have no inherent blood supply—they rely on the surrounding tissue. PRF is helpful in rhinoplasty because you want something to restore the blood supply and promote wound healing.”