By Dr Devrim Demirel, Head of Surgery, Ideal of MeD
Hair transplantation is a microsurgical solution to advanced hair loss that restores density through the relocation of genetically resistant follicles. While modern techniques such as FUE and DHI achieve excellent graft survival and natural hairline design, the procedure alone does not modify the biological environment responsible for androgenetic alopecia.
Long-term success therefore depends on preserving native hair, supporting graft integration, and optimizing scalp healing after surgery.
Platelet-rich plasma (PRP) has emerged as a regenerative adjunct that addresses these needs through autologous growth factor delivery. By enhancing angiogenesis, reducing inflammation, and stimulating follicular stem cells, PRP supports both transplanted grafts and surrounding native hair during the critical post-operative and maintenance phases.
The biological challenge after hair transplantation
Hair transplantation introduces controlled trauma to the scalp. Although transplanted follicles are resistant to DHT, the surrounding tissue can experience:
- Temporary ischemia and reperfusion
- Inflammatory signaling
- Cellular stress within native follicles
These factors may contribute to post-operative erythema, delayed healing, and shock loss of existing hair. Without biological support, native follicles may fail to recover fully, leading to progressive thinning and compromised long-term density.
PRP directly targets this regenerative gap by accelerating tissue repair and stabilizing follicular function.
What is PRP and how it is prepared
Platelet-rich plasma is derived from the patient’s own blood through centrifugation, concentrating platelets above baseline levels. Platelets contain alpha granules rich in growth factors essential for tissue regeneration, including:
- Platelet-derived growth factor (PDGF)
- Vascular endothelial growth factor (VEGF)
- Epidermal growth factor (EGF)
- Insulin-like growth factor 1 (IGF-1)
- Transforming growth factor beta (TGF-β)
Once activated, these growth factors initiate cellular signaling pathways that enhance angiogenesis, collagen synthesis, and follicular stem cell activity.
Mechanism of action in hair restoration
PRP exerts its effects across multiple biological pathways:
- Angiogenesis: improves blood supply to transplanted and native follicles
- Anti-inflammatory modulation: reduces post-surgical inflammatory damage
- Stem cell activation: stimulates bulge-region stem cells critical for hair cycling
- Anagen prolongation: encourages follicles to remain longer in the growth phase
These mechanisms make PRP particularly valuable during the early healing phase and for long-term follicular preservation.
Role of PRP in hair transplant surgery
PRP may be incorporated into hair transplantation protocols in several ways:
- Intra-operative graft soaking to support graft survival
- Immediate post-operative scalp injection to accelerate healing
- Delayed post-operative sessions to support native hair and regrowth
Clinical experience suggests PRP can improve the speed and quality of post-transplant recovery while enhancing the visual density of the final result.
PRP and native hair preservation
One of the most significant advantages of PRP lies in its effect on non-transplanted hair. Native follicles exposed to surgical stress and ongoing androgenetic influences may benefit from:
- Reduced miniaturization
- Improved hair shaft caliber
- Enhanced resistance to shock loss
This preservation is critical to maintaining long-term aesthetic balance between transplanted and native hair.
Treatment protocols and timing
Protocols vary, but a commonly used evidence-based approach includes:
- Initial session: during surgery or 2 to 4 weeks post-operatively
- Induction phase: 2 to 4 sessions spaced 4 to 6 weeks apart
- Maintenance: one session every 6 to 12 months
PRP is often combined with topical and/or systemic therapies to maximize durability of results.
Safety, tolerability, and patient acceptance
Because PRP is autologous, adverse reactions are rare. Mild discomfort, transient swelling, or temporary erythema may occur.
Importantly, PRP does not interfere with hormonal pathways, making it suitable for patients who are unwilling or unable to use pharmacologic treatments.
Clinical and aesthetic impact
When integrated into modern hair transplant protocols, PRP can contribute to:
- Faster healing and reduced inflammation
- Improved graft survival
- Better preservation of native hair
- Increased hair thickness and density
- Higher long-term patient satisfaction
Conclusion
PRP is a biologically sound, regenerative adjunct that complements the surgical aspects of hair transplantation. Its primary value lies in supporting graft integration, enhancing scalp healing, and preserving native hair over the long term. When incorporated into a comprehensive hair restoration strategy, PRP helps elevate hair transplantation from a purely surgical intervention to a regenerative process.