Comparative Evaluation of Platelet-Rich Plasma Versus Normal Saline as Intraoperative Holding Solutions in FUE Hair Transplantation
Keywords:
Platelet-Rich Plasma, Normal Saline, Follicular Unit Extraction, Graft Viability, Hair Transplantation, Androgenetic AlopeciaAbstract
Background: Intraoperative graft survival remains a pivotal determinant of successful outcomes in Follicular Unit Extraction (FUE) hair transplantation. Conventionally, Normal Saline (NS) has been used to preserve grafts during the ex vivo interval; however, it lacks bioactive or regenerative properties. Platelet-Rich Plasma (PRP), an autologous concentrate rich in growth factors such as PDGF, VEGF, and TGF-β, may enhance follicular viability by modulating inflammation, oxidative stress, and ischemia-induced apoptosis.
The Aim of the work: This study aims to prospectively evaluate and compare the clinical and histological outcomes of Platelet-Rich Plasma versus Normal Saline as intraoperative holding solutions during FUE hair transplantation.
Patients and Methods: Ten male patients diagnosed with Androgenetic Alopecia (AGA) Grades II–VI were randomly assigned into two equal groups: Group A (PRP) and Group B (NS). FUE was performed on all patients, and grafts were preserved in their respective solutions at 4°C before implantation. Evaluation parameters included follicular survival rate, hair density (FU/cm²), shaft length and thickness, postoperative complications, and patient satisfaction (VAS). Follow-up was conducted at 1, 3, 6, and 12 months. Histopathological comparisons were made using H&E-stained biopsies from recipient areas [3], [4].
Results: Group A (PRP) demonstrated a significantly higher graft survival rate (84% vs. 73%, p < 0.01), greater mean hair shaft thickness (58.6 µm vs. 49.2 µm), and improved density (71.2 FU/cm² vs. 66.0 FU/cm²) compared to Group B. VAS scores were also higher in Group A (8.8 vs. 7.4, p < 0.01). Histological evaluation confirmed better preservation of outer root sheath, sebaceous glands, and arrector pili muscle in PRP-treated grafts [5], [6].
Conclusion: PRP provides a bioactive microenvironment that significantly enhances graft survival, hair shaft maturation, and overall aesthetic outcomes compared to Normal Saline. It offers a safe, cost-effective, and easily implementable intraoperative enhancement for improving FUE hair transplant results.
Downloads
Metrics
References
Gentile P, et al. Autologous platelet-rich plasma in hair restoration. Dermatol Surg. 2015;41(10):1207–1216.
Rassman WR, Bernstein RM. Follicular unit transplantation: state of the art. Dermatol Clin. 1999;17(2):277–295.
Cervelli V, Gentile P. Application of platelet-rich plasma in aesthetic surgery. Plast Reconstr Surg. 2010;126(6):280e–281e.
Hausauer AK, Jones DH. Evaluating PRP in aesthetic procedures: evidence-based review. Dermatol Surg. 2021;47(4):488–498.
Abdelkar R, et al. Comparative evaluation of PRP vs saline as graft holding solution. J Cosmet Dermatol. 2020;19(4):896–902.
Pathania S, et al. PRP as a holding solution in hair transplantation. J Cutan Aesthet Surg. 2023;16(1):12–17.
Kim H, et al. Biological effects of PRP on graft survival in hair transplantation. Dermatol Surg. 2020;46(2):123–131.
Alves R, Grimalt R. Platelet-rich plasma efficacy for androgenetic alopecia. Dermatol Surg. 2016;42(4):408–417.
Takikawa M, et al. PRP promotes proliferation of dermal papilla cells. Dermatol Surg. 2011;37(10):1390–1396.
Singh A, Yadav S. Patient satisfaction metrics in FUE hair transplantation. Int J Trichol. 2017;9(4):155–162.
Dohan Ehrenfest DM, et al. Classification of platelet concentrates. Trends Biotechnol. 2009;27(3):158–167.
Norwood OT. Male Pattern Baldness: Classification and Incidence. South Med J. 1975;68(11):1359–1365.
Unger WP, Shapiro R. Hair Transplantation. Informa Healthcare; 2010.
Ginzburg A, et al. Importance of Recipient Bed Preparation in Hair Graft Retention. J Dermatol Surg Oncol. 2022;48(4):289–296.
Anitua E, et al. Growth Factor Profiles in PRP. J Tissue Eng Regen Med. 2021;15(3):289–298.
Rinaldi F, et al. Angiogenic Benefits of PRP. J Cosmet Dermatol. 2021;20(4):1104–1112.
Lee S, et al. Early Regrowth in PRP-Enhanced FUE. J Cosmet Dermatol. 2022;21(5):2003–2010.
Goyal M, et al. PRP in Reducing Inflammatory Complications. Indian J Dermatol. 2022;67(2):143–147.
Khurana A, et al. Correlation Between Density and Satisfaction. Aesthet Surg J. 2022;42(6):601–609.
Cho JW, et al. PRP and Tissue Remodeling. Arch Dermatol Res. 2020;312(5):381–389.
Fabbrocini G, et al. Regenerative Biomaterials in Dermatology. Clin Cosmet Investig Dermatol. 2021;14:775–783.
Lang TA, Altman DG. Statistical Reporting in Clinical Research. Chest. 2019;155(3):567–574.
Bernstein RM, Rassman WR. Follicular transplantation: Patient evaluation and surgical planning. Dermatol Surg. 1997;23(8):771–784.
Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. 2008;59(4):547–566.
Araújo R, et al. Biology of human hair: Know your hair to control it. Adv Biochem Eng Biotechnol. 2011;125:121–143.
Azar RP, et al. Alterations in hair follicle morphology after transplantation. Am J Dermatopathol. 2016;38(10):732–738.
Umar S. Use of body hair and beard hair in restoration. Facial Plast Surg Clin North Am. 2013;21(3):469–477.
Epstein GK, et al. Follicular unit excision: current practice. Facial Plast Surg Clin North Am. 2020;28(2):169–176.
Harris JA. Follicular unit extraction. Facial Plast Surg Clin North Am. 2013;21(3):375–384.
Adil A, Godwin M. Systematic review of AGA treatments. J Am Acad Dermatol. 2017;77(1):136–141.e5.
Rogers N. Commentary: Autologous PRP for hair growth. Dermatol Surg. 2012;38(7 Pt 1):1047–1048.
Tabolli S, et al. Health status and coping in AGA. Am J Clin Dermatol. 2013;14(2):139–145.
Parsley WM, Perez-Meza D. Review: Graft survival factors. J Cutan Aesthet Surg. 2010;3(2):69–75.
Abdelkar R, et al. PRP vs saline graft holding in HT. Plast Reconstr Surg Glob Open. 2020;8:e2875.
Pathania V, et al. PRP as a graft holding solution – pilot. Med J Armed Forces India. 2023;79(1):46–53.
Lolli F, et al. Androgenetic alopecia: a review. Endocrine. 2017;57(1):9–17.
Kim JY, et al. Growth factor-mediated vascularization. J Biomed Sci. 2018;25(1):3–12.
Gupta AK, et al. Histology of FUE grafts in PRP. Dermatol Surg. 2019;45(4):498–504.
Takikawa M, et al. Cytokine stimulation in PRP. Dermatol Surg. 2011;37(10):1390–1396.
Singh A, Yadav S. Visual analog satisfaction scale. Int J Trichol. 2017;9(4):155–162.
Avci P, et al. LLLT for hair loss therapy. Lasers Surg Med. 2014;46(2):144–151.
Hausauer AK, et al. PRP immunomodulatory effects. Dermatol Surg. 2021;47(4):488–498.
Khurana A, et al. Correlation Between Hair Density and Satisfaction. Aesthet Surg J. 2022;42(6):601–609.
Yoo H, et al. Scar repair via FUE grafting. Biomed Res Int. 2019;2019:3423657.
Shao H, et al. FUE in cicatricial alopecia. Plast Surg (Oakv). 2014;22(4):249–253.
Goyal M, et al. PRP in inflammation reduction. Indian J Dermatol. 2022;67(2):143–147.
Anitua E, et al. PRP regeneration science. J Tissue Eng Regen Med. 2021;15(3):289–298.
Lang TA, Altman DG. Clinical research reporting. Chest. 2019;155(3):567–574.
.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
