Your Questions

Q: Dr. Eppley, I am a 42 year-old male whose hair is thinning. I am on Propecia and Rogaine and it seems to have slowed it down but is not causing any regrowth. I have read about PRP blood treatments for hair loss and wondered what your thoughts were on how effective it might be. I know you have a lot of experience with PRP so your insight would be very valuable.

A: PRP, an acronym for platelet-rich plasma, is a concentrate of platelets derived from a patient’s own blood. Because platelets are packed with growth factors, small peptides that help modulate wound healing when injured, they have been used and shown to be effective in many medical applications. Their success in wound healing and many reconstructive surgery applications and their lack of any known adverse effects  has naturally led for PRP to be extended into numerous cosmetic applications. It has been used as an adjunct in facelifts, injectable filler and fat grafting. It is presumed that the platelet concentrate has a tissue stimulating effect for regenerating lost or aging tissues such as fat and skin elasticity. The medical evidence for such effects is weak at best but the idea is so logical that its current use can best be described as a ‘what can it hurt’ approach. PRP use in hair loss treatments or in combination with Neograft follicular unit hair transplantation is another PRP application that has not been scientifically evaluated but numerous practitioners report favorable results with its use. The question of exactly how effective PRP is on stimulating the follicles of hair whether they are in their natural location or after transplantation is not yet known. I am optimistic about the effects of PRP on hair regeneration but no one yet knows how many injection sessions or how often or how many treatments need to be done for maximal benefit. Its use with other hair loss/regeneration treatments therefore is up the patient and their hair restoration physician.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in occipital cranioplasty, and I have a couple of questions. The flat area is on the upper part of my head. I will be having hair transplant surgery and right now I’m probably a Class V. If I want to go ahead with the cranioplasty should I do it before the transplant procedures or after. I will have to have at least two sessions and I might not be a candidate for FUE. If that’s the case then the strip method will be used and the doctor will have to undermine my scalp. I’m afraid that if the cranioplasty is done first the doctor might have trouble undermining my scalp for the transplant. Second, with the cranioplasty I would want the stronger material (acrylic) and would want it to be fixed to the bone with screws, mostly because I’m active. The question is, would I be able to do a headstand with the material attached to my skull? Would it hold up to my full weight even if I do neck bridges, like in judo? Or once I have it done I would have to kiss those kinds of exercises goodbye? I would want that puppy in there permanently and solidly attached to the back of my head.

A: When it comes to occipital cranioplasty and hair transplantation done with the strip method, they are mutually exclusive. Occipital cranioplasty requires scalp expansion of which strip harvesting takes away scalp in the same general area. The two can never be done on the same patient no matter how they are sequenced. There is also the issue of vascular compromise to the posterior scalp caused by strip harvesting which make the blood supply to the scalp precarious in the midline if an occipital scalp flap was ever raised.

Dr. Barry Eppley

Indianapolis, Indiana