One common topic I often get questions about is follicular units. A common misconception about hair growth is that all hairs grow out of the scalp separately (aka “single hair growth”). While there are singular hairs that do in fact grow individually, the rest of the hairs, known as follicular units, grow very close to each other, and sometimes even out of the same exit point. They appear as closely-clustered units consisting of two, three, four, and sometimes even five terminal hairs per grouping.
As androgenetic alopecia progresses, there is a drop out of multi-follicular units mainly leaving behind single follicular units until those also drop out.
Even though these hairs are growing close together, it is interesting that DHT does not have the same effect on all of the follicles in a follicular unit at the same time. As androgenetic alopecia progresses, there is a drop out of multi-follicular units mainly leaving behind single follicular units until those also drop out.
There is a good example of this in the picture below where we see a miniaturizing follicle and a terminal follicle next to it with minimal miniaturization.
You can also think of it as a pine tree trunk with a smaller pine tree trunk coming out of the same base.
Follicular Unit Treatment
One PRP benefit is the growth factors released pushes miniaturized follicles in a follicular unit into the anagen phase, and because of this, some of these miniaturizing follicles and even follicles that are no longer visible but still have remnants left in the subcutaneous tissue can be launched into the anagen phase and again reveal a growing hair follicle, increasing the hair count in any certain area measured.
At HT&RC, I am using sonicated PRP which produces a Platelet Lysate with much high concentration of growth factors, especially the larger growth factor proteins like, VEGF. As a follicle miniaturizes the blood vessels supplying that follicle also decrease in size with smaller vessels. I think the VEGF stimulation of new blood cell growth may be one reason why the follicles are stimulated to revert back towards the terminal follicular state.
I have gone through 3 other centrifuges looking for the one that would consistently give the best concentration of platelets for PRP, and then I also added the additional processing step of sonication. I have seen a very consistent benefit, meaning increased density, from the sonicated PRP that I have been using since March 2018. There are very few other hair restoration physicians who use the sonicated PRP. As patients have come back for a follow-up, I have had more “WOW” moments looking at improvement than ever before with previous PRP centrifuges and before the sonication method.
I include the PRP or Platelet Lysate with every hair transplant. I believe that there is faster growth of the new follicles and even less shedding of the new follicles. Hopefully, translating to higher survival rates and better outcome to the transplants.