Optimizing CRP Treatments

Optimizing CRP Treatments

Hair Transplant & Restoration Center

Throughout my entire medical career, I don’t think I have been satisfied with the status quo. I am fortunate that things keep changing in medicine and keep improving. Beyond new discoveries in hair restoration, I also keep looking for a better way to perform various procedures, searching for continuous quality improvement with technology, equipment, and timing.

Continuous quality improvement using CRP (cytokine rich plasma) treatment has become a passion of mine. Over the past few years, I have changed out equipment and centrifuges in search of better platelet quality and results, and further refined PRP to produce CRP (which has a much higher growth factor concentration). Since I changed my PRP protocol to CRP sixteen months ago, the CRP has consistently given my patients much better results.

With this said, I believe I have the best product generated by the best equipment I can offer my patients to give them more hair density. Since not all CRP/PRP treatment and protocol is the same in the hair restoration industry, now the question is…

How often should the CRP be injected? When can I predict that the CRP benefit will run its course?

Up until now, I have suggested that after a series of three CRP treatments spaced out 4-6 weeks a part, the benefit could last about 18 months. Is that an accurate prediction for how long the good results will last? Let’s take a look at two different patient examples. This is not scientific fact, just my experience and observations treating two different patients with CRP.

Example A. Female patient in her mid-fifties

As with a lot of hair loss patients, it is not a simple, straight-line trajectory in tracking her improvement, but I will try to simplify the timelines to make things more understandable.

  • February 2016: She first came to see me concerned about thinning and excessive shedding and did disclose she had ongoing stress planning a wedding. We did a scalp biopsy which showed androgenetic alopecia.
  • May 2016: I took an initial Hair Check measurement, which I do with a lot of my patients, especially females.
    • Overly simplified, a hair check device allows me to repeatedly measure the density of hair in a precise location on the scalp. I record the number, and then repeat the measurement in the exact same spot at a later date. This way, we can track the density measurement over time to see how hair is responding to treatment.
    • The initial hair check measurement taken in her main area of concern was 96. So this was our baseline.
    • She was already on Spironolactone and was placed on Rogaine. I also started Help Hair vitamin and shake supplement.
  • September 2016: In the same location of concern, I took another Hair Check measurement which was 117.
  • November 2016: I started finasteride 5mg/day po and switched the Rogaine to Formula 82M (which has minoxidil, retin A and steroid).
  • July 2017: The next measurement reading was 119. I added LLLT
  • January 2018: Her Hair Check was 120.

In summary to this point: May 2016 to January 2018, with using various medical treatments her hair check density measurement improved from 96 to 120 over 22 months.

Based on what I visually saw under a magnifying lens at that time, miniaturization has subsided, and the density was "the best we could get" with previously mentioned treatments. We had not tried CRP, but I was not sure how much of an improvement in density we would see since miniaturization had subsided.

  • March 2018: I began a series of three CRP treatments. As it turns out, during this time, I was transitioning my PRP protocol to CRP (going back to my continuous journey to improve treatments). So the first treatment in March of 2018 was PRP, but the subsequent two treatments were CRP.
  • April 2018: CRP treatment
  • June 2018: CRP treatment
  • November 2018: Hair Check measurement was 149!!

After starting CRP treatments in March 2018, eight months later in November 2018 (five months after last treatment), the Hair Check measurement improved from 120 to 149.

In summary to this point: The original combination of medical treatments increased the Hair Check from 96 to 120. The addition of CRP treatments increased the Hair Check from 120 to 149. Meaning CRP improved density more than the combination of other treatments even when miniaturization has subsided. (This is the reason that I no longer group the impact of CRP in the same category with other medical treatments.)

Okay, so now we have reached the “top of the mountain” when it comes to medical therapy.

  • July 2019: Her Hair Check measurement was 120. This patient came back for a follow-up, and she expressed at the time that she thought “things were worse.” Indeed things were worse. She was back to the level of benefit from standard medical management, but the advantage from the CRP had dissipated.

This was 16 months after the first CRP/PRP treatment (13 months after the last CRP treatment).

Overall thoughts about CRP after tracking patient A's progress:
From this one patient, I can say that the CRP treatments more than doubled the benefit when compared to a combination of other treatments, but CRP seemed to last 10 to 13 months rather than 18 months.

Example B. Male patient in mid sixties

I wanted to include this example to show a completely different treatment situation and outcome.

This patient had a 3000 graft hair transplant covering the hairline to midvertex about 6.5 years ago, and was curious about the results a single CRP treatment would provide.

  • November 2018: I performed a single CRP treatment
  • February 2019: Patient reported hair was much denser and had received MANY unsolicited comments on “how good” his hair looked. Patient also said as a teenager, his hair was extremely thick with a lot of waviness and was “amazed” he had some waviness to his hair which had not been present since his hair started to miniaturize decades ago.
  • June 2019: Patient gradually noticed that his hair was “getting thinner” and the waviness had disappeared.

Because the patient was not using any other medical treatment at this time and had only one CRP treatment, I have to attribute this change to the CRP “running its course.” So from one treatment, there was a visible benefit for about six months from January to May-June.

How often should the CRP be injected? When can I predict that the CRP benefit will run its course?

Now, to sum up, what I have observed about timing:

  • One CRP treatment showed benefit for about six months. When doing the three treatments, the benefit lasted about a year instead of 18 months.
  • I also have no doubt there is more to discover about the optimal spacing of treatments which will evolve as time goes on, but potentially performing treatment about every four months may show long term benefit without regression.

And so we continue with continuous quality improvement…

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