PRP Protocol for Hair Loss: A Step-by-Step Reference

A documented PRP protocol is the difference between a service that produces consistent outcomes and one that produces clinic-specific anecdotes. Most poor PRP results trace back to protocol drift — the same clinic doing the same procedure differently between operators or weeks. This article is a working reference. Adapt it to your jurisdiction, your equipment, and your patient mix; do not deploy it without that adaptation.

Step 1: Patient selection and contraindication screening

Before any blood is drawn, two things must be documented: the patient's clinical eligibility and their understanding of realistic outcomes.

Eligible patients typically include early-to-moderate androgenetic alopecia (Norwood II–IV in men, Ludwig I–II in women), telogen effluvium, and post-transplant patients seeking to support graft survival. Patients with Norwood VI–VII or Ludwig III rarely respond meaningfully and should be redirected toward surgical assessment.

Contraindications to document and screen at every session: active scalp infection, untreated bleeding disorder, current anticoagulant therapy without prescriber clearance, active malignancy, current chemotherapy, pregnancy, breastfeeding, and known hypersensitivity to anticoagulant tubes used in the protocol.

Patient expectation-setting is the second consent step. PRP slows hair loss and modestly improves visible density. It does not regrow lost follicles. A patient who arrives expecting regrowth in bald areas will be unhappy at month six regardless of how well the procedure was performed. The framing belongs in the consent form, not the conversation.

Step 2: Blood draw

Volume depends on the kit and the area to be treated. A typical scalp session uses 20–60 ml of whole blood.

Use the anticoagulant tubes specified by your kit. Citrate-based tubes are most common; ACD-A is also widely used. EDTA tubes are unsuitable — EDTA inhibits platelet function. Invert tubes gently 8–10 times after draw to mix anticoagulant; do not shake.

Step 3: Centrifugation

Use the time and speed specified by your kit. Both matter; they are not interchangeable. Two general protocols exist:

• Single spin — typically 1,500–2,500 RPM for 5–8 minutes. Produces a larger plasma volume at lower platelet concentration. Easier and faster.
• Double spin — first spin separates plasma from red cells; second spin (typically 3,000–4,000 RPM for 5–10 minutes) further concentrates platelets. Produces a smaller, more concentrated injectate. More technique-sensitive.

Whichever protocol you adopt, document it and hold it constant. Operators should never decide spin parameters case by case.

The centrifuge itself should be validated and serviced annually. Time-stamp every spin and record the operator. The audit trail will save you when an outcome is questioned six months later.

Step 4: Plasma extraction

Extract the plasma layer carefully using the kit's specified technique — usually a pipette or syringe transfer through a separator. Avoid disturbing the buffy coat in single-spin protocols where the platelets sit just above the red cell layer.

If using double-spin, the second spin produces a clear distinction between platelet-poor plasma (PPP) at the top and platelet-rich plasma (PRP) at the bottom. Discard or save PPP per protocol; the PRP is what gets injected.

Step 5: Optional activation

Activation is the protocol variable with the least consensus. Some clinics activate platelets with calcium chloride (typically 10% solution at 1:9 ratio with PRP) immediately before injection. Others rely on platelet activation by tissue contact at the injection site.

Both approaches have clinical advocates and published series. The pragmatic answer is: choose one, document it, train the whole team to it, and don't switch protocols mid-year. Switching is what produces inconsistent outcomes — not the choice itself.

Step 6: Anaesthesia

Topical anaesthesia with a lidocaine/prilocaine cream applied 30–45 minutes before injection is standard. For more sensitive patients or larger areas, a ring block at the supraorbital and supratrochlear nerves can be added.

Cooling devices are an alternative or supplement. They reduce discomfort and reduce the need for topical numbing time. Validate any device used in the protocol document.

Step 7: Injection technique

The injection itself is where operator variation matters most. Standardise the following:

• Needle gauge: 30G or 32G, length 4–6 mm
• Volume per site: 0.05–0.1 ml
• Spacing: 1 cm grid pattern across the affected area
• Depth: deep dermis to subdermal junction (3–5 mm depending on anatomy)
• Pattern: systematic — frontal first, then mid-scalp, then vertex — not freehand

Document the injection map in the patient file. A simple grid diagram annotated with the date and the injection volumes makes the next session reproducible by a different operator if needed.

Session intervals and maintenance

A standard loading course is 3 to 4 sessions at monthly intervals. Patient-reported improvement typically appears between months 3 and 6, with photographic evidence usually clearer than patient perception in this window.

Maintenance after the loading course is the protocol decision most clinics get wrong. The defensible options:

The audit at month 6 is the single most important clinical visit. Standardised photography against baseline, patient-reported satisfaction, and a documented decision on next steps. The full audit framework sits inside the PRP and mesotherapy training for clinics pillar guide.

Combining with surgery

Perioperative PRP is widely used around hair transplant surgery to support graft survival and reduce shock loss. Document the timing protocol — typically a session at the time of surgery and another at 4–6 weeks post-op — and apply it consistently. Mid-protocol PRP for non-surgical patients on a separate cadence is also reasonable and is often where the PRP hair treatment training for clinics curriculum spends its operational hours.

Comparing with mesotherapy

For patients who cannot or prefer not to undergo blood draw, mesotherapy with a documented cocktail is an alternative. Indications, evidence and combinations are covered in PRP vs. mesotherapy for hair loss. Many clinics offer both; the protocols share the injection-side discipline outlined above.

Setting up the service

If you are building a PRP service from scratch — equipment, pricing, marketing — the rollout view is in building a PRP program in your clinic. The protocol on this page is the clinical core; the rollout article is everything that surrounds it.

Practitioner-facing resources from suppliers and clinical groups — Bind Pharma among them — sometimes publish their own equipment shortlists and timing schedules. These are useful comparison points; they are not substitutes for a clinic-specific protocol that your team owns.

When to deviate from this protocol

A documented protocol is a starting point, not a constraint. Reasons to deviate include a particular kit's manufacturer instructions that override generic timing, patient anatomy requiring different needle gauge or injection depth, or audited outcomes at six and twelve months suggesting the standard schedule under-serves your patient mix. The discipline is to deviate deliberately and document the change — never silently. Every deviation should be reviewed at the next monthly clinical meeting, accepted into the standard protocol if it produces better outcomes, or reverted if it doesn't.