PRP (Platelet-Rich Plasma) and PRF (Platelet-Rich Fibrin) both use concentrated components from your own blood to stimulate hair follicle activity, but they differ in preparation, growth factor release kinetics, cost, and the strength of clinical evidence supporting their use. For alopecia areata patients specifically, PRP has more published research behind it, while PRF represents a newer approach with theoretical advantages that are still being validated. This comparison covers everything you need to make an informed decision.
This article is for informational purposes only and does not constitute medical advice.
Understanding PRP (Platelet-Rich Plasma)
How PRP Is Prepared
A small blood draw (typically 10 to 60ml) is centrifuged to separate plasma from red blood cells. The platelet-rich layer is isolated and concentrated to 3 to 5 times the normal platelet count. An anticoagulant is added during collection to prevent clotting, keeping the platelets in a liquid form ready for injection.
How PRP Works
Once injected into the scalp, platelets are activated and release growth factors including PDGF (Platelet-Derived Growth Factor), VEGF (Vascular Endothelial Growth Factor), EGF (Epidermal Growth Factor), and TGF-beta (Transforming Growth Factor). These factors stimulate dormant follicles, promote blood vessel formation around follicles, reduce inflammation, and support the anagen (growth) phase of the hair cycle.
PRP Evidence for Alopecia Areata
PRP has been studied in multiple clinical settings for hair loss. The overall data shows 30 to 40% increases in hair density, with sessions costing $500 to $2,000 each and an initial course of 3 to 4 sessions recommended. However, most of the stronger evidence comes from androgenetic alopecia (pattern hair loss) rather than alopecia areata specifically.
For alopecia areata, smaller studies have shown that PRP can accelerate regrowth when combined with corticosteroid injections and may reduce the number of steroid sessions needed. As a standalone treatment for alopecia areata, PRP is less reliable because it does not directly address the autoimmune mechanism driving the condition.
Understanding PRF (Platelet-Rich Fibrin)
How PRF Is Prepared
PRF uses the same starting point (a blood draw) but with a critical difference: no anticoagulant is added. The blood is centrifuged at a lower speed, allowing a fibrin matrix to form naturally. This produces a gel-like substance that contains platelets, white blood cells, and growth factors embedded within a structural fibrin network.
How PRF Works
The fibrin matrix acts as a scaffold that releases growth factors slowly over 7 to 14 days, compared to the rapid burst release of PRP (which delivers most growth factors within hours of injection). This sustained release is the primary theoretical advantage of PRF. The white blood cells (leukocytes) trapped in the fibrin matrix may also provide additional anti-inflammatory and immune-modulating effects.
PRF Evidence for Alopecia Areata
PRF is newer to the hair restoration field, and published clinical data specifically for alopecia areata is minimal. Most current evidence comes from dental and orthopedic applications where PRF has been used for wound healing. The hair loss studies that do exist are primarily case series and pilot studies with small sample sizes. Results are promising but not yet validated at the level of PRP research.
Head-to-Head Comparison
| Factor | PRP | PRF |
|---|---|---|
| Preparation | Centrifuge with anticoagulant | Centrifuge without anticoagulant |
| Consistency | Liquid (injectable) | Gel/membrane (injectable or placeable) |
| Growth Factor Release | Rapid burst (hours) | Sustained release (7 to 14 days) |
| White Blood Cells | Removed or minimal | Retained in fibrin matrix |
| Stem Cell Content | Minimal | Higher concentration retained |
| Cost per Session | $500 to $2,000 | $500 to $2,500 |
| Sessions Needed | 3 to 4 initially, then every 3 to 6 months | 3 to 4 initially (may need fewer maintenance) |
| Clinical Evidence (Hair) | Moderate (multiple studies) | Limited (emerging data) |
| Evidence for AA Specifically | Small studies available | Minimal published data |
| Preparation Time | 15 to 30 minutes | 10 to 20 minutes |
| Shelf Life | Must be used immediately | Must be used immediately |
| Pain Level | Moderate (multiple injections) | Similar to PRP |
Which Growth Factor Profile Matters More for Alopecia Areata?
For androgenetic alopecia, the growth factor stimulation from both PRP and PRF directly addresses the primary problem: follicle miniaturization and reduced blood supply. The choice between burst release (PRP) and sustained release (PRF) is a matter of optimization.
For alopecia areata, the equation is different. The primary problem is autoimmune attack, not growth factor deficiency. Neither PRP nor PRF directly suppresses the immune system at a level comparable to corticosteroid injections (60 to 70% response rate) or JAK inhibitors (35 to 40% major regrowth in severe cases).
Where PRP and PRF may add value for alopecia areata patients:
- Anti-inflammatory effects: Both contain anti-inflammatory cytokines that may help calm the localized immune response around follicles
- Follicle reactivation: Growth factors may help dormant (but undamaged) follicles re-enter the growth cycle once the immune attack has been suppressed by primary treatment
- Tissue repair: Both promote healing of the perifollicular tissue damaged by inflammation
The sustained release profile of PRF is theoretically better for maintaining an anti-inflammatory environment around follicles over a longer period. However, this theoretical advantage has not been proven in controlled clinical studies for alopecia areata.
Cost Analysis Over 12 Months
PRP Treatment Plan
| Item | Cost |
|---|---|
| Initial 4 sessions (monthly) | $2,000 to $8,000 |
| Maintenance sessions (every 3 to 6 months: 2 to 3 sessions) | $1,000 to $6,000 |
| Year 1 Total | $3,000 to $14,000 |
PRF Treatment Plan
| Item | Cost |
|---|---|
| Initial 3 to 4 sessions (monthly) | $1,500 to $10,000 |
| Maintenance sessions (every 4 to 6 months: 2 sessions) | $1,000 to $5,000 |
| Year 1 Total | $2,500 to $15,000 |
PRF proponents argue that fewer maintenance sessions are needed due to the sustained release mechanism, which could reduce long-term costs. This claim is reasonable but not yet backed by comparative trial data.
Combination Protocols for Alopecia Areata
The most promising use of PRP or PRF for alopecia areata is not as a standalone treatment but as part of a multi-therapy approach.
PRP/PRF + Corticosteroid Injections
Alternate PRP or PRF sessions with corticosteroid injections. The steroids suppress the immune attack while the platelet therapy promotes regrowth in areas where the immune response has been controlled. Some clinicians perform both in the same session, targeting different areas.
PRP/PRF + Microneedling
Microneedling immediately before PRP or PRF injection creates micro-channels that allow deeper penetration of growth factors to the follicle bulb. The controlled injury from microneedling also triggers its own wound healing response that complements the platelet-derived factors.
PRP/PRF + JAK Inhibitors
For severe alopecia areata patients on oral JAK inhibitors, adding PRP or PRF sessions may accelerate regrowth in areas where the immune suppression has taken effect. This combination is being explored in several ongoing studies.
Making Your Decision
Choose PRP if:
- You want the option with more published research behind it
- Your clinic has extensive PRP experience for hair loss
- You prefer a treatment with a more established protocol and predictable outcomes
- Cost predictability is important to you
Choose PRF if:
- You want to avoid anticoagulant additives in the preparation
- The sustained growth factor release profile aligns with your treatment goals
- Your clinic has specific PRF expertise and preparation equipment
- You are comfortable with a newer approach that has less published validation
For either option, remember:
- Neither PRP nor PRF should replace primary alopecia areata treatment (corticosteroid injections or JAK inhibitors)
- Both work best as adjunct therapies combined with immunosuppressive treatment
- Results take 3 to 6 months to become visible
- Maintenance sessions are required to sustain benefits
For a deeper understanding of the underlying condition, read about alopecia areata causes and autoimmune triggers. If your condition reaches stable remission and you are considering surgical restoration, review the hair transplant candidacy requirements.
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