ORIGINAL CONTRIBUTION The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study Roge M. Navarro MD 1 | Ander Pino MSc 2 | Asunci  on Martinez-Andres MD 1 | Consuelo Molina PhD 1 | Ana Mar  ıa Martinez BS 1 | Nahikari Martinez BS 1 | Gorka Orive PhD 2 | Eduardo Anitua MD, DDS 2 1 Centro Dermatol ogico-Est etico de Alicante, Alicante, Spain 2 BTI Biotechnology Institute, Vitoria (  Alava), Spain Correspondence Eduardo Anitua MD, DDS, BTI Biotechnology Institute, Vitoria (Alava), Spain Email: eduardoanitua@eduardoanitua.com Summary Background: Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia. Aims: The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients. Methods: The biologic potential of PRGF was firstly in vitro evaluated over follicu- lar germinal matrix and dermal papilla cells. Afterward, fifteen patients were sub- jected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed. Results: Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itch- ing sensation. Conclusions: This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also pro- vides a biologically active scaffold that induces resident cell proliferation and main- tains an optimal integrity of the grafted hair. KEYWORDS alopecia, follicular unit extraction, plasma rich in growth factors, tissue regeneration Accepted: 7 September 2017 DOI: 10.1111/jocd.12446 J Cosmet Dermatol. 2017;1–12. wileyonlinelibrary.com/journal/jocd © 2017 Wiley Periodicals, Inc. | 1