LAUSR

Dear Sir, We have read with interest the paper ‘‘Platelet Rich Plasma Hybridized Adipose Transplant (PHAT) for the Treatment of Hair Loss: A Case Series’’ written by Talei et al. [1]. It has been demonstrated that platelet-rich plasma (PRP) can improve hair quality. It can be used alone or combined with other regenerative methods [2]. The authors described the PRP-hybridized adipose transplant (PHAT). The rationale of this method is the use of both immediate release growth factors, in the form of the injected PRP along with sustained release of growth factors through the activity of the initially ischemic transplanted fat and stromal cells. While this method showed excellent results, we have some concerns regarding the methodology. First, the authors did not specify the platelet count in their PRP. As for any treatment, it is critical to know the exact concentration of active substance being used, as any treatment should be standardized [3–5]. Numerous counting devices for blood and PRP samples are today easily available. Second, leukocytes concentration and the platelet/ leukocyte ratio in their PRP were not mentioned. Leukocyte concentration in the PRP may influence clinical outcomes and should be considered. Third, authors did not specify if they activated or not their PRP. When platelets are activated through addition of calcium chloride, their morphology changes irreversibly, and growth factors are released faster than they are not activated [2]. We fully share the authors opinion regarding the possibility of obtaining excellent results using the PHAT procedure to improve the hair and scalp quality and to fight hair loss. However, according to us, these characteristics of their PRP should be better standardized and described.