Hair loss treatments at med spas: PRP, exosomes, microneedling, and what actually works

Hair loss treatments have proliferated at med spas over the past five years. PRP, exosomes, and laser caps are now widely advertised alongside older pharmaceutical standbys. Here's what the evidence actually says about each approach.

Why hair loss is complicated to treat

Hair loss has multiple causes — androgenetic alopecia (pattern hair loss), telogen effluvium (stress or nutritional shedding), alopecia areata (autoimmune), and others. The treatments below are primarily studied for androgenetic alopecia (the most common type). An accurate diagnosis matters before starting any treatment because the wrong intervention is a waste of money.

PRP (Platelet-Rich Plasma) for hair loss

PRP involves drawing a small amount of your blood, spinning it in a centrifuge to concentrate the platelets, then injecting the platelet-rich plasma directly into the scalp at the level of the hair follicles.

How it works: Platelets release growth factors (PDGF, VEGF, IGF-1) that stimulate follicular activity, potentially extending the growth phase and waking dormant follicles. The mechanism is plausible and supported by the evidence — but results are incremental, not dramatic.

What the evidence shows: A 2019 systematic review in Aesthetic Plastic Surgery found statistically significant improvement in hair density and thickness across multiple RCTs. A 2022 meta-analysis in Dermatologic Surgery confirmed benefit, but noted high variability in protocols (centrifuge speed, platelet concentration, injection depth) that makes comparing studies difficult.

Realistic outcome: Slowing of further loss and modest improvement in density — approximately 20–40% increase in follicular density in responders. Not a reversal for patients with advanced thinning.

Protocol: 3–4 sessions, 4–6 weeks apart, then 1–2 maintenance sessions per year. Results begin appearing at 3–6 months; the follicular cycle is slow.

Cost:

| Treatment | Per session | Typical course |
|---|---|---|
| PRP (scalp) | $600–$1,500 | $1,800–$6,000 (3–4 sessions) |
| PRP + microneedling | $800–$1,800 | $2,400–$7,200 |

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Exosome therapy for hair loss

Exosomes are extracellular vesicles — tiny particles released by cells that carry signaling molecules (growth factors, mRNA, proteins) from cell to cell. Exosome hair treatments use exosomes derived from mesenchymal stem cells.

Important caveat: Exosome products are not FDA-approved drugs. They occupy a regulatory gray zone. The FDA has issued warnings about unapproved exosome products and clarified that stem-cell-derived exosomes require biological license applications. This doesn't mean they're ineffective — early data is promising — but it does mean quality control varies enormously between manufacturers.

What early evidence suggests: Small studies show exosome injections may outperform PRP for hair density improvement, but head-to-head RCT data is limited. Most published data comes from manufacturer-sponsored studies or case series.

Cost: $1,500–$3,000 per session. Higher cost reflects the sourcing and processing of exosome products.

Bottom line: Exosomes are promising but unproven at scale. Appropriate for patients who have tried PRP without adequate response and want to try next-line options — with realistic expectations.

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Microneedling for hair loss

Scalp microneedling uses a dermaroller or automated pen to create micro-injuries in the scalp, stimulating wound healing and growth factor release. It's often combined with PRP or topical minoxidil application immediately after (the micro-channels improve penetration).

Evidence: A 2013 RCT in the Journal of Cutaneous and Aesthetic Surgery compared microneedling + minoxidil vs minoxidil alone — the combination group had significantly greater improvement in hair count. Subsequent studies have replicated this finding.

As a standalone: Modest effect at best. As an adjunct to PRP or topical treatments: meaningful amplification.

Protocol: 4–6 sessions, 2–4 weeks apart, with at-home topical therapy between sessions.

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Low-Level Laser Therapy (LLLT)

LLLT devices (laser caps, laser combs, clinical laser panels) deliver red and near-infrared light to the scalp, which is thought to improve cellular metabolism in follicles and extend the growth phase.

FDA clearance: Several LLLT devices are FDA-cleared for hair growth (Class II device clearance — not drug approval). This means they've demonstrated safety and efficacy evidence sufficient for clearance, not that they are definitively proven.

Evidence: Multiple RCTs support modest improvement in hair count and thickness. The magnitude of effect is generally smaller than PRP or pharmaceuticals.

In-clinic vs. at-home: Clinical LLLT panels are more powerful; consumer laser caps can be effective for maintenance.

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How med spa treatments compare to pharmaceuticals

| Treatment | Evidence level | Mechanism | Stops loss? | Grows hair? | Monthly cost |
|---|---|---|---|---|---|
| Finasteride (oral) | High (RCTs) | DHT blocker | Yes | Yes (modest) | $10–$40 |
| Minoxidil (topical) | High (RCTs) | Vasodilator/unknown | Partially | Yes (modest) | $15–$30 |
| Minoxidil (oral) | Moderate | Vasodilator | Yes | Yes | $10–$30 |
| PRP | Moderate | Growth factors | Partial | Yes (modest) | $150–$500 |
| Exosomes | Low-moderate | Signaling molecules | Unknown | Yes (early data) | $300–$1,000 |
| LLLT | Moderate | Cellular metabolism | Partial | Yes (modest) | $0–$50 (home device) |

The honest summary: Finasteride and minoxidil have the strongest evidence base at the lowest cost. PRP is a reasonable adjunct — especially for patients who want to avoid systemic medications, or who have a partial but incomplete response to pharmaceuticals. Exosomes are earlier-stage. None of these are cures for significant hair loss.

Who is a good candidate for med spa hair loss treatments?

Good candidates:
Early-to-moderate androgenetic alopecia (not completely bald in the treatment area — dormant follicles need to exist)
Patients already on or willing to combine with pharmaceutical therapy
Patients who want to avoid oral medications (finasteride has sexual side-effect risk in some men; oral minoxidil has systemic effects)

Poor candidates:
Significant scarring alopecia (follicles are permanently destroyed — regeneration is impossible)
Advanced pattern baldness with years of complete follicular loss in the affected area
Alopecia areata (autoimmune; requires different treatment approach)

Questions to ask your provider

Do you confirm diagnosis before treating, or do you treat all hair loss the same way?
What PRP protocol do you use — which centrifuge system, what concentration, what injection depth?
What combination approach (PRP + LLLT + topicals) do you recommend for my pattern and stage?
Are you using FDA-cleared devices for LLLT or for exosome products?
What realistic timeline should I expect before evaluating whether the treatment is working?

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