PRP

What is PRP?

PRP stands for platelet-rich plasma. This plasma, prepared from a small sample of your own blood and with a higher platelet concentration than the blood itself, is applied to the tissue being treated. A sample of your blood is taken and spun in a centrifuge; the components separate according to their density, and the platelet-rich layer is collected. In other words, the fluid used is not a filler but a product made from your own blood.

Platelets are cell fragments involved in blood clotting, and they carry growth factors that play a role in tissue repair. According to scientific reviews, these factors stimulate the formation of blood vessels and the production of connective tissue, and together with other components of the plasma they create an environment for repair. PRP is used in many fields, from orthopaedics to dentistry and from wound care to gynaecology. Its main uses in dermatology (the branch of medicine that deals with the skin) are skin renewal, scar treatment and hair loss.

There is also more than one way of applying it. PRP can be delivered into the skin through many small injections with fine needles (the mesotherapy technique), by microneedling or with needle-free systems. According to research, the centrifuge protocol, the design of the device used and the application technique affect the platelet concentration, safety and clinical outcome. PRP treatments in the genital area are covered on the Genital PRP Treatments page.

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Why is PRP not a standardised product?

Two products prepared under the name PRP can differ in what they contain, and this difference is considered one of the main limitations of PRP. The first source of difference is the preparation method. PRP is classified by its leucocyte (white blood cell) content, its fibrin structure and its platelet concentration. Single-spin centrifugation, double-spin centrifugation or the technique known as buffy coat each change the composition of the final product; what changes is the ratio of platelets, leucocytes, plasma proteins and extracellular vesicles (tiny sacs released by cells) to one another. Classification systems were developed to describe this difference in a comparable way, and the very existence of these systems shows that the difference is real.

The second source of difference is the person. According to a review on this subject, the platelet count alone does not predict the result: a person’s age, metabolic state and level of oxidative stress determine how the platelets function, while the centrifuge settings, temperature control and activation method determine whether the growth factors are preserved. In other words, two PRP preparations of the same volume may not have the same biological content.

In hair loss, the evidence supporting the reliability of PRP is uncertain, and conflicting results have been reported. The result can also vary with the design of the device used and the application technique. For this reason, the results reported in studies should be read not as a promise but as observations made with specific protocols. It is a good idea to ask how the PRP will be prepared before your treatment.

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PRP for facial skin

The data on PRP for facial skin point in one direction, but they are not conclusive. In a meta-analysis combining nine randomised trials (trials in which participants are randomly assigned to groups) and 358 patients, both patient satisfaction and objective assessment were significantly better in the PRP group than in the control group. There was no significant difference between the two groups in how often side effects occurred.

How large the improvement is remains a separate question. A systematic review covering 24 studies, eight of them randomised, and 480 patients reported that PRP given by injection on its own produced at least a temporary, modest improvement in skin appearance, texture and lines. The degree of improvement was mostly below 50%, and the most convincing evidence was found for skin texture. How long the effect lasts is not known.

A review of 20 articles on PRP and platelet-rich fibrin found the strongest evidence for skin thickness and elasticity, and the weakest evidence for skin hydration. In a randomised trial in which PRP was injected into one side of the face and saline into the other, and data from 19 participants were analysed, dermatologists who did not know which side had received which treatment found no significant difference between the two sides. The participants, however, reported more improvement in texture and lines on the PRP side.

According to an umbrella review (a review of systematic reviews) in this area, 18 of the 28 original studies on which 13 reviews were based had no control group, and confidence in 12 of the 13 reviews was low or very low. Its conclusion: the available evidence is not enough to reach a firm judgement about PRP for facial rejuvenation.

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PRP around the eyes

The area around the eyes is one of the areas of skin where PRP has often been studied, but the results depend on which outcome is looked at. Fine lines, darkening of the skin (periorbital hyperpigmentation) and sun-related skin ageing are assessed separately. In a systematic review and meta-analysis covering a total of 19 studies and 455 patients, combining the data from three randomised trials showed higher satisfaction in people treated with PRP than in the control groups.

The comparisons in this meta-analysis were not all of one kind: PRP was compared with saline, platelet-poor plasma and mesotherapy, and where it was added to laser treatment, it was compared with laser alone. The researchers say that randomised trials with long follow-up, a low risk of bias and no industry funding or conflicts of interest are needed, and that the cause of the darkening being treated should be defined separately.

A more recent systematic review of 26 studies, looking at PRP and platelet-rich fibrin together, reported that these treatments were only moderately effective for darkening around the eyes, and that findings on objective improvement in lines and skin texture were conflicting; it also stressed that variation in preparation methods limits how clearly conclusions can be drawn. In a double-blind split-face study (one side of the face compared with the other) with ten participants, in which neither the participants nor the assessors knew which side had received which treatment, PRP and platelet-poor plasma produced similar improvement in lines around the eyes; neither treatment improved the nasolabial fold (smile line).

These studies measure lines, colour and skin quality, not hollowness or volume loss under the eyes. Under-eye hollows are a separate issue; which of these applies to you is determined at a consultation.

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PRP for acne scars

For acne scars, PRP has mostly been studied not on its own but added to another treatment, and the certainty of the evidence is low. According to an umbrella review of 15 systematic reviews, the data in this area are based on 34 original studies: 10 are parallel-group randomised trials, 21 are split-face studies and 3 are uncontrolled studies (studies with no comparison group). In most of these studies, PRP was used together with microneedling or laser treatment and compared with the same treatment without PRP.

In these studies, the groups that had PRP added showed greater clinical improvement and higher patient satisfaction, and crusting and redness lasted for a shorter time. However, most of the reviews were judged to be of low methodological quality, and the certainty of the evidence for the outcomes was rated as low or very low. According to the researchers, this evidence is not enough to make a clear clinical decision about using PRP together with microneedling or laser treatment.

This has a practical meaning for you: these results come mostly from studies in which PRP was added to another treatment, and they cannot automatically be applied to PRP used on its own. The type and depth of your scars, and which approach might be worthwhile, are assessed at a consultation; active acne is a separate issue.

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PRP for hair loss

In hair loss, PRP has been studied most in androgenetic alopecia (male- or female-pattern hair loss). Randomised trials and meta-analyses report an increase in hair density but show no significant change in hair shaft thickness. Because hair loss also has other causes, whether PRP should be considered is discussed only after the cause of the hair loss has been identified.

A systematic review and meta-analysis bringing together 43 randomised trials in different types of hair loss and 1,877 participants reported that activated PRP increased hair density and reduced relapse (hair loss starting again) compared with placebo (a dummy treatment); adverse effects were more common with non-activated PRP. PRP was found to have no significant effect on hair shaft thickness. The evidence was rated as moderate, and the need for standardised, high-quality studies was stressed.

A smaller meta-analysis that looked only at androgenetic alopecia, covering nine randomised trials and 238 patients, reported that hair density increased at three and six months compared with placebo, but that there was no significant difference from placebo in hair count or hair shaft diameter. A meta-analysis of seven articles focusing on female-pattern hair loss also found an increase in the density of terminal hairs (thick, pigmented hairs), but no significant increase in hair shaft thickness. The researchers advise interpreting these findings with caution until they are repeated in larger groups of patients.

A meta-analysis of nine randomised trials and 451 participants comparing PRP with minoxidil applied to the scalp (topical minoxidil) showed no clear advantage for PRP in the main outcomes, such as hair density, terminal hair count and moderate-to-high hair regrowth, although patient satisfaction was higher in the PRP group. According to reviews of PRP in androgenetic alopecia, differences in centrifugation, activation and application protocols lead to inconsistent results. A review of regenerative treatments (treatments aimed at renewing tissue) also notes that cellular composition is reported inconsistently, follow-up periods are short and there are no data comparing protocols.

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What can’t PRP do?

PRP is not a filler or a lifting treatment: it does not replace lost volume or lift sagging tissue. The outcomes examined in studies relate to skin quality, such as skin texture, fine lines, colour, thickness and elasticity; in a randomised split-face study, no improvement was seen in the nasolabial fold.

The improvement reported in the skin is mostly modest, and it is not known how long the effect lasts. According to the umbrella review of systematic reviews, the evidence is not enough to reach a firm judgement on facial rejuvenation. This does not mean that PRP does not work; it means that current data are not enough to expect any particular result with certainty.

In hair loss, studies report an increase in hair density but show no significant change in hair shaft thickness. The meta-analysis comparing PRP with minoxidil also showed no clear advantage in the main outcomes. In other words, the available data do not show PRP as an option that replaces established hair loss treatments; PRP is regarded as one of the methods whose evidence is still developing.

There is also a commercial side to this field. According to the review of regenerative treatments in androgenetic alopecia, widespread commercialisation, a lack of high-quality evidence and changing regulations make it hard even for doctors to find the right path in this area. The fact that a treatment is widely used does not mean that the evidence for it is strong.

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Known risks

The side effects reported in studies are mostly mild and temporary, such as redness, swelling, bruising and pain at the treatment site. In the randomised trial in which PRP was injected into one side of the face and saline into the other, redness, swelling and bruising were reported often; the researchers stated that these were not related to PRP itself. At 12 months, no participant reported any side effects.

A systematic review of studies that used only PRP for facial rejuvenation also found side effects to be infrequent: bruising and swelling (oedema) from the injections occurred, and occasionally small bumps, flaking and dryness at the treatment site. Side effects reported in hair loss are also described as mild and temporary; examples include pain or redness at the treatment site.

The way PRP is prepared also affects safety: in the large meta-analysis on hair loss, adverse effects were more common with non-activated PRP. In the meta-analysis on skin ageing, there was no significant difference in the frequency of side effects between PRP and the control group.

This information comes from studies, not from this clinic, and it is not a substitute for a risk assessment tailored to you. Which risks are most relevant to you is assessed at a consultation, together with the medicines you take and your health. Before the procedure, you will be asked whether you take blood thinners, antiplatelet medicines (medicines that stop platelets from clumping together) or supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor.

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Rare but serious risks: vascular occlusion and infection

Because PRP is prepared from your own blood, it is often thought to be harmless; the scientific data do not confirm this. A review of adverse events linked to PRP lists infection after the procedure, blindness, inflammation, allergic reaction and the development of nodules (small lumps under the skin); the most frequently reported event is infection. PRP cannot be sterilised in the way medicines are, so it is important to prevent contamination with germs at every step, from taking the blood to giving the treatment. Most of these reports are case reports on individual patients, and better-quality data are needed to establish cause and effect.

Vision loss has also been reported after PRP injections in the face. In one patient, after PRP was injected into the frown lines (glabellar lines), vision loss developed in one eye because of a blocked artery supplying the eye; imaging showed ischaemia (when tissue is not getting enough blood) in the muscles that move the eye, and infarction (tissue damage caused by loss of blood flow) in the optic nerve and some areas of the brain. Another publication describes four patients who developed permanent blindness because of a blocked artery supplying the eye after PRP injections given by beauty practitioners who were not doctors; in three patients the injection was given between the brows, and in one into the nasolabial fold.

These reports are rare and do not tell us how often such events occur; however, they show that the blood vessels of the face matter not only for fillers but for any fluid that is injected.

Blood-borne infections are a separate issue. In a public health investigation in the US, HIV infection was found in four former clients who had a facial microneedling treatment with PRP at an unlicensed spa, and in the sexual partner of one client; the virus samples were found to be very similar to one another. The investigation showed that the spa had not followed recommended infection control practices and had not kept client records.

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When is caution needed?

Scientific publications do not contain a widely accepted consensus on contraindications (reasons not to have the treatment) specific to PRP in dermatology; the most detailed work on this subject was prepared for musculoskeletal injections. According to this statement, which an international PRP research group prepared using a formal consensus method, PRP can act as a carrier for some diseases, and its composition can change depending on a person’s medical conditions. The coexisting conditions that stand out in this respect are infection, cancer and blood disorders.

The consensus statement consists of four general principles and 23 recommendations. Of these recommendations, 10 relate to infectious diseases (such as viral and bacterial infections, dialysis, medicines that suppress the immune system and dental treatment), 5 to cancer (such as a local tumour, or cancer that has been cured, is active or is in remission) and 8 to blood disorders (such as low blood cell counts). The authors state clearly that, because there are few data on this subject, the recommendations are largely based on expert opinion.

This statement was not written for treatments on the face or scalp, so it would not be right to read its topics as a checklist of whether PRP is suitable for you. Its main message is this: even though PRP is prepared from your own blood, your general health and the medicines you take are part of the assessment. If you have a chronic illness or a blood disorder, or take any medicines regularly, always tell your doctor about them at the consultation. Whether the treatment should be postponed or not done at all is decided through a medical assessment.

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