Platelet rich plasma is a promising therapy in dermatology and aesthetic medicine. In this article we will discuss the
pros and cons of platelet rich plasma (PRP) and the usage of PRP in aesthetics. PRP is especially used for conditions
like facial and neck rejuvenation, fine lines and wrinkles, abdominal striae and facial scarring.

Usage of platelet rich plasma (PRP) in aesthetic
medicine is a new concept. In dermatology and
cosmetic medicine, PRP has been used to treat acne,
scarring, and alopecia (especially in women). It is also
effective for skin rejuvenation and tightening around
the eyes. Before injecting PRP to treat hair loss, a tiny
scalp roller with spikes is used to stimulate the thinning
areas. The rationale is that this sends a message to the
hair follicles to start the healing process. Then, PRP
is injected over the affected area to further stimulate
stem cells in the follicle. Platelet-rich plasma is injected
by multiple tiny punctures under the dermis, with or
without topical local anesthesia [1,2]. The process is
painless if sufficient topical anesthesia is applied. When
PRP is injected into the damaged area, it stimulates
the tissue, causing mild inflammation that triggers the
healing cascade. As a result, new collagen begins to
develop. As this collagen matures, it begins to shrink
and tightens and strengthens the skin. Improvement
in skin texture and tone is noticeable within 3 weeks.
Full collagen regeneration requires 3 months [3,4]. The
PRP treatments can be used on all skin types and tones.
Minimal swelling, bruising, and redness for the initial
12 to 24 hours are expected. A bruise at the needlestick
site may be visible for 2 to 3 days. Swelling from the
fluid is what the patient will notice first. During several
weeks, the platelets stimulate growth factors, which
assists in more collagen stimulation. Treatment results
vary but last up to 18 months in most patients.
In PRP, activated platelets release many other bioactive
proteins responsible for attracting macrophages and
mesenchymal stem cells. Inside the platelet are two
types of granules, namely, alpha granules and dense
bodies. Alpha granules contain the clotting and
growth factors that are released in the healing process.
Normally at the resting state, platelets require a trigger
to activate and become a participant in wound healing
and hemostasis.Growth factors and other cytokines in
platelets include the following: platelet-derived growth
factor, transforming growth factor, fibroblast growth
factor, insulinlike growth factor 1, insulin like growth
factor 2, vascular endothelial growth factor, epidermal
growth factor, interleukin 8, keratinocyte growth factor,
and connective tissue growth factor [5,6]. The platelets
secrete growth factors, including platelet-derived growth
factor and vascular endothelial growth factors. Plateletderived
growth factor is one of numerous growth factors
or proteins that regulate cell growth and division [7-9].
In particular, it has a significant role in the formation
of blood vessels (angiogenesis) and the growth of blood
vessels from already existing blood vessel tissue. Vascular
endothelial growth factor is a chemical signal produced
by cells that stimulates the growth of new blood vessels.
It is part of the system that restores the oxygen supply
to tissues when blood circulation is inadequate.

Advantages of using PRP for aesthetic medicine include
the following: tissue regeneration and rejuvenation,
induction of cell differentiation, extracellular matrix
formation, recruitment of other cells to the site
of injury, and an increase in collagen production,
which can increase skin thickness and overall skin
health [10,11]. In addition, PRP is nonallergenic, is
an autologous physiological product, eliminates donor
transmissible infections, and is a biological glue for
tissue adhesion, especially in skin flaps, bone grafts,
and trauma.
Alhough PRP is a promising therapy for most patients,
the practitioner must take into account some
considerations during the initial assessment before
suggesting this treatment. Contraindications include
the following: sepsis, cancer, chemotherapy, platelet
dysfunction syndrome, critical thrombocytopenia,
hypofibrinogenemia, hemodynamic instability,
anticoagulation therapy, acute and chronic infections,
chronic pathological conditions of the liver, severe
metabolic and systemic disorders, and skin disease
(systemic lupus erythematosus, porphyria, and
allergies), as well as heavy nicotine, drug, and alcohol
consumption. Adverse effects of PRP treatment may
occur, some of which are significant. The most common
adverse effects are infection, skin discoloration and
bruising, pain in the injected area, allergic reaction (a
rare occurrence), and blood clot (because PRP therapy
uses a needle, a vein could be damaged). Certain factors
(eg, smoking and alcohol intake) diminish stem cell
release. Avoiding these will increase the success of
the PRP procedure. The platelets work by causing an
inflammatory reaction. If this inflammatory reaction
is diminished, the clinical outcome is significantly
compromised [12,13]. For this reason, the use of
anti-inflammatory drugs is not recommended. This
restriction should be in place for about 1 to 2 weeks.
Platelet concentration is a rich source of various
cytokines and growth factors, which are activated after
its injection into the target tissue. Platelets are activated
endogenously by coagulation factors (in some methods
of preparing PRP, the activated PRP is injected to the
tissue). Following their attachment to special receptors
on the cell surfaces, some intracellular processes are
activated, that facilitate extracellular matrix (ECM)
accumulation and improve cell proliferation and
differentiation. Tissue regeneration is resulted from cell
proliferation, angiogenesis and cell migration [14,15].
Matrix metaloproteinas proteins (MMP) are involved
in aging process by degradation of collagen and other
extracellular matrix (ECM) proteins, this characteristic
can be used to benefit rejuvenation. They can help
regeneration of dermis through omission of collagen
fragments that are harmful to the dermal connective
tissue, and so, provide an appropriate foundation
for new collagen deposition. In some studies aPRP
(activated PRP) increases the expression of MMP-1
and MMP-3 protein. Thus, aPRP may cause ECM
remodeling through stimulating the removal of photodamaged
ECM components and inducing the synthesis
of new collagen by fibroblasts, which are in turn
proliferated by their stimulation. Another mechanism
of PRP for skin rejuvenization, is through acceleration
of hyaluronic acid production. Hyaluronic acid absorbs
water and makes hyaluronic acid matrix swelled which
increases skin volume and turgor. It also promotes cell
proliferation, extracellular matrix synthesis and helps to
the adjustment of the collagen fibers diameter. Overall,
it could enhance skin elasticity [16,17]. All these
processes and some other unknown ones contribute
to tissue rejuvenation through PRP.
Platelet Rich Plasma (PRP) is used for stimulation
of both superficial and deep dermis layers. For
superficial stimulation, the injection must be done
in the superficial dermis. The PRP must be injected
into the deep dermis or subdermal tissues when using
as filler. The superficial injection might be done just
like mesotherapy technique in order to improve the
skin texture, volume and hydration. The technique
is easy to be performed and has no important sideeffects
[18,19]. Side-effects might appear from mild
bruising and occasional swelling to rarely infections.
Compared with other skin rejuvenation therapies,
the clinical experience using PRP can result in skin
rejuvenation and global facial volumisation. PRP is
a form of bio-stimulator that is safe and creates an
immediate, long lasting volumetric effect with natural
looking results.
To prepare PRP, a small amount of blood is drawn
from the patient’s arm. The blood is then placed in a
centrifuge that spins at high speed and separates the
platelets from the rest of the blood components. The
typical baseline blood platelet count is approximately
200 000 per microliter; therapeutic PRP centrifuges
concentrate the platelets by roughly 5-fold. However,
broad variability exists in the production of PRP by
various concentrating equipment and techniques. The
platelets collected in PRP are activated by the addition of thrombin and/or calcium gluconate, which induces
the release of these factors from alpha granules. The
entire process takes less than 15 minutes and increases
the concentration of platelets and growth factors up to
600%, along with an inherent rise in human stem cell
proliferation due to exposure to concentrated platelets
up to 10 times above native levels. The concentrated
PRP is then injected into and around the affected
area, jump-starting and significantly strengthening the
body’s natural healing signals. Injections of PRP heal
the area over time, during 1 to 3 months. Because the
patient’s blood is used, there is no risk of a transmissible
infection and a low risk of allergic reaction.
Aging of the skin, dermal components, and cells means
that the skin texture and appearance deteriorate and
have been damaged [20].Aging affects the hands and
soft tissue of the face, neck, and decollete. This is
characterized by sagging jowls, thinning of the skin,
puffiness, age spots, and wrinkling.In dermatology
and cosmetic medicine, PRP has been used to treat
acne, scarring (Figs 1A and B), and alopecia (especially
in women). It is also effective for skin rejuvenation
and tightening around the eyes (for thin crepe-like
skin and fine lines) and in the following areas: cheeks
and midface, thinning skin on the neck, jawline
and submalar regions, back of hands, decollete, and
others (eg, knees, elbows, and upper arms, as well as
for postpregnancy skin laxity). Platelet-rich plasma is
injected by multiple tiny punctures under the dermis,
with or without topical local anesthesia. The process
is painless if sufficient topical anesthesia is applied.
When PRP is injected into the damaged area, it
stimulates the tissue, causing mild inflammation that
triggers the healing cascade. As a result, new collagen
begins to develop [21]. As this collagen matures, it
begins to shrink and tightens and strengthens the skin,
as well as the tendons and ligaments of the damaged
area when it is injected at that level. Improvement in
skin texture and tone is noticeable within 3 weeks.
Full collagen regeneration requires 3 months. Topical
skin care and light therapies can enhance these
results. Advanced wrinkling cannot be reversed, and
severe scarring may not respond to treatment. In my
experience, surgical scars respond well cosmetically.
The PRP treatments can be used on all skin types and
tones. Minimal swelling, bruising, and redness for the
initial 12 to 24 hours are expected. A bruise at the
needlestick site may be visible for 2 to 3 days. Swelling
from the fluid is what the patient will notice first.
During several weeks, the platelets stimulate growth
factors, which assists in more collagen stimulation.
Treatment results vary but last up to 18 months in
most patients. Biannual touch-up treatments will
maintain the results. As an initial treatment strategy,
up to 3 injections may be given within a 6-month
time frame. These are usually performed 2 to 3 weeks
apart. Certain factors (eg, smoking and alcohol
intake) diminish stem cell release. Avoiding these
will increase the success of the PRP procedure. The
platelets work by causing an inflammatory reaction.
If this inflammatory reaction is diminished, the
clinical outcome is significantly compromised. For
this reason, the use of anti-inflammatory drugs is not
recommended. This restriction should be in place for
about 1 to 2 weeks. Proponents of PRP therapy argue
that negative clinical results are associated with poorquality
PRP harvest or concentration by inadequate
devices. The specification that gathering devices
capture a percentage of a given thrombocyte count
is a marketing bias because significant individual
variability exists in the platelet concentration of human
plasma [22]. More is not necessarily better in this case.
Variability in platelet concentrating techniques may
alter platelet degranulation characteristics, which could
affect clinical results.
There are various uses of PRP in aesthetic medicine:
• PRP has made the most significant progress in the
facial area. Platelet Rich Plasma (PRP) with fat
transfer is the surgical combination of injecting
a patient’s own plasma containing growth factors
along with their own purified fat to augment areas
of lost volume and wrinkles on the face.
• Containing beneficial growth factors, PRP may
additionally be used with fat transfer or subcision to
re-plump areas of lost volume or depressed scarring from acne or trauma [23]. Subcision surgically
releases the pulled down portion of the scar from
within, inducing the body’s healing response to
create blemish free skin cells.Combined with fat
transfer, PRP softens the appearance of depressed,
roling scars.
• The latest facial rejuvenation procedure is the face
lift which combines the power of new PRP
technology and facial fillers to minimize the signs of
facial aging. This non- surgical procedure promotes
new tissue growth to improve overall facial skin
tone for a more youthful appearance. The PRP is
combined with a facial filler and then re- injected
into areas of concern around the face [24]. Patients
benefit from this procedure as there is minimal
downtime and results can last for over a year. The
true “lift” effect is achievable with a combination
of fillers, layered with the PRP serum. The fillers
provide an instant fill or volume correction and
the PRP – injected above the filler – immediately
kick-starts a skin regeneration process. Patients can
see and feel the effects within minutes as their skin
becomes tauter and smoother.The use of PRP with
fillers not only enhances the skin tone and texture,
but prolongs the effective filler correction for 3 to
6 months longer than when fillers are used alone.
Monthly intradermal injections of PRP in 3 sessions
have shown satisfactory results in face and neck
rejuvenation and scar attenuation. A study showed
that a combination of fractional non-ablative
(erbium glass) laser therapy with topical application
of PRP, resulted in objective improvement in skin
elasticity, a lower erythema index and an increase in
collagen density as well. Histological examination
showed an increase in length of dermoepidermal
junction, amount of collagen and fibroblasts in the
treated skin.
• Patients who don’t want or need fillers can benefit
from PRP. The activated PRP serum can be injected
just under the skin surface to stimulate the body to
make a small amount of its own ‘filler’. Although
this will not approximate the same results as one
gets from a gel filler, some improvement in textural
changes can be seen.
• PRP in combination with fractional ablative lasers
(carbon dioxide) for deep wrinkles and severe
photodamaged skin, has also been shown to
reduce commonly encountered, transient adverse
effects and decrease the downtime. Fractional laser
treatments are known for their ability to retexture
skin. Adding PRP takes laser resurfacing to a new
level by accelerating healing and increasing desired
new collagen formation. Following your laser
treatment,activated PRP serum is applied to skin
that is ideally suited to accept the wound-healing
platelet serum.
• PRP can also be used as ‘PRP Facial’(Figs 2A
and B) which consists of PRP applied to skin that
has been prepared by an automatic microneedle.
Thise micro-needling makes tiny “wounds” in
the skin which accept the PRP serum and begins
the process of collagen creation along with the
tissue enhancement from growth factors found
in the plasma serum. The micro needling based
procedure is also producing great results in terms
of minimizing the appearance of both scarring
and stretch marks.In scarring, the micro needling
is used to break up the fibrous tissues of the scar
and the PRP spurs the growth of healthy tissue.
For stretch marks, micro needling creates damage
over the thinned skin of the stretch mark. PRP then
promotes growth of thicker skin (Figs 2A and B).
Advantages of PRP Rejuvenation
• Uses bodys own natural platelets so there is no risk
of allergic reaction
• Natural collagen is formed in response to the
presence of the activated platelets
• PRP is ideal for the patient who does not want any
synthetic fillers
• There is little to no swelling, bruising or lumping as
the fluid assimilates in the natural skin environment
• PRP can be used to enhance Laser procedures for
faster and improved healing
• PRP Therapy is equally as effective in men as in
women
Figure 2: (a and b) Pre and post treatment of a 24 years old girl after

• Can provide outstanding results either with or
without the use of underlying fillers.
CONCLUSIONS
As with all therapies, adequate training and experience
are paramount. The beauty of the PRP technique,
especially in dermatology and as an adjunctive tool in
practice, is that it can be used as part of a multifaceted
or layered approach. Significant clinical outcomes can
be obtained with concomitant use of light therapies,
fillers, and mesotherapy. Due to limited studies on
clinical efficacy and safety, further studies are required
to investigate the mechanism of action behind the
therapeutic effects of these products and their long
term safety.Still,the PRP has certain limitations as there
is no standardisation in PRP preparation and specific
quality parameters in PRP preparation are still lacking.