Use of Platelet-Rich Plasma for Skin Rejuvenation

Platelet-rich plasma (PRP) is autologous blood plasma with a concentration of platelets well above baseline. The usual concentration of platelets in the blood is approximately 150,000 to 400,000 platelets per cubic microliter. PRP contains 4-7 times the physiologic concentration of platelets.

PRP is prepared by centrifugation of blood drawn from the patient before any procedure or surgery. Some of the growth factors that PRP contains are: 

• Platelet-derived growth factor: can initiate connective tissue healing, increases mitogenesis and angiogenesis and enhances collagen synthesis. 
• Transforming growth factor-β: increases chemotaxis and stimulates deposition of collagen matrix. 
• Fibroblast growth factor: stimulates angiogenesis, proliferation of myoblasts and promotes migration of fibroblasts.
• Epidermal growth factor: increases proliferation of mesenchymal cells, epithelial cells and stimulates differentiation of epithelial cells. 
• Keratinocyte growth factor: stimulates epithelization.
• Vascular endothelial growth factor: increases vascular permeability, enhances endothelial cell migration and proliferation.

Platelet-rich plasma is obtained by enriching blood with an autologous concentration of platelets. An attractive component of PRP is its high concentration of growth factors, including platelet-derived growth factor, transforming growth factor, vascular endothelial growth factor, and epithelial growth factor.

Application of PRP for Skin rejuvenation

Use in conjunction with microneedling

Microneedling is the result of multiple, often oscillating needles causing damage to the skin, which then induces the skin itself to repair by collagen stimulation. They reach the papillary and reticular dermis in a purely mechanical way. Therefore, there is preservation of stratum corneum and the epidermal barrier function, leading to the lack of scarring.

This trauma alone can activate the healing process. Immediately following the injury, fibroblasts inundate the region for wound healing, stimulating endothelial cells and starting the process of angiogenesis, as well as elastin and collagen production. Commonly termed collagen induction therapy, microneedling has been used to improve the appearance of acne scarring, skin discoloration, melasma, fine lines, wrinkles and facial scars. When used in conjunction with PRP, its effects can be potentiated and can help improve skin elasticity.

Microneedling therapy, also known as collagen induction or percutaneous collagen induction, is an increasingly popular treatment modality for skin rejuvenation. This approach employs tiny needles to puncture the skin and stimulate local collagen production minimally invasive. Clinicians have incorporated the use of platelet-rich plasma (PRP) to augment cosmetic outcomes. 

Microneedling devices have expanded in recent years and include needles ranging in length from 0.25 mm to 3.0 mm. Treatment with micro-needling promotes skin rejuvenation by creating small puncture wounds in the epidermis and dermis. This injury triggers the wound healing cascade and alters the modulation of growth factors to promote regenerative effects. 

Following micro-needling therapy, increases occur in elastic fiber formation, collagen deposition, and dermal thickness. The treatment preserves the overall integrity of the epidermal layers and basement membrane, allowing the epidermis to heal without abnormality.

Microneedling has demonstrated several uses beyond general skin rejuvenation. In patients with atrophic acne scars, therapy can improve scar appearance, skin texture, and patient satisfaction. Hypertrophic and hypopigmented burn scars on the body, face, arms, and legs have shown to be receptive to repeated treatments. Micro-needling promises to effectively treat androgenic alopecia by increasing hair regrowth in patients who previously showed poor response to conventional therapy with minoxidil and finasteride. 

Use as facial injection

PRP is commonly injected to the face and neck to help increase facial volume through collagen stimulation. This injection can be either intradermal or subdermal, or a combination of the two. PRP injections have been shown to improve the skin color and texture as well as the depth of fine lines and wrinkles through an increase of dermal collagen. 

In general, these treatments are done at 4- to 6-week intervals and repeated at least 3-5 times, or until the desired result is achieved. Additional procedures for maintenance are performed in a timeline that is spaced out for maintenance.

Microneedling with PRP and injections of PRP can be combined during the same treatment. For most patients, microneedling will help the overall skin texture, whereas injections will further help collagen stimulation from the deeper tissues, helping to improve volume.

Patients should always avoid direct sunlight immediately after and for at least 2 weeks following the procedure. Sun protection should always be used. Hydration of the skin is also important and can be achieved with a variety of hyaluronic acid serums.

PRP is increasingly being utilized for hair loss, scarring and facial rejuvenation. Currently, PRP appears to be safe with no long-term side effects noted. It may be used synergistically with existing treatment options with added benefit.

Clinical Studies

Because of the regenerative effects of these proteins, PRP has been investigated as a modality to augment wound healing in a variety of clinical areas, such as maxillofacial surgery, orthopedics, cardiovascular surgery, and treatment of soft tissue ulcers.

Several studies have compared the effects of micro-needling with and without the application of PRP. Asif et al. performed a split-face comparison study of 50 patients with atrophic acne scars. On the right side, micro-needling was performed followed by intradermal injections and topical application of PRP. On the left side, micro-needling was performed, followed by intradermal injection of distilled water. The study included three treatment sessions with 1 month between each. Scars on the right side improved by 62.2%, and scars on the left side improved by 45.8%. Before treatment, both sides demonstrated similar severity scores. Still, final severity scores were significantly reduced in the micro-needling plus PRP group relative to the micro-needling plus distilled water group.

Microneedling therapy continues to evolve with a range of applications now emerging in dermatology. As PRP has gained popularity, there has been increased interest in its utilization to amplify the regenerative effects of micro-needling. 

Although the number of direct comparisons examining micro-needling with and without PRP is limited, the available evidence indicates that the addition of PRP may improve cosmetic outcomes. 

These results have been demonstrated primarily in managing acne scars, but favorable effects may extend to other indications.

Sources:

Peng, G. L. (2019). Platelet-Rich Plasma for Skin Rejuvenation. Facial Plastic Surgery Clinics of North America, 27(3), 405–411.

Hashim PW, Levy Z, Cohen JL, Goldenberg G. Microneedling therapy with and without platelet-rich plasma. Cutis. 2017 Apr;99(4):239-242. PMID: 28492598.

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