Platelet Rich Plasma (PRP)

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In today’s world, the need for a firm, youthful skin is huge and is increasing by the day. The clinical signs of facial aging include wrinkles, open pores, pigmentation, and sagging. These are caused by changes in all layers of skin, loss of subcutaneous fat, downward migration of the fat pads, increased sebum and melanin production, and change in the bony structure. Skin aging is affected by a number of intrinsic and extrinsic factors. There are striking similarities between the events involved in wound healing and those that could effectively address the effects of intrinsic and extrinsic skin aging. It has been assumed that skin aging is analogous to a wound that is sufficiently extensive to overwhelm the skin’s repair mechanisms, which becomes attenuated with age.

The use of platelet-rich plasma (PRP) as a treatment modality for skin rejuvenation has been increasing rapidly over the past decade. Platelets become the logical choice for replacement and renewal of cells, tissues, or organs due to low invasiveness/high healing, easy availability, and abundance in growth factors. PRP is considered to be a growth factor cocktail, which promotes wound healing, angiogenesis, and tissue remodeling.

Studies have shown that PRP has around 578 different types of proteins like platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor beta (TGFβ).These proteins and growth factors can stimulate stem cells and improve cellular proliferation, differentiation, and regeneration, hence, leading to skin rejuvenation and hPRP can activate fibroblasts and synthesize collagen and other elements of the extracellular matrix and hence becomes an attractive option for skin rejuvenation and scar attenuation. The use of PRP as monotherapy for skin rejuvenation, acne scars, periorbital rejuvenation, lipofilling, and in combination with fractional CO2 and other resurfacing modalities is increasing rapidly. 

The application of PRP monotherapy for rejuvenation of aging facial skin was evaluated in 518 patients across three studies.Two studies performed single session, whereas one study performed two to four sessions depending on the age of the patient. The infraorbital area, nasolabial folds, and crow’s feet areas were the most commonly injected; other areas of treatment included the forehead/malar region, the preauricular region, and the jaw region. All studies performed intradermal injections; in addition, Yuksel et al. used a Dermaroller (Cynergy, Carson City, Nev.) and draped each patient’s face in gauze soaked in platelet-poor plasma for 30 minutes. Follow-up periods ranged from 1 week to 1 year. Studies within this review confirmed PRP to be beneficial for rejuvenating aging facial skin. Results showed improvements in the volume, texture, and tone of facial skin and decrease both fine and deep wrinkles.

To evaluate the effect of multiple needle punctures during PRP, serial puncture PRP injections were compared to saline injections in 127 patients. PRP injections resulted in significantly greater improvements in skin texture, tone, wrinkles, and dermal collagen compared to saline though plain saline injections also lead to increase in dermal collagen and improvement in skin sallowness to some extent.

PRP appears to be safe, with a low-risk profile. The commonly reported side effects include pain during injections, erythema, edema, and bruising.

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