Yingtai: The Application of PRP in Facial

Yingtai: The application of PRP in facial

The application of PRP in facial rejuvenation aims to reverse the skin issues brought about by the passage of time. Over time, factors both internal and external lead to thinning of the epidermis, reduction of collagen, and loss of subcutaneous fat, resulting in thinner skin with decreased strength, elasticity, and regenerative potential. Facial rejuvenation can be achieved through various means, such as rhytidectomy and dermal fillers, which directly alter or supplement aging tissues; while microneedling and lasers combat natural aging by stimulating tissue regeneration through minimally invasive methods. Platelets play a crucial role in the inflammatory and proliferative phases of wound healing and possess regenerative properties. Platelet-Rich Plasma (PRP) products have a platelet concentration approximately 4 to 7 times higher than baseline. PRP preparations can be categorized into four types based on the content of white blood cells and fibrin .

PRP has a low fibrin content, while Rich Platelet Fibrin (PRF) has a high fibrin content. PRP is in a liquid state after preparation, making it easier for subcutaneous injection and is the preferred choice for most facial rejuvenation procedures. It can be activated with calcium chloride or thrombin to obtain a gel-like form similar to PRF, and the activation of PRP leads to degranulation and the release of various adhesion molecules and growth factors. Among these regenerative cytokines, Platelet-Derived Growth Factor (PDGF), Transforming Growth Factor-beta (TGF-β), Fibroblast Growth Factor (FGF), Epidermal Growth Factor (EGF), and Vascular Endothelial Growth Factor (VEGF) enhance collagen synthesis, stimulate cell proliferation, and increase chemotaxis. However, few studies have been able to quantify the concentration of these growth factors .

There is still debate in the academic community about the role of PRP in facial rejuvenation. When used as an adjunct in facial rejuvenation, PRP is theoretically capable of reducing postoperative recovery time, decreasing the incidence of complications, and enhancing aesthetic outcomes. However, since the clinical application of PRP is relatively new, most of the evidence comes from in vitro studies, and these theoretical advantages lack sufficient clinical validation .

It is believed that as PRP applications become more widespread, its role in facial rejuvenation will be clarified. Both PRP and PRF can be used alone as natural bioactive fillers for intradermal or subcutaneous injection. They have similar mechanisms of action, activating dermal fibroblasts, increasing collagen production, and promoting hyaluronic acid deposition . The extracellular matrix remodeling effect of PRP has been confirmed in vitro experiments . As mentioned earlier, PRF, due to its cross-linked fibrin scaffold, is more viscous in form. Unlike hyaluronic acid fillers, PRF is not easily dissolved, and special attention should be paid to aspiration before each injection .

The number and interval of PRP facial injections depend on individual experience, generally recommending 3 to 5 injections, spaced 4 to 6 weeks apart, to achieve a loading response, followed by a personalized maintenance plan . Some combine hyaluronic acid fillers with PRP injections, believing that the addition of PRP will promote cell differentiation and skin growth, maintaining volume even after the hyaluronic acid is absorbed. This filler, also known as "vampire facial" because it is derived from blood, has been used in facial rejuvenation .

Alam et al. conducted a randomized controlled trial recruiting volunteers with facial skin aging at Glogau level II or above. Each volunteer received 3mL of PRP or sterile saline intradermally on both cheeks, with neither the volunteers nor the researchers knowing the injection groups. Although dermatologists could not discern differences in skin pigmentation and texture between the saline and PRP sides, patients self-reported a significant reduction in wrinkles on the PRP side after a 6-month follow-up . Similarly, Yuksel et al. found that patient ratings were more optimistic than dermatologist ratings. They recruited 10 patients who received 3 PRP facial injections of 1.5mL each, spaced 2 weeks apart, with the forehead, cheekbones, and chin areas treated with a dermaroller microneedle, and crow's feet treated with a 27-gauge syringe. Three months after the treatment, dermatologists only found a significant improvement in skin firmness, while patients claimed a significant improvement in overall appearance, skin firmness, and wrinkles . It should be noted that noticeable changes often take several months to become apparent, and the duration of these changes is unclear . Neither of these studies found that PRP injections could improve pigmentation. To our knowledge, apart from individual case reports, there is no evidence that PRP alone can cause changes in pigmentation . Interestingly, some have found that PRP injections can be used to treat under-eye dark circles. Dark circles are caused by excessive pigmentation or thin skin. Since PRP has not been found to affect pigmentation changes, the mechanism by which PRP improves dark circles may be related to its ability to increase skin thickness .

A study assessing the efficacy of soft tissue fillers and PRP combined use found that 75 patients who received a combination of hyaluronic acid and PRP all achieved good aesthetic results, with no severe complications, indicating that the addition of PRP may be safe and does not affect the cosmetic effects of the filler . In the field of orthopedics, several studies have been conducted on the combined use of hyaluronic acid and PRP for the treatment of osteoarthritis, also finding few complications with this mixture . Nevertheless, it is currently unclear how the aesthetic effects of PRP compare to the use of fillers alone, and it is also unclear whether PRP can truly maintain the volume of the filler . Fractional laser resurfacing damages a small amount of local tissue in a dot matrix pattern, causing partial ablation of the epidermis and the pigment-producing cells it contains, thereby stimulating adjacent healthy tissue to refill the damaged area. At the same time, the laser also generates heat in the dermis, leading to contraction and deposition of collagen. The resulting reduction in pigmentation and increase in skin firmness are used to reverse skin aging .