Platelet-Rich Plasma Injections For Face: The Good, The Bad, The Beautiful, & The Ugly
A friend asked me to comment on the dangers and positive potentials of Platelet-Rich Plasma injections for the Face.
Though I am not a dermatologist, I have been looking into using PRP for my severe dry eye patients. There are some things everyone should know about PRP for the face.
1. All cosmetic procedures have risks.
2. Nothing is 100% guaranteed
3. There is a risk of infection, scar formation, increased skin pigmentation (1 case I could find in the literature) and making things worse
4. The literature, even the best performed study gives part of the truth, but you may fall in the complication group, so always keep that in mind.
5. Some studies are sponsored by the industry that is trying to encourage you to part with your hard earned cash. Be always aware of studies that show “glowing results.” Also be careful with doctors who have stock in a company or are paid consultants by the company. Their suggestions may be swayed by who is paying them.
6. I am personally a bit skeptical of cosmetic surgery outcomes results since there is a lack of objective measures in cosmetic surgery studies from what I can see. A statement of “am I better or not” is often left to the patient in some studies without objective, standardized measures of “improvement” or “more beautiful.” Note that if a patient has just paid thousands of dollars for a treatment, they may be more inclined in some populations to say “they look better.” But some studies did have some objective measures of “more pimples or scars per square mm of face.” Look carefully at results for objective measures of success.
Background:
Platelet-rich plasma (PRP) has been used over the last several years as an effective treatment in various medical and surgical fields. I am currently looking to use PRP for my severe dry eye patients. There are publication about the use of PRP in wound treatment, maxillofacial surgery, soft tissue injuries, periodontal and oral surgery, orthopedic surgery, trauma surgery, gastrointestinal surgeries, burns, cosmetic and plastic surgery. PRP specifically has attracted the attention of dermatologists in the aesthetic field for skin rejuvenation for many years now.
A patient’s blood is drawn, and the platelets are isolated. PRP contains a high concentration of several growth factors in α-granules of platelets, secreted after the activation of platelets by aggregation initiators. Several growth factors and cytokines work in the stimulation process of fibroblast collagen synthesis, which can help modify cell structure.
So here is what I found:
1. Many studies published were not in the US. Most of these studies did not say if the authors were consultants to any company. See references below.
2. Most studies in the last years were very positive.
3. 1 study below reported increased pigmentation in the skin of a patient having PRP injections of the face.
4. It is important to go to a reputable/safe doctor to avoid complications.
Most Studies have the following statements & conclusions:
Side-effects such as mild bruising/ecchymosis (black& blue changes on skin)/hematoma (blood clot under skin), occasional swelling, mild or prolonged erythema (redness), burning sensation, and rarely infections were reported. I found 1 case report below of increased skin pigmentation after PRP for the face. Mild erythema occurred probably due to calcium chloride. Mild and transient side effect such as bruising/ecchymosis, burning sensation, mild erythema, and severe erythema were observed in the present study. We did not observe any serious side effects due to PRP. We considered that PRP is a safe choice as a cosmetic procedure for facial skin rejuvenation.
PRP increases dermal collagen levels not only by growth factors, but also by skin needling (the mesotherapy technique ‘point by point’). PRP application could be considered as an effective (even a single application) and safety procedure for facial skin rejuvenation.
In Conclusion:
Platelet-Rich Plasma Injections For Face is safe in the majority of patients but it is not 100% without risk of complications.
Be sure you go to an MD who you can trust and is not out there just to make money on this
treatment.
Sandra Lora Cremers, MD, FACS
References:
Does Platelet-Rich Plasma Therapy Increase Pigmentation?
- 1Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey.
Abstract
Platelet-rich plasma (PRP) is an autologous solution of plasma containing 4 to 7 times the baseline concentration of human platelets. Platelet-rich plasma has been widely popular in facial rejuvenation to attenuate wrinkles and has been practically used. The authors have been encountering various patients of increased hiperpigmentation following PRP applications that were performed to attenuate the postinflammatory hiperpigmentation especially after laser treatment. The authors have been using PRP for facial rejuvenation in selected patients and in 1 patient the authors have encountered increased pigmentation over the pigmented skin lesions that were present before the application. The authors recommend that the PRP might increase pigmentation especially in the face region and precautions might be taken before and after the application. Platelet-rich plasma should not be used for the treatment of post inflammatory hiperpigmentation.
Histologic Evidence of New Collagen Formulation Using Platelet Rich Plasma in Skin Rejuvenation: A Prospective Controlled Clinical Study.
- 1Department of Dermatology, Acıbadem Fulya Hospital, Istanbul, Turkey.
- 2Department of Dermatology, Eskisehir Military Hospital, Eskisehir, Turkey.
- 3Department of Pathology, Anadolu Medical Center, Kocaeli, Turkey.
- 4Department of Dermatology, Yunus Emre Government Hospital, Eskisehir, Turkey.
- 5Department of Pathology, Eskisehir Military Hospital, Eskisehir, Turkey.
- 6Department of Dermatology, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey.
Abstract
BACKGROUND:
Platelet-rich plasma (PRP) is an autologous concentration of human platelets contained in a small volume of plasma and has recently been shown to accelerate rejuvenate aging skin by various growth factors and cell adhesion molecules.
OBJECTIVE:
This study was conducted to evaluate the efficacy and safety of intradermal injection of PRP in the human facial rejuvenation.
METHODS:
This study was a prospective, single-center, single-dose, open-label, non-randomized controlled clinical study. PRP injected to the upper site of this right infra-auricular area and all face. Saline was injected to the left infra-auricular area. Histopathological examinations were performed before PRP treatment, 28 days after the PRP, and saline (control) treatments.
RESULTS:
Twenty women ranging in age from 40 to 49 years (mean age, 43.65±2.43 years) were enrolled in the study. The mean optical densities (MODs) of collagen in the pre-treatment, control, and PRP-treated area were measured. They were 539±93.2, 787±134.15, 1,019±178, respectively. In the MOD of PRP, 89.05 percent improvement was found when MOD of PRP was compared with MOD of pre-treatment. The mean MOD of collagen fibers was clearly highest on the PRP side (p<0.001). The PRP-to-saline improvement ratio (89.05% to 46.01%) was 1.93:1. No serious side effects were detected.
CONCLUSION:
PRP increases dermal collagen levels not only by growth factors, but also by skin needling (the mesotherapy technique ‘point by point’). PRP application could be considered as an effective (even a single application) and safety procedure for facial skin rejuvenation.
Platelet-rich plasma and hyaluronic acid – an efficient biostimulation method for face rejuvenation.
- 1Department of Plastic Reconstructive and Aesthetic Surgery, Balikesir University, Balikesir, Turkey. betul.ulusal@gmail.com.
Abstract
BACKGROUND:
Cosmetic applications of platelet-rich plasma (PRP) are new, and reports are scarce and dispersed in the literature. There are a variety of commercially available kits and injection techniques, and the number and intervals of injections vary. New investigations should focus on developing a standardized procedure for PRP preparation and application methods to augment its efficacy and potency.
OBJECTIVES:
In this report, we aim to provide data and commentary to assist and add to current guidelines.
METHODS:
A series of 94 female patients with varying degrees of facial aging signs were treated with PRP and hyaluronic acid (HA). Mean age was 53.0 ± 5.6. The mean injection number was 3.6 ± 2.0. Platelet-poor and platelet– rich plasma parts were mixed with 0.5 cc %3.5 hyaluronic acid and 0.5 cc procaine and injected with a 30G, 13-mm needle into deep dermis and hypodermis. Patients were asked to rate their personal satisfaction with their skin texture, pigmentation, and sagging. In addition, the overall results were rated by three independent physicians and the patients themselves. The outcomes were peer-reviewed, and correlations between the degree of the aesthetic scores and the number of injections were explored.
RESULTS:
There was a statistically significant difference in general appearance, skin firmness-sagging and skin texture according to the patients’ before and after applications of PRP. A statistically significant correlation was found between the number of injections and overall satisfaction.
CONCLUSIONS:
Compared to the baseline, the PRP and HA injections provided clinically visible and statistically significant improvement on facial skin. The improvements were more remarkable as the injection numbers increased.
Tissue sealants may reduce haematoma and complications in face-lifts: A meta-analysis of comparative studies.
Abstract
The use of tissue sealants has increased among different surgical specialities. Face-lift and rhytidoplasty may cause several complications such as haematoma, ecchymosis, oedema, seroma, skin necrosis, wound dehiscence and wound infection. However, administration of tissue sealants may prevent the occurrence of some complications. We performed a meta-analysis of studies that compared tissue sealant use with controls to evaluate the outcomes. A systematic literature search was performed. The primary outcome was the incidence of haematoma. Secondary outcomes were wound drainage amount, oedema, ecchymosis, seroma, skin necrosis and hypertrophic scarring. Thirteen studies involving 2434 patients were retrieved and included in the present analysis. A statistically significantly decrease in post-operative haematoma [risk ratio (RR), 0.37; 95% CI, 0.18-0.74; p = 0.005] and wound drainage (MD, -16.90, 95% CI = -25.71, -8.08, p < 0.001) was observed with tissue sealant use. A significant decrease in oedema was detected (RR, 0.30; 95% CI, 0.11-0.85, p = 0.02) but not in ecchymosis, seroma, skin necrosis, and hypertrophic scarring with tissue sealant use. The use of tissue sealants prevents post-operative haematomas and reduces wound drainage. Previous studies have shown a similar trend, but the power of this meta-analysis could verify this perception.
LEVEL OF EVIDENCE:
Assessment of the efficacy and safety of single platelet-rich plasma injection on different types and grades of facial wrinkles.
- 1Department of Dermatology and Venereology, Faculty of Medicine, Tanta University Hospitals, Tanta University, Tanta, Egypt.
- 2Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Abstract
BACKGROUND:
Platelet-rich plasma (PRP) is considered as a growing modality for tissue regeneration and a developing research area for clinicians and researchers. PRP injection treatment provides supraphysiological concentrations of growth factors that may help in accelerated tissue remodeling and regeneration.
AIM OF THE STUDY:
To evaluate the efficacy and safety of single autologous PRP intradermal injection for treatment of facial wrinkles and for facial rejuvenation.
PATIENTS AND METHODS:
A total of 20 subjects with different types of facial wrinkles were included in this study. All subjects received single PRP intradermal injection and were clinically assessed before and after treatment for a period of 8 weeks using Wrinkle Severity Rating Scale (WSRS), Skin Homogeneity and Texture (SHnT) Scale, Physician Assessment Scale, and Subject Satisfaction Scale.
RESULTS:
The mean value of WSRS reduced from 2.90 ± 0.91 before treatment to 2.10 ± 0.79 after 8 weeks of treatment. The most significant results were with younger subjects that have mild and moderate wrinkles of the nasolabial folds (NLFs). Fourteen of seventeen subjects with NLFs showed more than 25% improvement in their appearance. Side effects of PRP treatment were minimal to mild and with excellent tolerability.
CONCLUSION:
Single PRP intradermal injection is well tolerated and capable of rejuvenating the face and producing a significant correction of wrinkles especially the NLFs.
Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study.
- 1Department of Dermatology, Venereology, and Leprosy, National Institute of Medical Sciences, Jaipur, Rajasthan, India.
Abstract
BACKGROUND:
Acne scarring causes cosmetic discomfort, depression, low self-esteem and reduced quality of life. Microneedling is an established treatment for scars, although the efficacy of platelet-rich plasma (PRP) has not been explored much.
OBJECTIVE:
The objective of this study was to evaluate the efficacy and safety of platelet-rich plasma (PRP) combined with microneedling for the treatment of atrophic acne scars.
METHODS:
Fifty patients of 17-32 years of age with atrophic acne scars were enrolled. Microneedling was performed on both halves of the face. Intradermal injections as well as topical application of PRP was given on right half of the face, while the left half of the face was treated with intradermal administration of distilled water. Three treatment sessions were given at an interval of 1 month consecutively. Goodman’s Quantitative scale and Quantitative scale were used for the final evaluation of results.
RESULTS:
Right and left halves showed 62.20% and 45.84% improvement, respectively, on Goodman’s Quantitative scale. Goodman’s Qualitative scale showed excellent response in 20 (40%) patients and good response in 30 (60%) patients over right half of the face, while the left half of the face showed excellent response in 5 (10%) patients, good response in 42 (6%) patients and poor response in three patients.
CONCLUSION:
We conclude that PRP has efficacy in the management of atrophic acne scars. It can be combined with microneedling to enhance the final clinical outcomes in comparison with microneedling alone.
http://drprpusa.com/platelet-rich-plasma-injections-for-face-the-good-the-bad-the-ugly/
Platelet-Rich Plasma Injections For Face: The Good, The Bad & The Ugly