Most of 22 studies in a recent review suggest positive results from platelet-rich plasma (PRP) treatment for androgenic alopecia, facial skin aging, fat grafting and acne scarring.
But big questions remain. The studies in the systematic review lack standard PRP preparation protocols, application methods and standardized objective assessments of skin quality before and after PRP treatment. Existing studies looking at PRP for facial aesthetics and alopecia don’t tend to have control groups, and collectively don’t offer clear information about how many treatments are needed or how long PRP’s effects last, according to the review in the May issue ofPlastic and Reconstructive Surgery.
The evidence supporting PRP appears strongest among the six studies, including 84 total patients, looking at PRP to treat androgenic alopecia. A mean volume of 22.6 mL of whole blood was collected from subjects in the six studies. Three studies reported on the volume of PRP prepared from the whole blood, which was a mean 8 mL of PRP harvested per session. Three studies reported using multiple injections in a linear pattern, about 1 cm apart, a technique called nappage. And in most studies, researchers performed four treatments, ranging from once weekly to once monthly. Researchers reported substantial hair growth in all but one of the studies. The one study still showed improved patient satisfaction from the treatment.
All of the 14 studies evaluating use of PRP for facial rejuvenation reported positive aesthetic outcomes — whether researchers used PRP alone or with fat grafting. Researchers in four of seven studies looking at PRP alone performed three treatments, total, once every two to four weeks. In the remaining three studies, researchers performed one PRP treatment. Other findings: Researchers used a mean 2.7 mL for each treatment in the seven studies. And while application sites varied, the most commonly injected were the infraorbital area, nasolabial folds and crow’s feet. Reported benefits from PRP treatment on the face were improvements in the volume, texture and tone, as well as decreased appearance of wrinkles.
Seven studies, including 437 patients, evaluated PRP-assisted fat grafting. Six of those offer detailed methodology on PRP preparation, including collecting a mean 35.7 mL of whole blood, which yielded a mean 5.2 mL of PRP. Based on five studies, the ratio of fat to PRP used in each procedure ranged from 2:1 to 10:1, with a mean ratio of 5.8 mL of fat to 1 mL of PRP. While the nasolabial folds and malar regions were most commonly injected, authors also injected cheekbones and the temporal region.
Two studies, representing 57 patients, found positive results with the use of PRP to treat facial acne scars. Researchers injected PRP intradermally into atrophic skin scars or used PRP in conjunction with microneedling.
The good news for now is PRP treatment for facial aesthetics and hair loss appears safe. Concerns about what might happen should high-density platelet solution get into a vessel haven’t panned out as a complication in any of studies in the authors’ literature search.
"To date, the question of whether PRP’s cocktail of growth factors generates a more youthful appearance has not been definitively answered," the researchers write.
More formal randomized, controlled trials studying the use of PRP in facial cosmetic procedures are needed, according to the review.