Platelet-Rich-Plasma (PRP) is becoming a more common term outside of the medical field as it has gained traction through the social-media and celebrity endorsement of procedures such as the “Vampire Facial.” However, the dermatologic benefits of PRP are broad. Various studies examining PRP’s applications have produced robust results. This post will highlight the basics of PRP procedures, specifically pertaining to facial acne scar repair and hair growth treatments.
What is Platelet-Rich-Plasma?
The blood is made up of several important components, including red blood cells, white blood cells, and platelets. Platelets have interesting biological features that are crucial to these dermatologic treatments as they are involved in the processes of blood clotting and wound healing. They contain α-granules, which secrete various growth factors (such as vitamins and hormones) and proteins involved in cell signaling, migration, and tissue development – all of which can help with tissue rejuvenation.
All of these secreted components interact with the local environment to promote processes such as:
- cellular differentiation (one cell type becoming a different type of cell)
- proliferation (rapid increase in cell numbers)
- and regeneration (the process of cells renewing themselves) (1,2)
In medical applications, the plasma fraction used in the procedures contains a 3-7 fold higher concentration of platelets relative to the blood (3). Processing prior to use in aesthetic procedures ensures the serum does not prematurely secrete all the beneficial compounds or clot. This will be described in the following sections.
PRP is considered safe, with minimal side effects and contraindications (4). As such, it has a niche in a wide range of dermatologic procedures because it has multifactorial benefits and anti-inflammatory effects (5). For example, by activating specific cell signaling pathways, PRP can promote hair growth and follicle survival (6). Additionally, the anti-inflammatory effects of PRP help reduce inflammation where it is injected when used to treat conditions such as hair loss due to alopecia or when used in aesthetic procedures to rejuvenate the face (7,8).
Uses in Skin Rejuvenation
Acne is an often chronic condition that affects around 90% of people. As a result, scarring occurs in approximately 95% of people experiencing acne. It can be painful and difficult to deal with, and may lead to the development of low self-esteem and depression in many people (9,10). Common treatment used for acne and scarring include retinoids, chemical peels, microdermabrasion, or laser resurfacing – all of these treatments are able to induce collagen formation and remodeling to improve the appearance of scars (11–13).
Although it is a new option in the treatment of acne scars, PRP may be effective in improving their appearance. It has been found to increase the density of collagen fibers through the activation of fibroblasts, which are cells that create the components that make up the structural framework of tissues. The activity of these fibroblasts can help smooth out pitted acne scarring and ultimately rejuvenate the skin’s appearance (14,15).
The procedure itself is relatively uncomplicated – after an initial assessment of the patient’s face, the production of PRP begins with collecting between 10-60 mL of blood from the arm on the day of the treatment. Anti-coagulants are added to the blood to prevent it from prematurely clotting or secreting the α-granules before it is ready to be used. The blood sample is then processed using centrifugation – this is a machine that spins the blood at a high velocity and is able to separate the cells of the blood into distinct layers based on their varying weights (3). The PRP layer can be drawn out with a syringe when it is ready for use.
For people with healthy, normal skin, the PRP treatment for the face consists of an initial cleansing of the face, followed by application of a numbing cream. This is used to prepare the skin for the microneedling pen – a device that is rolled over the entire face to create micro-injuries that act somewhat like “channels” for the PRP serum so that it can penetrate the skin more effectively. These micro-injuries also induce collagen formation and restructuring. Once microneedling is completed, the PRP is applied to the skin as a serum and allowed to absorb, enhancing the wound-healing response. The topical use of growth factors in PRP has been shown to improve the smoothness of skin and decrease wrinkles (16–18). Many people seek out the vampire facial just for this purpose – to rejuvenate their skin and refresh their appearance.
Typically, this method alone is effective even for those with acne scars – studies have demonstrated that the side of the patient’s face that was treated using the PRP and microneedling combination showed more improvement in scarring than the side that was treated with PRP alone. (19,20) If patients have severe scarring, there is also an option to inject PRP intradermally along with microneedling and PRP serum application. This helps the PRP work from the inside out and localizes the effects of the platelets to wherever they are injected, ultimately reducing inflammation and increasing collagen production to reduce the appearance of scars. Although multiple studies demonstrate the benefits of PRP for acne scars (21–23), there is currently no standardization for its use or the technique in this treatment. More big studies are required to define these standards and also understand whether specific patient types (those with more severe acne, varying types of acne scars, duration of scars) need more frequent or intense combination therapies including PRP. (3)
Treating Thinning Hair and Hair Loss
Hair loss occurs for a variety of reasons, but the most common cause is androgenetic alopecia (AGA), otherwise known as male pattern or female pattern baldness. It is one of the more common hair loss disorders and largely affects men and to a lesser extent, women (24). Losing hair is a normal daily process and humans lose hundreds of strands daily. Unfortunately with alopecia, the hair does not grow back, which can lead to emotional and psychological distress (25). This condition is mostly genetic, but factors including diet, stress, hormonal imbalance, and other medications can contribute.
Most of the time, people will use Rogaine (Minoxidil) to try growing new, thicker hair, or Propecia (Finasteride) to prevent its loss in the first place. Some people also attempt going under the knife for hair transplant surgeries, whereby hairs are grafted from the back of the head to the front using follicular unit transplantation (FUT) or follicular unit extraction (FUE). Both processes can take several hours and require some downtime. For extensive androgenetic alopecia more than one session may be contemplated.
PRP is used to promote hair growth and follicle survival in the scalp by localizing the biological properties of the platelets. The anti-inflammatory effects of PRP are thought to reduce the inflammation associated with hair loss conditions like AGA (7,8).
Additionally, PRP can promote hair growth and follicle survival because it activates cell pathways that prevent cell death (26). Members of the medical community also suggest that PRP injections stimulate natural hair growth and maintenance by increasing blood supply to the hair follicles or increasing thickness of the hair shaft. The treatment for hair loss therapy is very similar to that of the face – the blood is drawn and processed, centrifuged to separate out the PRP from the rest of the blood, and then it is injected subdermally or subcutaneously into the scalp.
Randomized controlled trials of PRP for hair have demonstrable evidence that regular PRP treatments can significantly improve the density of hair, hair count, diameter, and shedding, but the results are likely better in patients with mild AGA or recent onset hair loss. Ultimately, this is still a relatively new field and there are inconsistencies among measurements and protocols so comparisons between studies can be limited. PRP can be combined with other treatment modalities to improve results. Thus, although there may be some recent reports and small controlled trials exploring the benefits of PRP for hair loss treatment, larger trials and more experience will help determine the efficacy of PRP therapy compared to Rogaine/Minoxidil, Low Level Laser Therapy and Propecia/Finasteride/Proscar. (25,26) Combination therapy may help maximize hair loss stabilization and hair regrowth.
What’s the Verdict?
Using PRP has yielded demonstrable benefits in both patients with acne scarring and hair loss. It also appears that the results are more remarkable in patients with lower severity of both scarring and alopecia. Evidently PRP has healing and anti-inflammatory properties, and in studies thus far it seems to increase hair number and thickness with minimal or no side effects.
- Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007 Dec 13;357(24):2482–94.
- Rozman P, Bolta Z. Use of platelet growth factors in treating wounds and soft-tissue injuries. Acta Dermatovenerol Alp Pannonica Adriat. 2007 Dec;16(4):156–65.
- Hesseler MJ, Shyam N. Platelet-rich plasma and its utility in the treatment of acne scars – A systematic review. J Am Acad Dermatol. 2019 Feb 8;
- Anitua E, Pino A, Jaén P, Navarro MR. Platelet rich plasma for the management of hair loss: Better alone or in combination? J Cosmet Dermatol. 2018 Jun 14;
- Sadick NS, Callender VD, Kircik LH, Kogan S. New Insight Into the Pathophysiology of Hair Loss Trigger a Paradigm Shift in the Treatment Approach. J Drugs Dermatol JDD. 2017 Nov 1;16(11):s135–40.
- Li ZJ, Choi H-I, Choi D-K, Sohn K-C, Im M, Seo Y-J, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2012 Jul;38(7 Pt 1):1040–6.
- Mahé YF, Michelet JF, Billoni N, Jarrousse F, Buan B, Commo S, et al. Androgenetic alopecia and microinflammation. Int J Dermatol. 2000 Aug;39(8):576–84.
- Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N. The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. J Drugs Dermatol JDD. 2011 Dec;10(12):1404–11.
- Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Australas J Dermatol. 1997 Aug;38(3):115–23.
- Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999 Oct;41(4):577–80.
- Harris DW, Buckley CC, Ostlere LS, Rustin MH. Topical retinoic acid in the treatment of fine acne scarring. Br J Dermatol. 1991 Jul;125(1):81–2.
- Spencer JM. Microdermabrasion. Am J Clin Dermatol. 2005;6(2):89–92.
- Lee JB, Chung WG, Kwahck H, Lee KH. Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2002 Nov;28(11):1017–1021; discussion 1021.
- Abuaf OK, Yildiz H, Baloglu H, Bilgili ME, Simsek HA, Dogan B. Histologic Evidence of New Collagen Formulation Using Platelet Rich Plasma in Skin Rejuvenation: A Prospective Controlled Clinical Study. Ann Dermatol. 2016 Dec;28(6):718–24.
- Elghblawi E. Platelet-rich plasma, the ultimate secret for youthful skin elixir and hair growth triggering. J Cosmet Dermatol. 2017 Sep 8;
- Fitzpatrick RE, Rostan EF. Reversal of photodamage with topical growth factors: a pilot study. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol. 2003 Apr;5(1):25–34.
- Atkin DH, Trookman NS, Rizer RL, Schreck LE, Ho ET, Gotz V, et al. Combination of physiologically balanced growth factors with antioxidants for reversal of facial photodamage. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol. 2010 Feb;12(1):14–20.
- Mehta RC, Smith SR, Grove GL, Ford RO, Canfield W, Donofrio LM, et al. Reduction in facial photodamage by a topical growth factor product. J Drugs Dermatol JDD. 2008 Sep;7(9):864–71.
- Nofal E, Helmy A, Nofal A, Alakad R, Nasr M. Platelet-rich plasma versus CROSS technique with 100% trichloroacetic acid versus combined skin needling and platelet rich plasma in the treatment of atrophic acne scars: a comparative study. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2014 Aug;40(8):864–73.
- Fabbrocini G, De Vita G, Pastor FJ, Panariello L, Fardella N, Sepulveres R, et al. Combined use of skin needling and platelet-rich plasma in acne scarring treatment. 2011;24:117–83.
- Asif M, Kanodia S, Singh K. Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol. 2016 Dec;15(4):434–43.
- Ibrahim ZA, El-Ashmawy AA, Shora OA. Therapeutic effect of microneedling and autologous platelet-rich plasma in the treatment of atrophic scars: A randomized study. J Cosmet Dermatol. 2017 Sep;16(3):388–99.
- El-Domyati M, Abdel-Wahab H, Hossam A. Microneedling combined with platelet-rich plasma or trichloroacetic acid peeling for management of acne scarring: A split-face clinical and histologic comparison. J Cosmet Dermatol. 2018 Feb;17(1):73–83.
- Giordano S, Romeo M, di Summa P, Salval A, Lankinen P. A Meta-analysis On Evidence Of Platelet-rich Plasma for Androgenetic Alopecia. Int J Trichology. 2018 Feb;10(1):1–10.
- Tabolli S, Sampogna F, di Pietro C, Mannooranparampil TJ, Ribuffo M, Abeni D. Health status, coping strategies, and alexithymia in subjects with androgenetic alopecia: a questionnaire study. Am J Clin Dermatol. 2013 Apr;14(2):139–45.
- Gupta A, Carveil J. A Mechanistic Model of Platelet-Rich Plasma Treatment for Androgenetic Alopecia. Dermatol Surg. 2016;42(12):1335–9.
No comments »