In this article, I will try to summarize and provide some information on a new treatment that many patients are asking about: Platelet Rich Plasma. Like all new treatments, I am always skeptical at first (that is my job as a physician as I need to make sure it is safe and it works), and therefore spend time reading and understanding the research that is available. The majority of this editorial will summarize a paper published in The Journal of Cosmetic Dermatology (2015, 0, 1-9) by Leo, Kumar, Kirit, Konathan and Sivamani. This article is a systematic review and touches on many of the potential uses of platelet rich plasma.
What is Platelet Rich Plasma?
Plasma is one of the components of human blood. When we separate blood (which is done using a device we call a centrifuge), we isolate two different components: blood cells and plasma. The plasma of the blood is a clear fluid that contains growth factors such as platelet-derived growth factors, transforming growth factor beta and vascular endothelial growth factor. At this point, there is no need to worry about the specifics of these growth factors, however what is important is to know that they are known to help grow tissue in your skin.
How do you harvest or collect Platelet Rich Plasma?
In order to collect Platelet Rich Plasma, nurses or doctors first extract some blood and put in it a centrifuge. This is a device that spins the blood and causes the heavier components to leave the liquid. Those heavy parts are the cells, which leave the liquid plasma.
What are the main types of Platelet Rich Plasma (PRP)?
There are 4 types of Platelet Rich Plasma, however in cosmetic medicine and facial plastic surgery, 2 are commonly used and studied*.
- Pure PRP* – Consists of plasma and a large number of platelets
- Leukocyte PRP* – Consists of plasma, platelets and leukocytes, a type of blood cell
- Platelet rich Fibrin Matrix – This is formed by adding calcium to the PRP
- Leukocyte and Platelet Rich Fibrin Matrix
What is Platelet Rich Plasma Used for – and Does It Work?
To answer this question, I’ve reviewed the published scientific article by MS Leo et al (2015). This article is a systematic review, which means the author of the study looked at all the published research on the topic and summarized the best studies. This is a great way to summarize a large number of studies to get a good idea if a treatment works.
Platelet Rich Plasma has been used for the following problems:
- Hair Loss and Hair Thinning
- Scar treatments and revisions
- Acne Scars
- Treatment of Wrinkles
- Treatment of Wrinkles after laser therapy
- Helping with Dark Circles under the eyes
- Reducing deep skin folds
I will go through each one of these and discuss what our current scientific understanding is, and whether or not PRP has research suggesting that it works.
Hair Thinning and Hair Loss
Androgenetic hair loss is the medical term used for a common form of hair loss. In men, it is known as ‘male pattern baldness.’ Although less common, this type of hair loss also occurs in women. Although there are a number of treatments available, platelet rich plasma is currently being used and studied as a treatment for hair loss.
There is evidence suggesting that if a plastic surgeon injects PRP every 2-3 weeks for 12 weeks, the thickness of your hair will increase. In addition to this, there is an increase in the number of hairs that are growing as well as an increase in the speed of hair growth.
The one limitation of the use of PRP for hair loss is that it does not appear useful in people who have severe baldness. It seems as though it is best used for thinning hair as opposed to established baldness.
Scar Revision and Scar Treatments – Traumatic and Surgical Scars
There have been research studies assessing the usefulness of PRP when treating scars. Typically, at our Plastic Surgery Clinic in Ottawa, we use either ablative or non-ablative laser or radiofrequency scar treatments. Although we achieve excellent results, researchers are looking for ways to improve this.
One such method is to inject platelet rich plasma into scars before treatment with the lasers. The research notes that doing this results in a better scar than treating with the laser alone. Many of these studies are small and low number, therefore it is difficult to know if this is a real effect or if the results would hold up to higher levels of scrutiny.
Scar Revisions and Scar Treatments – Acne Scars
Acne scars can be very difficult to treat. Typically, a combination of lasers, radio frequency scar treatments and creams can be helpful. Researchers are now studying whether injecting PRP into the acne scars after a laser scar treatment will improve the results. What they found is that those people who have the PRP injected after the laser or radiofrequency scar revision will heal quicker (by about 2 days) and that the scars appear mildly better.
Similar to above, the studies are small and few.
Skin Rejuvenation and Wrinkle Reduction
Skin rejuvenation refers to treatments that cause skin to look brighter, more youthful and healthy. We often use treatments such as chemical peels, retinol-based creams and other skin care to achieve this result. Since Platelet Rich Plasma contains growth factors, cosmetic and plastic surgeons are trying to determine if it will have an effect of the appearance of the skin.
There is some evidence that injecting PRP into the wrinkles under and around your eyes will improve their appearance, however it is not known how long this improvement lasts.
Platelet Rich Plasma injections into the nasolabial folds (the lines by the sides of your nose down to your mouth) cause them to improve in appearance and become less pronounced.
Finally, PRP injections also have been shown to increase the amount of collagen, blood vessels (this is a good thing) and the development of healthy fat cells.
Currently, there are some limitations to the use of Platelet Rich Plasma. One is that the research is still in the early phases. Most of the studies are small and therefore it is difficult to draw firm conclusions. I often recommend for my patients to consider other options first.
In addition to this, using Platelet Rich plasma is invasive. Blood needs to be taken from the patient and then injected back into the skin. Not everyone is comfortable with this process and therefore one needs to have an honest discussion regarding the benefits and risks of the procedure.
Hopefully more research will come to light and help determine whether Platelet Rich Plasma lives up to some of the early claims. At this time, many sites are using it and will speak highly of it. However we still do not know the long term results and therefore some element of caution is required.
There is some good evidence that Platelet Rich Plasma will improve the signs of hair loss, scarring, acne scarring, fine lines and wrinkles as well as some deeper lines. However, future research is required to assess if these results are long-lasting.
Dr James P. Bonaparte, MD, MSc, FRCSC
Assistant Professor – Department of Otolaryngology – Head and Neck Surgery
Practicing in Facial Plastics and Reconstructive Surgery
University of Ottawa
JB Facial and Cosmetic Surgery Center of Ottawa