PRP Therapy (Platelet‑Rich Plasma Therapy) in Dermatology and Cosmetology: Effects, Indications, Technique

PRP therapy (platelet‑rich plasma therapy), also widely known as plasmatherapy or autologous plasma therapy, is an invasive biostimulation technique in which a patient’s own blood plasma is injected to stimulate skin regeneration and to treat hair and scalp conditions.

History and Development of PRP Therapy

PRP technology emerged in the 20th century, when concentrated platelets began to be used in the management of thrombocytopenia. After 1990, the method was introduced into dentistry and maxillofacial surgery, as platelets had demonstrated high regenerative potential. Somewhat later, PRP therapy became widely used in orthopedics and sports medicine, and in the early 21st century it entered dermatology and aesthetic medicine.

Biological Effects of PRP: How Biostimulation Works

Injection of platelet‑rich plasma into the skin initiates a cascade of natural reactions:

• Platelets are activated and growth factors are released.
• Fibroblasts are stimulated; these cells are responsible for producing collagen, elastin, and hyaluronic acid.
• Angiogenesis is enhanced and new blood vessels are formed.
• Microcirculation and tissue trophism improve.
• Inflammation is reduced and wound healing is initiated.
• Epidermal renewal accelerates and the extracellular matrix becomes stronger.

As a result, powerful biostimulation of the face and body is observed, improving overall skin quality.

Mechanism of Action

Platelet cytoplasm contains three types of secretory granules that are instrumental in therapy:

1. Dense granules: contain catecholamines, serotonin, ADP, ATP, and calcium;
2. Alpha granules: the main source of growth factors, interleukins, and cytokines;
3. Lysosomes: contain acid hydrolases.

Growth factors stimulate migration and proliferation of fibroblasts, endothelial cells, and epithelial cells; promote extracellular matrix formation; intensify angiogenesis; and support connective tissue remodeling.

Major Growth Factors and Effects

Key components of PRP therapy that contribute to its effectiveness include:

• PDGF (Platelet‑Derived Growth Factor): stimulates proliferation of fibroblasts, smooth muscle cells, and vascular endothelial cells; activates macrophages; enhances chemotaxis and angiogenesis.
• TGF‑β (Transforming Growth Factor‑β): regulates cell proliferation and differentiation; stimulates synthesis of type I and III collagen, elastin, and glycosaminoglycans; exhibits anti‑inflammatory effects.
• VEGF (Vascular Endothelial Growth Factor): a key regulator of angiogenesis; stimulates the growth and permeability of new capillaries, improving microcirculation.
• EGF (Epidermal Growth Factor): accelerates epidermal regeneration; activates keratinocytes and fibroblasts.
• IGF and IGF‑1 (Insulin‑Like Growth Factors): stimulate cell growth and protein synthesis.
• FGF (Fibroblast Growth Factor): supports angiogenesis, fibroblast migration, and differentiation.
• IL‑1, IL‑6, IL‑8 (Interleukins 1, 6, 8) and TNF‑α (Tumor Necrosis Factor‑α): modulate the inflammatory response and participate in regulating immune activity.

PRP Classification

Different types of PRP therapy are classified by composition and concentration.

By composition of main components

• P‑PRP (Pure PRP): plasma with a high platelet concentration, without leukocytes;
• L‑PRP (Leukocyte‑ and Platelet-Rich PRP): plasma with elevated concentrations of platelets and leukocytes.
• PRF (Platelet‑Rich Fibrin): a gel‑like form without added anticoagulant, representing a fibrin clot with a high platelet concentration.
• L‑PRF (Leukocyte- and Platelet-Rich Fibrin): a fibrin clot containing both platelets and leukocytes.
• Combination products: PRP variants supplemented with hyaluronic acid, stem cells, or other biologically active components.

By platelet concentration

• PRP LC: low concentration (up to 750 × 10⁹/L).
• PRP MC: medium concentration (750–1200 × 10⁹/L).
• PRP HC: high concentration (> 1200 × 10⁹/L).

By activation status

• NA-PRP: nonactivated PRP.
• A-PRP: activated PRP.

By leukocyte content

• LL‑PRP: low leukocyte content (<< 4 × 10⁹/L).
• ML‑PRP: normal leukocyte content (4–9 × 10⁹/L)
• HL‑PRP: high leukocyte content (> 9 × 10⁹/L)

Technique of PRP Therapy

Although many techniques for this procedure have been developed, all of them comprise several basic sequential stages:

Stage 1: Blood Collection

Depending on the required volume of plasma, an average of 10 to 200 mL of venous blood is collected into specialized vacuum tubes or standard anticoagulant syringes. Citrate, sodium heparin, lithium heparin, or complex preservatives may be used as anticoagulants.

Stage 2: Centrifugation

PRP is obtained by single or double centrifugation of venous blood. During centrifugation, erythrocytes and platelets separate into three main fractions:

1. Erythrocyte fraction (bottom layer): dark red, contains erythrocytes; not used.
2. Platelet‑rich plasma (PRP, middle layer): dark yellow; the main therapeutic component (platelet concentration 3–7 times above baseline).
3. Platelet‑poor plasma (PPP, top layer): light yellow; contains few platelets.

Stage 3: Isolation of Plasma Fraction Required

Stage 4: Preparation Injection

After cleansing the skin, applying topical anesthesia, and disinfecting the area, the obtained PRP is injected subcutaneously or intradermally using fine needles (30–32G) or cannulas, as well as via microneedling. Injection depth: 1–4 mm depending on the area.

Stage 5: Post‑Procedure Care

During the first 48 hours it is recommended to: protect the skin from UV exposure, avoid baths and saunas, and limit intense physical activity.

Recommended course: 3–6 sessions spaced 2–4 weeks apart.

Indications

In aesthetic medicine, PRP therapy is used to address a wide range of concerns:

Face and Body Skin Rejuvenation

• Improvement of skin texture and turgor.
• Reduction of fine wrinkles (biostimulation).
• Restoration of radiance and hydration (especially when combined with hyaluronic acid).

Correction of Pigmentation and Scars

• Treatment of post‑acne and scars (stimulation of neocollagenesis).
• Management of hyperpigmentation.
• Rehabilitation after laser resurfacing and plastic surgery.

Treatment of Alopecia

Hair and scalp PRP therapy improves microcirculation, activates follicular metabolism, and prolongs the anagen phase.

• Reduction of hair shedding.
• Increase in hair thickness and density.
• Used as rehabilitation after hair transplantation.

Contraindications and Side Effects

PRP therapy is considered effective and has a high safety profile, but in certain clinical situations it should be used with caution.

Absolute Contraindications:

• Malignancies.
• Blood disorders (coagulopathies, thrombocytopenia, anemia).
• Active infections.
• Viral hepatitis B, C, HIV.
• Autoimmune diseases.

Relative Contraindications:

• Pregnancy and breastfeeding.
• Use of anticoagulants.
• Exacerbation of chronic diseases.
• Pronounced inflammation in the treatment area.
• Acute herpes.
• Individual intolerance to the procedure (rare).

Side Effects: Most commonly limited to local reactions: swelling, erythema, and mild tenderness at the injection site. Small hematomas, slight itching, or firmness in the injection sites may also occur.

These manifestations usually resolve spontaneously within several hours or days and do not require specific treatment. Systemic reactions are extremely rare.

Advantages and Disadvantages

Benefits:

• High biocompatibility: no allergic reactions due to the use of autologous blood.
• Short recovery time: minimal injection marks.
• Ideal biocompatibility: stimulation of the body’s own regenerative processes.
• Effectiveness: demonstrated improvement in skin and hair quality.

Limitations:

• Lack of a unified standard (different tubes yield different results).
• Need for a course of treatments.

PRP in Other Areas of Medicine

Beyond aesthetic medicine, PRP is actively used in:

• Orthopedics and sports medicine: treatment of tendinopathies, tendon tears, and osteoarthritis (pain reduction, accelerated recovery).
• Dentistry and maxillofacial surgery: improved implant survival, treatment of periodontitis and osteonecrosis (bone regeneration).
• Gynecology and urology: restoration of mucosa, treatment of urinary incontinence, improvement of erectile function.

Neurology: treatment of tunnel syndromes, neuropathies, and peripheral nerve repair.