Platelet-Based Therapies in Aesthetic Medicine

Platelet-Based Therapies in Aesthetic Medicine

Purpose: This blog is intended to be an educational review of published medical research

Disclaimer: The following summarizes findings from peer-reviewed studies. It is not intended to recommend or promote any specific treatment.

Introduction

Platelet-based therapies, most commonly called platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have been studied with increasing frequency in aesthetic and reconstructive medicine over the past decade. PRP and PRF are created from the patient’s own blood and produce a concentration of the patient’s own platelets. This creates an autologous (from one’s self) product that can play a key role in healing and tissue repair.(1-3)

Interest in PRP and PRF comes from their presumed ability to support the body’s natural repair processes. This article provides an overview for our patients of what the medical literature reports about PRP and PRF for hair thinning, facial skin quality, and under-eye concerns, including benefits and limitations.  Evidence for many of these treatments is still evolving.

How Platelet-Based Therapies Work

Platelets contain naturally occurring substances called growth factors. These help regulate:

* Wound healing

* Collagen production

* Blood vessel formation

* Skin and tissue repair (1,2)

PRP delivers these growth factors soon after treatment. PRF, on the other hand, includes a natural fibrin framework that allows for a slower and more prolonged release of growth factos. Several reviews suggest that for this reason, PRF may keep growth factors active in tissues for a longer period.(1-4)

Hair Thinning and Hair Restoration

Among cosmetic applications, hair thinning—particularly androgenetic alopecia (commonly known as male pattern hair loss)—has the strongest scientific support for platelet-based therapies.

Multiple reviews and clinical trials report that PRP treatment can lead to increased hair density, Thicker individual hairs and reduced hair shedding compared with baseline measurements (5-7)

One randomized controlled study showed an increase of approximately 20 hairs per square centimeter after three monthly treatments. (7) More recent studies evaluating injectable PRF have reported improved hair thickness and follicle quality after a series of treatments.(8,9)

Factors That May Influence Results

Clinical reviews suggest that outcomes may be better in younger patients, women and patients treated across the entire scalp rather than in small, isolated areas.(10) There are important limitations to keep in mind. The results ot these treatments are generally positivie, however, even when successful there are limitations:

• Improvements are usually moderate rather than dramatic,
• Ongoing maintenance treatments are often needed, and
• Hair loss remains a long-term condition regardless of therapy. (5,6)

Facial Skin Quality and Rejuvenation

Studies evaluating PRP and PRF for facial rejuvenation commonly report improvements in:

• Skin texture
• Elasticity and firmness
• Fine lines
• Pore appearance
• Overall patient satisfaction (11-14)

Some studies using specialized imaging or skin measurements also show increases in skin thickness and collagen content following treatment. (11-12)

When PRP and PRF have been directly compared, reviews consistently report better outcomes with PRF for facial skin quality, including smoother texture and improved elasticity.(1-4) However, differences in how treatments are prepared and measured make it difficult to define a single “best” protocol.  The literature emphasizes that:

• Improvements tend to be gradual and natural-appearing
• These treatments do not replace surgical lifting or volume restoration
• Results vary between individuals

Under-Eye (Periorbital) Rejuvenation

PRP has been studied for the under-eye area, with reported improvements in:

• Fine wrinkles
• Skin texture
• Certain types of under-eye darkening (15-16)

A meta-analysis found higher patient satisfaction compared with placebo or simple injection treatments. (16) A proper evaluation of the presumed cause of the hyperpigmentation should be undertaken, however, it is usually difficult to sure of the exact etiology. Medical reviews stress that dark circles under the eyes can have different causes and may require different therapies. For example, volume loss responds best to fillers or fat grafting, while dark pigmentation may improve with platelet-based therapies. (17) A randomized clinical trial showed that nanofat grafting was more effective than PRP for dark circles caused by volume loss.¹⁸

There are no peer reviewed clinical studies directly comparing PRP and PRF specifically for lower eyelid pigmentation. Although PRF may be superior for facial rejuvenation overall, there is not enough evidence to draw firm conclusions for this specific concern either. (1-4)

Several studies describe PRP and PRF being used as supportive treatments rather than standalone therapies. Examples include of such treatments include laser resurfacing and fat grafting. (11-13)  These combination approaches are common in many clinical practices, but it is difficult in that situation to determine how much benefit comes from platelet therapy itself.

Multiple reviews and clinical studies have commented on the safety profile of PRP and PRF. There have been no reported serious complications. The most commonly reported side effects included temporary redness, swelling, bruising, and mild discomfort at injection sites but these usually resolve without any treatments. (11-14) Because PRP and PRF are derived from a patient’s own blood, allergic or immune reactions are uncommon.

Limitations on Review of the Current Literature

There are several limitation to the current state of knowledge to the use of PRP and PRF.  As there are many suppliers of PRP and PRF preparation “kits” to the medical community there is no standardized methods for preparing PRP or PRF. As a result, there is a wide variation in platelet concentration. In addition many of the studies have a small number of patients, short follow-up periods and outcomes are measured using different criteria. (1-4,19).

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Summary

Thus, based on the current peer-reviewed medical literature:

• The strongest evidence supporting platelet-based therapies is for hair
• Facial skin improvements are consistent but usually modest and not seen in all patients
• PRF seems to show better results than PRP for facial rejuvenation
• Under-eye concerns require careful evaluation of the underlying cause
• Combination treatments are common but remain difficult to study rigorously and document efficacy

References

1. Davies C, Miron RJ. Autologous platelet concentrates in esthetic medicine. *Periodontol 2000.* 2025;97(1):363-419.

2. Chamata ES, Bartlett EL, Weir D, Rohrich RJ. Platelet-rich plasma: evolving role in plastic surgery. *Plast Reconstr Surg.* 2021;147(1):219-230.

3. Proffer SL, Wyles SP, Hausauer AK. Update on platelet-rich plasma and platelet-rich fibrin for dermatologic surgery. *Dermatol Surg.* 2024;50(11 Suppl):S149-S159.

4. Qin N, Kochheiser M, Akosman I, et al. Systematic review of platelet-rich plasma and platelet-rich fibrin in facial rejuvenation. *Ann Plast Surg.* 2025;94(4 Suppl 2):S376-S389.

5. Gentile P, Garcovich S. PRP in androgenetic alopecia. *Int J Mol Sci.* 2020;21(8):2702.

6. Kourosh AS, et al. Advances and controversies in hair restoration. *Dermatol Surg.* 2024;50(5):446-452.

7. Shapiro J, et al. PRP for androgenetic alopecia: randomized trial. *J Am Acad Dermatol.* 2020;83(5):1298-1303.

8. Lu K, et al. Injectable PRF and hair follicle regeneration. *Exp Cell Res.* 2021;409(1):112888.

9. Yao S, et al. Injectable PRF in androgenetic alopecia. *Arch Dermatol Res.* 2025;317(1):493.

10. Hausauer AK, Humphrey S. Clinical evidence for PRP. *Dermatol Surg.* 2020;46(4):447-456.

11. Maisel-Campbell AL, et al. PRP for skin aging: systematic review. *Arch Dermatol Res.* 2020;312(5):301-315.

12. Phoebe LKW, et al. PRP for skin rejuvenation. *Skin Res Technol.* 2024;30(4):e13714.

13. Gentile P, Garcovich S. PRP in facial rejuvenation. *Plast Reconstr Surg.* 2023;152(1):72e-82e.

14. Motosko CC, et al. Critical review of platelet therapies. *Plast Reconstr Surg.* 2018;141(5):1115-1123.

15. Badran AY, et al. PRP for periorbital hyperpigmentation. *Dermatol Surg.* 2025;51(1):61-66.

16. Evans AG, et al. Periorbital PRP meta-analysis. *Arch Dermatol Res.* 2021;313(9):711-727.

17. Michelle L, et al. Treatments of periorbital hyperpigmentation. *Dermatol Surg.* 2021;47(1):70-74.

18. Kadry A, et al. PRP vs nanofat for dark circles. *Dermatol Surg.* 2023;49(3):247-252.

19. Kourosh AS, et al. Controversies in platelet-based therapies. *Dermatol Surg.* 2024;50(5):446-452.

Frequently Asked Questions (FAQs)

1. What exactly are PRP and PRF?

PRP (platelet-rich plasma) and PRF (platelet-rich fibrin) are treatments made from a small sample of a patient’s own blood. The blood is processed to concentrate platelets, which contain natural substances involved in healing and tissue repair. These concentrated platelets are then applied or injected into specific areas being studied or treated. (1-3)

 2. How are PRP and PRF different from each other?

Both come from the patient’s blood, but they are prepared differently. PRP releases growth factors relatively quickly after treatment. PRF on the other hand contains a natural fibrin structure that allows growth factors to be released more slowly over time. Comparative reviews of facial rejuvenation studies generally report better outcomes with PRF than PRP, although preparation methods are not standardized. (1-4)

 3. Are PRP and PRF considered “natural” treatments?

They are considered autologous treatments meaning they come from the patient’s own body. However, autologous or natural does not mean risk-free or universally effective, and results vary between individuals. (1-3)

 4. What conditions have been studied the most?

Based on published research:

• Hair thinning (especially pattern hair loss)** has the strongest scientific evidence.(5-7)
• Facial skin quality and texture shows modest improvements.(11-14)
• Lower lid treatments show mixed results depending on etiology.(15-18)

 5. How effective are these treatments according to the literature?

Most studies report modest improvements, not dramatic changes. Patients often notice gradual enhancement rather than major transformation. Nevertheless, patient satisfaction is generally reported as high even when objective changes are limited.(11-14)

 6. How many treatments are typically required?

In most of the studies reviewed treatments for thinning hair required initially 3 or more monthly sessions followed by maintenance treatments. (5-7). Treatments for facial rejuvenation were space 2-4 weeks apart and also required a series of on the average 3 treatments. (11-13).  Lower lid treatment similarly required a series of 3 sessions based a month apart. (15-16) Exact protocols, however, vary widely between studies. (1-4)

 7. Are the results permanent?

No. The medical literature suggests that benefits tend to diminish over time, particularly for hair thinning, and that maintenance treatments are often required to sustain results.(5-6)

 8. Who tends to respond better according to studies?

Some studies suggest younger patients, women treated for thinning hair patients treated across their entire scalp reported the best results (10). Individual responses, however, vary widely and are unpredictable.(1-3)

 9. Can PRP or PRF help with dark circles under the eyes?

It depends on the cause of the dark circles. Pigment-related hyperpigmentation may be modest and relatively short-lived (15-16). PRP or PRF cannot correct darkness due to volume loss which is better treated with fillers or fat grafting (17-18) A randomized clinical trial showed that nanofat grafting was more effective than PRP for lower lid hyperpigmentation, a result which is consistent to that we see in our practice as well. (18)

 10. Is PRF better than PRP for the under-eye area?

Unfortunately, there have not been any direct head-to-head clinical trials comparing PRP and PRF specifically for lower eyelid pigmentation. While PRF seems to show superior results in facial rejuvenation overall, there is insufficient evidence to conclude that it is superior for under-eye pigmentation.(1-4,15-18)

11. Are PRP and PRF often combined with other treatments?

Yes. Studies describe platelet-based therapies being used alongside laser resurfacing and other energy-based skin treatments, microneedling and fat grafting. These combinations may improve healing or outcomes, but that has not been definitively documented. (11-13)

 12. What are the risks or side effects?

To the best of our knowledge, serious complications have not been reported. The commonly reported side effects include but are not limited to temporary redness, swelling, bruising, and soreness at injection sites. Fortunately, these side effects typically resolve without treatment.(11-14)  Significantly, as these treatments use the patient’s own blood, allergic reactions are uncommon.(1-3)

 13. Why do results vary so much between studies?

There are many reasons for the variation in results. There is no single, standardized method for preparing PRP or PRF.  As a result, there are difference in platelet concentration and cellular content.  The treatment protocols vary among the studies and many of the studies have a small number of patients enrolled.  In addition, the methods and techniques to measure results have not been uniform .(1-4,19)

 14. Are these treatments considered “proven”?

Although the literature gives some supported for these treatments, particularly for hair thinning, but they are yet at the point that they can be considered standard treatments. Most would describe them as promising therapies but still evolving.(1-4,19)

This review and FAQ section are not intended to give medical advice. It is intended to provide a brief summary of what current research and studies report, set realistic expectations and enable one to ask informed questions during medical consultations. Decisions about treatment should always be individualized and only made after consultation including history and relevant examination with a qualified physician.