Abstract
Injection of platelet concentrates for the treatment of aging skin has gained popularity. The objective was to systematically assess the evidence regarding the Safety And Effectiveness Of PRP (platelet-rich plasma) for reducing the visible signs of aging. Cochrane Library, MEDLINE (PubMed), EMBASE, and Scopus were searched from inception to March 2019 for prospective trials and case series assessing PRP for skin aging in 10 or more patients. Twenty-four studies, including 8 randomized controlled trials (RCTs), representing 480 total patients receiving PRP, were included. Based on physician global assessment, injection PRP monotherapy was shown to at least temporarily induce modest improvement in facial skin appearance, texture, and lines. Periorbital fine lines and pigmentation may also benefit. Adjuvant PRP accelerated healing after fractional laser resurfacing. Although the degree of improvement was typically less than 50%, patients generally reported high satisfaction. It was limited by heterogeneity in PRP preparation and administration, and lack of standardization in outcome measures. PRP injections are safe and may be modestly beneficial for aging skin. The evidence is most convincing for improvement of facial skin texture. The persistence of these effects is not known. More high-quality trials with sufficient follow-up are needed to optimize treatment regimens.
Amanda L. Maisel-Campbell and Aliaa Ismail contributed equally to this work and are the co-first authors.
Notes
Funding
Departmental Research Funds, Dept of Dermatology, Northwestern University.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- Macaulay IC, Carr P, Gusnanto A, Ouwehand WH, Fitzgerald D, Watkins NA (2005) Platelet genomics and proteomics in human health and disease. J Clin Investig 115(12):3370–3377 PubMedCrossRefGoogle Scholar
- Senzel L, Gnatenko DV, Bahou WF (2009) The platelet proteome. Curr Opin Hematol 16(5):329–333 PubMed PubMedCentral CrossRef Google Scholar
- Abuaf OK, Yildiz H, Baloglu H, Bilgili ME, Simsek HA, Dogan B (2016) Histologic evidence of new collagen formulation using platelet rich plasma in skin rejuvenation: a prospective controlled clinical study. Ann Dermatol 28(6):718–724 PubMed PubMedCentral CrossRef Google Scholar
- Cho JM, Lee YH, Baek RM, Lee SW (2011) Effect of platelet-rich plasma on ultraviolet b-induced skin wrinkles in nude mice. J Plast Reconstr Aesthet Surg 64(2):e31–e39 PubMedCrossRef Google Scholar
- Hom DB, Linzie BM, Huang TC (2007) The healing effects of autologous platelet gel on acute human skin wounds. Arch Fac Plast Surg 9(3):174–183 Google Scholar
- Di Matteo B, Filardo G, Kon E, Marcacci M (2015) Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy—a systematic review. Musculoskelet Surg 99(1):1–9 PubMed CrossRef Google Scholar
- Gholami M, Ravaghi H, Salehi M, Yekta AA, Doaee S, Jaafaripooyan E (2016) A systematic review and meta-analysis of the application of platelet rich plasma in sports medicine. Electron Physician 8(5):2325–2332 PubMed PubMedCentral CrossRef Google Scholar
- Leo MS, Kumar AS, Kirit R, Konathan R, Sivamani RK (2015) Systematic review of the use of platelet-rich plasma in aesthetic dermatology. J Cosmet Dermatol 14(4):315–323 PubMed CrossRef Google Scholar
- Panda S, Doraiswamy J, Malaiappan S, Varghese SS, Del Fabbro M (2016) Additive effect of autologous platelet concentrates in treatment of intrabony defects: a systematic review and meta-analysis. J Investig Clin Dent 7(1):13–26 PubMed CrossRef Google Scholar
- Alam M, Hughart R, Champlain A et al (2018) Effect of platelet-rich plasma injection for rejuvenation of photoaged facial skin: a randomized clinical trial. JAMA Dermatol 154(12):1447–1452 PubMed CrossRef Google Scholar
- Gawdat HI, Tawdy AM, Hegazy RA, Zakaria MM, Allam RS (2017) Autologous platelet-rich plasma versus readymade growth factors in skin rejuvenation: a split face study. J Cosmet Dermatol 16(2):258–264 PubMed CrossRef Google Scholar
- Hui Q, Chang P, Guo B, Zhang Y, Tao K (2017) The clinical efficacy of autologous platelet-rich plasma combined with ultra-pulsed fractional CO2 laser therapy for facial rejuvenation. Rejuvenation Res 20(1):25–31 PubMed PubMedCentral CrossRef Google Scholar
- Kang BK, Shin MK, Lee JH, Kim NI (2014) Effects of platelet-rich plasma on wrinkles and skin tone in Asian lower eyelid skin: preliminary results from a prospective, randomised, split-face trial. Eur J Dermatol 24(1):100–101 PubMed Google Scholar
- Kim H, Gallo J (2015) Evaluation of the effect of platelet-rich plasma on recovery after ablative fractional photothermolysis. JAMA Fac Plast Surg 17(2):97–102 CrossRef Google Scholar
- Na JI, Choi JW, Choi HR et al (2011) Rapid healing and reduced erythema after ablative fractional carbon dioxide laser resurfacing combined with the application of autologous platelet-rich plasma. Dermatol Surg 37(4):463–468 PubMed CrossRef Google Scholar
- Shin MK, Lee JH, Lee SJ, Kim NI (2012) Platelet-rich plasma combined with fractional laser therapy for skin rejuvenation. Dermatol Surg 38(4):623–630 PubMed CrossRef Google Scholar
- Sevilla GP, Dhurat RS, Shetty G, Kadam PP, Totey SM (2015) Safety and efficacy of growth factor concentrate in the treatment of nasolabial fold correction: split face pilot study. Indian J Dermatol 60(5):520 PubMed PubMedCentral Google Scholar
- Cabrera-Ramirez JO, Puebla-Mora AG, Gonzalez-Ojeda A et al (2017) Platelet-rich plasma for the treatment of photodamage of the skin of the hands. Actas Dermo-sifiliograficas 108(8):746–751 PubMed CrossRef Google Scholar
- Cameli N, Mariano M, Cordone I, Abril E, Masi S, Foddai ML (2017) Autologous pure platelet-rich plasma dermal injections for facial skin rejuvenation: clinical, instrumental, and flow cytometry assessment. Dermatol Surg 43(6):826–835 PubMed CrossRef Google Scholar
- Díaz-Ley B, Cuevast J, Alonso-Castro L et al (2015) Benefits of plasma rich in growth factors (PRGF) in skin photodamage: clinical response and histological assessment. Dermatol Ther 28(4):258–263 PubMed CrossRef Google Scholar
- Elnehrawy NY, Ibrahim ZA, Eltoukhy AM, Nagy HM (2017) Assessment of the efficacy and safety of single platelet-rich plasma injection on different types and grades of facial wrinkles. J Cosmet Dermatol 16(1):103–111 PubMed CrossRef Google Scholar
- Mehryan P, Zartab H, Rajabi A, Pazhoohi N, Firooz A (2014) Assessment of efficacy of platelet-rich plasma (PRP) on infraorbital dark circles and crow’s feet wrinkles. J Cosmet Dermatol 13(1):72–78 PubMed CrossRef Google Scholar
- Redaelli A, Romano D, Marcianò A (2010) Face and neck revitalization with platelet-rich plasma (PRP): clinical outcome in a series of 23 consecutively treated patients. J Drugs Dermatol 9(5):466–472 PubMed Google Scholar
- Scarano A, Iezzi G, Di Cristinzi A, Bertuzzi GL, Carinci F, Lauritano D (2012) Full-facial rejuvenation with autologous platelet-derived growth factors. Eur J Inflamm 10(1):31–35 Google Scholar
- Sclafani AP (2010) Platelet-rich fibrin matrix for improvement of deep nasolabial folds. J Cosmet Dermatol 9(1):66–71 PubMed CrossRef Google Scholar
- Abdul-Hussein AA, Kadhem QI, Idan DS (2018) Skin rejuvenation using platelet-rich plasma in Al Muthanna Governorate/Iraq. Indian J Public Health Res Dev 9(10):891–897 CrossRef Google Scholar
- Charles-de-Sa L, Gontijo-de-Amorim NF, Takiya CM et al (2018) Effect of use of platelet-rich plasma (PRP) in skin with intrinsic aging process. Aesthet Surg J 38(3):321–328 PubMed CrossRef Google Scholar
- El-Domyati M, Abdel-Wahab H, Hossam A (2018) Combining microneedling with other minimally invasive procedures for facial rejuvenation: a split-face comparative study. Int J Dermatol 57(11):1324–1334 PubMed CrossRef Google Scholar
- Everts PA, Pinto PC, Girao L (2018) Autologous pure platelet-rich plasma injections for facial skin rejuvenation: biometric instrumental evaluations and patient-reported outcomes to support antiaging effects. J Cosmet Dermatol 18:1–11 Google Scholar
- Fedyakova E, Pino A, Kogan L, Eganova C, Troya M, Anitua E (2018) An autologous protein gel for soft tissue augmentation: in vitro characterization and clinical evaluation. J Cosmet Dermatol 18:1–11 Google Scholar
- Lee Z-H, Sinno S, Poudrier G et al (2019) Platelet rich plasma for photodamaged skin: a pilot study. J Cosmet Dermatol 18:77–83 PubMed CrossRef Google Scholar
- Willemsen JCN, Van Dongen J, Spiekman M et al (2018) The addition of platelet-rich plasma to facial lipofilling: a double-blind, placebo-controlled, randomized trial. Plast Reconstr Surg 141(2):331–343 PubMed PubMedCentral Google Scholar
- Phillips R, Ball C, Sackett D et al (2009) Oxford Centre for evidence-based medicine—levels of evidence. Center for evidence based medicine. https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 18 Jun 2019
- Author Information Pack (2019) J Am Acad Dermatol. https://www.elsevier.com/wps/find/journaldescription.cws_home/623370?generatepdf=true. Accessed 18 Jun 2019
- Robinson JK, Dellavalle RP, Bigby M, Callen JP (2008) Systematic reviews: grading recommendations and evidence quality. Arch Dermatol 144(1):97–99 PubMed CrossRef PubMedCentral Google Scholar
- Nofal E, Helmy A, Nofal A, Alakad R, Nasr M (2014) 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 40(8):864–873 PubMed PubMedCentral Google Scholar
- Waibel JS, Rudnick A, Shagalov DR, Nicolazzo DM (2017) Update of ablative fractionated lasers to enhance cutaneous topical drug delivery. Adv Ther 34(8):1840–1849 PubMed PubMedCentral CrossRef Google Scholar
- Marx RE (2001) Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 10(4):225–228 PubMed CrossRef Google Scholar
- Singer HM, Almazan T, Craft N et al (2018) Using Network Oriented Research Assistant (NORA) technology to compare digital photographic with in-person assessment of acne vulgaris. JAMA Dermatol 154(2):188–190 PubMed CrossRef Google Scholar
- Dobos G, Lichterfeld A, Blume-Peytavi U, Kottner J (2015) Evaluation of skin ageing: a systematic review of clinical scales. Br J Dermatol 172(5):1249–1261 PubMed CrossRef Google Scholar
- Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 27(3):158–167 PubMed CrossRef Google Scholar
- O’Connell SM, Impeduglia T, Hessler K, Wang XJ, Carroll RJ, Dardik H (2008) Autologous platelet-rich fibrin matrix as cell therapy in the healing of chronic lower-extremity ulcers. Wound Repair Regen 16(6):749–756 PubMed CrossRef Google Scholar
- Sanchez M, Anitua E, Azofra J, Andia I, Padilla S, Mujika I (2007) Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med 35(2):245–251 PubMed CrossRef Google Scholar
- Simon BI, Gupta P, Tajbakhsh S (2011) Quantitative evaluation of extraction socket healing following the use of autologous platelet-rich fibrin matrix in humans. Int J Periodontics Restor Dent 31(3):285–295 Google Scholar
- Dohan Ehrenfest DM, Bielecki T, Mishra A et al (2012) In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes. Curr Pharm Biotechnol 13(7):1131–1137 PubMed PubMedCentral CrossRef Google Scholar
- DeLong JM, Russell RP, Mazzocca AD (2012) Platelet-rich plasma: the PAW classification system. Arthroscopy 28(7):998–1009 PubMed CrossRef Google Scholar
- Magalon J, Chateau AL, Bertrand B et al (2016) DEPA classification: a proposal for standardising PRP use and a retrospective application of available devices. BMJ Open Sport Exerc Med 2(1):e000060 PubMed PubMedCentral CrossRef Google Scholar
- Baillie L, Askew D, Douglas N, Soyer HP (2011) Strategies for assessing the degree of photodamage to skin: a systematic review of the literature. Br J Dermatol 165(4):735–742 PubMed CrossRef Google Scholar
- Iyengar S, Williamson PR, Schmitt J et al (2016) Development of a core outcome set for clinical trials in rosacea: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials 17(1):429 PubMed PubMedCentral CrossRef Google Scholar
- Kottner J, Jacobi L, Hahnel E et al (2018) Core outcome sets in dermatology: report from the second meeting of the International Cochrane Skin Group Core Outcome Set Initiative. Br J Dermatol 178(4):e279–e285 PubMed CrossRef Google Scholar
- Schlessinger DI, Iyengar S, Yanes AF et al (2017) Development of a core outcome set for clinical trials in facial aging: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials 18(1):359 PubMed PubMedCentral CrossRef Google Scholar
- Schmitt J, Deckert S, Alam M et al (2016) Report from the kick-off meeting of the Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN). Br J Dermatol 174(2):287–295 PubMed CrossRef Google Scholar
- Waldman A, Sobanko JF, Alam M (2016) Practice and educational gaps in cosmetic dermatologic surgery. Dermatol Clin 34(3):341–346 PubMed CrossRef Google Scholar
- Shoenberg E, Hattier G, Wang JV, Saedi N (2019) Platelet-rich plasma (PRP) for facial rejuvenation: an early examination. Clin Dermatol. https://doi.org/10.1016/j.clinicdermatol.2019.06.003 CrossRef Google Scholar