PRP facial: what the studies really show

The principle

My nurse takes a simple blood sample. The tube spends a few minutes in a centrifuge, which separates the plasma from the red blood cells. We collect the part of the plasma concentrated in platelets, which release growth factors. I then reinject it into the skin as tiny micro-injections.

The preparation is autologous: it comes from you and is used only for you. It is prepared in a sterile, single-use, CE-marked kit, during the same session, and is never stored.

What the studies show on the PRP facial

A systematic review published in 2020 gathered 24 studies, including 8 randomised trials, totalling 480 patients treated with PRP. Its conclusions are measured. According to its authors, PRP injected on its own modestly improves, at least for a time, the appearance of the skin, its texture and fine lines. The improvement usually remains below 50%, and we do not know how long it lasts. The data are mainly convincing for skin texture.

A randomised trial published in 2018, with 19 participants analysed, illustrates this nuance well. Each participant received, in a single session, PRP in one cheek and saline in the other, without knowing which side was which. Six months later, participants rated texture and wrinkles as more improved on the PRP side. The two dermatologists who assessed the photographs without knowing the sides, however, found no significant difference.

Radiance, dark circles, acne scars

Radiance is often highlighted, but it is hard to measure. In the 2018 trial, sallowness, as rated by the dermatologists, had improved just as much on the saline side as on the PRP side.

Around the eyes, the 2020 review mentions a possible benefit on fine lines and pigmentation. A study devoted to dark circles involved only ten people, with no comparison group, after a single session: the colour under the eyes was more even, but neither the measured pigment nor the lines had changed significantly. A dark circle caused by a hollow is a matter of volume, which PRP does not treat.

For acne scars, the favourable studies mainly concern the combination with microneedling, a technique that creates tiny punctures in the skin. A 2021 meta-analysis of 14 studies, 4 of them randomised, and 472 patients showed that adding PRP to microneedling increased the chances of a clear improvement compared with microneedling alone. Injected on its own, the value of PRP for scars remains debated. If scars are your main concern, I will tell you frankly whether another approach is more suitable.

Modest evidence, a poorly standardised method

There is not one PRP, but many. The kit, the centrifugation, the platelet concentration, the injection technique and the number of sessions vary from one study to another. The 2020 review highlights this heterogeneity and the lack of standardised outcome measures. The PRP task force of the Indian Association of Dermatologists also acknowledges the uncertainty about which protocol to follow; for skin quality, it recommends 3 to 6 sessions, 4 to 6 weeks apart.

At the practice, the protocol is three sessions one month apart. The result, if it comes, is gradual. Before each new session, I reassess the skin on the same photographs; if nothing is changing, we can stop there.

What PRP does not do

• It does not restore volume: not to the cheekbones, the hollows or the jawline.
• It does not erase deep lines.
• It does not correct sagging skin.
• It does not give an immediate result.

These concerns call for other treatments, which we can discuss at the consultation.

Contraindications and side effects

I do not offer PRP in the following situations:

• a platelet disorder (very low count or poor function) or a blood disease;
• anticoagulant treatment, or regular use of anti-inflammatory drugs;
• active cancer, particularly of the blood;
• a current infection, a recent fever, or infected skin where the treatment would be done;
• pregnancy and breastfeeding, as a precaution.

The usual side effects are pain during the injections, redness, swelling and small bruises. In the 2018 trial they were common but temporary: at one year, no participant reported any adverse effect. One case of loss of vision after a PRP injection between the eyebrows has also been reported in the literature: this is extremely rare, but it is part of the information I owe you. I also ask you to avoid anti-inflammatory drugs for two weeks after the session. However, never stop an anticoagulant or prescribed aspirin on your own: we discuss it with your doctor first.