What is the protocol for using platelet-rich plasma (PRP) therapy for facial rejuvenation or treatment of post-inflammatory hyperpigmentation (PIH)?

PRP Protocol for Facial Rejuvenation and Post-Inflammatory Hyperpigmentation (PIH)

For facial rejuvenation, PRP should be administered through intradermal injections at 2-4 week intervals for 3-6 sessions, while for PIH, chemical peeling with TCA 3.75% and lactic acid 15% is more effective than PRP therapy. 1

PRP for Facial Rejuvenation

Preparation Protocol

• Collect autologous blood and centrifuge to obtain platelet-rich plasma with 4-7 times baseline concentration of platelets 2
• Standard centrifugation protocols vary but typically involve:
  • First spin: 5-15 minutes at 1000-2000g 3
  • Second spin (if applicable): 5-10 minutes at higher force 3

Administration Methods

• Intradermal Injection Technique:

  • Use small gauge needles (30G recommended) for facial injections 3
  • Administer 2-3 mL of PRP via point-by-point injections into the dermis 3
  • For periorbital areas, use 22G × 2 inches (~5 cm) cannula for safety 3

• Microneedling with PRP:

  • Apply PRP topically after microneedling for enhanced penetration 3
  • Use lower depth settings (0.25 mm) for delicate areas like periorbital region 3
  • Microneedling combined with PRP shows better results than microneedling alone 3

Treatment Schedule

• Standard Protocol:
  • 3 sessions at 2-4 week intervals is the most common approach 3
  • For optimal results, some protocols recommend up to 6 sessions 3
  • Maintenance treatments may be performed every 6-12 months 3

Expected Outcomes

• Facial rejuvenation benefits include:
  • Reduction in wrinkle count and volume 3
  • Decreased brown spot counts and area 3
  • Improved skin firmness and elasticity 3
  • Enhanced overall facial appearance with 9-12% improvement at 1-6 months 3
  • Periorbital dark circles improvement (47.8-60.9%) 3
  • Periorbital wrinkle improvement (73.9-78.3%) 3

PRP for Post-Inflammatory Hyperpigmentation (PIH)

Important Caution

• PRP is NOT recommended as first-line treatment for PIH 1, 4
• Chemical peeling shows significantly better results than PRP for PIH 1
• Some studies report PRP may actually increase pigmentation in certain cases 4

Alternative Recommended Approach for PIH

• Chemical peeling with TCA 3.75% and lactic acid 15% shows excellent improvement in 38% of cases compared to only 4.8% with PRP 1
• For patients seeking PRP despite these limitations:
  • Use 3-4 sessions at 2-4 week intervals 1
  • Consider combination with other modalities like carboxytherapy 3

Enhanced Protocols and Combinations

PRP + Hyaluronic Acid

• Combining PRP with hyaluronic acid (HA) shows superior results compared to PRP alone 3
• Cellular matrix (PRP+HA) group showed 20-24% improvement in facial appearance compared to 9-12% with PRP alone 3
• Significantly improved skin elasticity compared to PRP monotherapy 2

PRP + Other Modalities

• PRF (Platelet-Rich Fibrin) shows promising results for periorbital rejuvenation 3
• Nanofat plus PRF demonstrates higher satisfaction rates and improved facial texture compared to traditional approaches 3
• Combined therapy with home care regimens improves cutaneous spots, wrinkles, and texture after 8 weeks 3

Precautions and Limitations

• Avoid PRP for active PIH as it may worsen hyperpigmentation 4
• Warn patients about potential bruising and swelling, especially in periorbital areas 3
• Limited high-quality evidence exists for PRP in facial rejuvenation; most studies show low to critically low confidence in results 5
• Results may vary based on patient age, BMI, and skin condition 2
• For periorbital areas, plasma gel may be more effective than conventional PRP 3

Clinical Pearls

• Assess patient expectations before treatment; results develop gradually over weeks to months 1
• Document baseline with standardized photography for objective assessment 3
• Biometric measurements provide more accurate assessment of subtle changes than visual assessment alone 2
• Patients with lower BMI may respond better to PRP+HA combinations for skin elasticity 2
• Older patients (50s-60s) may see better improvement in skin firmness with combination therapies 2