PRP with Microneedling for Skin Rejuvenation
Combining PRP with microneedling is superior to microneedling alone for facial rejuvenation, with the recommended protocol being 3-6 treatment sessions performed every 2 weeks, though benefits diminish significantly after 6 months. 1
Treatment Protocol
Session Frequency and Duration
- Perform one session every 2 weeks for a total of 6 sessions 1
- Alternative protocols use 3 sessions with 15-day intervals, though 6 sessions show more robust outcomes 1
- Schedule follow-up assessment at 3 months post-treatment to evaluate response 1
Administration Technique
- Apply PRP topically after microneedling rather than intradermal injection when combining these modalities 2, 3
- Microneedling creates microchannels that enhance PRP penetration into the dermis 4, 2
- Some protocols combine both topical application AND intradermal PRP injection for enhanced results, showing 62.20% improvement versus 45.84% with microneedling alone 3
Expected Outcomes by Timeline
- 1 month post-treatment: 12% improvement in wrinkle scores 1
- 3 months post-treatment: 11% improvement 1
- 6 months post-treatment: Only 6% improvement, indicating significant decline in effect 1
- Pore reduction observable as early as 1 week post-treatment 1
Histopathological Evidence Supporting Combination Therapy
The combination demonstrates superior dermal remodeling compared to either treatment alone: 1
- Significant increase in epidermal thickness, particularly pronounced with combined treatment 1, 2
- Neocollagenosis with organized collagen bundle formation 1, 2
- Increased collagen volume and enhanced collagen organization 1
- Higher mean optical density of collagen (1019) compared to pre-treatment (539) and saline control (787) 1
- Increased fibroblast activity in treated areas 1
Clinical Improvements
Patients receiving combined PRP-microneedling show 89.05% improvement versus 46.01% with control treatments (ratio 1.93:1): 1
- Significant reduction in wrinkle count and volume 1
- Improved skin texture (both fine and coarse) 1
- Decreased brown spot counts and area 1
- Enhanced skin firmness and elasticity 1
- Reduction in pore size 1
Important Caveats and Limitations
Durability of Results
The most critical limitation is that wrinkle improvement does NOT show lasting effect beyond 6 months 1
- Q scores decline from 12% at 1 month to only 6% at 6 months 1
- Maintenance treatments will be necessary for sustained results 4, 5
Evidence Quality Issues
- Lack of standardization in PRP preparation techniques across studies makes direct comparison difficult 1, 4
- No standardized assessment scores used consistently across trials 1
- One high-quality RCT found PRP only "nominally but not significantly superior to normal saline" for some photoaging parameters 1
Comparison to Alternative Combinations
Microneedling with irradiated amniotic collagen matrix (IACM) may be MORE effective than PRP for facial rejuvenation 1, 6
- IACM showed superior improvement in wrinkle severity rating scale and global aesthetic improvement scale 6
- However, IACM is less widely available and requires further validation 6
Safety Profile
Adverse events are consistently mild and self-limited: 1, 7
- Pain during treatment (11.2% of patients, with only 2% rating as mildly painful) 7
- Erythema (transient) 1
- Burning sensation 1
- Bruising 1
- Transient itchiness (1.9% after first treatment) 7
- No serious adverse events reported in reviewed studies 5, 7
Practical Implementation
Patient Selection
- Best results for photoaging, fine lines, skin texture improvement, and mild wrinkles 1, 4, 5
- Works on various scar types including atrophic acne scars (62.20% improvement) 3
- Enhanced efficacy when treating face and trunk versus extremities 1
Optimization Strategies
Consider combining PRP with hyaluronic acid for superior outcomes: 1, 4
- Cellular matrix (PRP + HA) shows 20%, 24%, and 17% improvement at 1,3, and 6 months 1
- This exceeds PRP alone (9%, 11%, 8% at same timepoints) 1