What is the best approach for Platelet-Rich Plasma (PRP) treatment, injections or micro needling?

Best Approach for PRP Treatment: Combination Therapy

The optimal approach for PRP treatment is combining microneedling with intradermal PRP injections, which demonstrates superior outcomes (70.43% mean improvement) compared to either modality alone. 1

Evidence-Based Treatment Algorithm

Primary Recommendation: Combined Approach

Perform microneedling FIRST, then immediately inject PRP intradermally while channels are open. This sequence is critical—studies show that applying PRP topically after microneedling provides no added benefit, but intradermal injection following microneedling produces synergistic effects. 1

• Mean improvement rates: Combined therapy (70.43%) > PRP injections alone (48.82%) > Microneedling alone (39.71%) 1
• Patient satisfaction: 43% achieved excellent response with combination therapy versus only 20% with single modality 1
• Clinical superiority: Combination treatment shows statistically significant higher odds (OR: 2.97) of achieving >50% improvement in scar grading scales 2

Treatment Protocol Specifications

Initial Series:

• 3-4 treatment sessions spaced 1 month apart 1
• Needle depth: 1.5mm for microneedling 1
• Frequency: Alternating every 2 weeks when combining modalities, or monthly for single approach 1

Maintenance:

• Every 6-12 months after initial series completion 1, 3

Technical Execution Details

Step 1: Intradermal PRP Injections (Perform BEFORE Microneedling)

• Use 30-gauge, 4mm needles with bevel facing up 1
• Create intradermal papules 5mm apart in problem areas 1
• Target specific concerns: crow's feet, glabellar lines, nasolabial folds 1
• Critical timing: Inject while PRP is in liquid form, before clotting occurs 1

Step 2: Microneedling (Immediately After Injections)

• Depth: 0.25-2.5mm depending on indication 3
• Device: Automated, electrically powered at 3,000-5,000 RPMs 3
• The microneedling pushes PRP deeper into microchannels, delivering growth factors (PDGF, TGF-β) that stimulate collagen type 1 expression 3

Critical Pitfall to Avoid

Never apply PRP topically AFTER microneedling as the sole method. One study showed no advantage when PRP was only applied topically post-microneedling, likely because the PRP cannot penetrate adequately once channels begin closing. 1 The evidence consistently shows intradermal injection is superior to topical application. 1

PRF Consideration

If using PRF instead of PRP, the combination approach shows even greater superiority—3-fold higher therapeutic response compared to PRP. 1, 4 However, PRF clots within 20-40 minutes, requiring faster execution. 1

Safety Profile

• Downtime: 24-48 hours (significantly shorter than lasers) 3
• Adverse events: Mild and similar between combination and single modality—no increased risk of severe erythema or edema 2
• Safe for all Fitzpatrick skin types including III-VI 3, 4

Post-Treatment Care

• Avoid sunlight for 24 hours 3, 4
• Avoid heavily scented products for 24 hours 3, 4
• Use gentle, non-comedogenic cleansers during healing 3

When Single Modality May Be Considered

Intradermal PRP injections alone may be reasonable for patients who cannot tolerate microneedling or have contraindications, though outcomes will be inferior (48.82% vs 70.43% improvement). 1 Microneedling alone without PRP is the least effective option and should be avoided when PRP is available. 1