What is the recommended treatment approach for a healthy adult patient with a traumatic scar using Platelet-Rich Plasma (PRP) plus dermaroller therapy?

PRP Plus Dermaroller for Traumatic Scars

For traumatic scars in healthy adults, the combination of microneedling (dermaroller) with platelet-rich plasma (PRP) is the recommended treatment approach, with PRP applied before microneedling to allow deeper penetration into microchannels created by the needles. 1

Treatment Protocol

Session Schedule and Technique

• Perform 3-4 treatment sessions spaced 4 weeks apart 1, 2, 3
• Use a microneedling device with 1.5 mm needle depth for most traumatic scars 1
• Apply PRP before microneedling, not after—this critical timing allows the needling action to push PRP deeper into the dermis through the microchannels 1
• Consider maintenance treatments every 6 months after the initial series 1

Pre-Treatment Preparation

• Apply compounded topical anesthesia for a minimum of 30 minutes 4
• Completely remove anesthesia before starting the procedure 4
• Ensure adequate skin lubrication to avoid dry tugging sensation 4
• Map problem areas (deeper scars) for stamping technique at greater depth 4

PRP Preparation Standards

The evidence shows varied centrifugation protocols, but the most commonly cited approach uses:

• Double-spin technique: First spin at 1500 rpm for 10 minutes, second spin at 3700 rpm for 10 minutes 1
• Anticoagulant: Sodium citrate or ACD 1
• Can be activated with 10% calcium chloride if using intradermal injection 1

Expected Clinical Outcomes

Efficacy Data

The combination approach demonstrates superior results compared to either modality alone:

• 70.43% mean improvement with combined microneedling plus PRP 1
• 48.82% improvement with PRP alone 1
• 39.71% improvement with microneedling alone 1
• 43% of patients achieve excellent response with combination therapy versus 20% with single modality 1

Specific Improvements Reported

• 21.5% of patients report softer and more elastic scar tissue 2
• 7.5% experience improved mobility and functionality 2
• 7.5% observe improvement in scar color 2
• 5.6% show overall healthier skin appearance 2

Histological Changes

• Increased epidermal thickness 1, 4
• Neocollagenesis with enhanced collagen organization 1
• Increased dermal thickness 1
• Collagen laid down in normal lattice pattern rather than parallel bundles 1

Comparative Evidence: Alternative Approaches

Fat Grafts Plus PRP

One study compared three approaches for traumatic scars and found:

• Fat grafts mixed with PRP plus nonablative laser (1540 nm) was most effective 3
• This combination showed 22% better wound healing compared to fat grafts with PRP alone 3
• 11% better healing compared to laser alone 3

However, this approach is more invasive and requires fat harvesting, making microneedling plus PRP the more practical first-line option for most traumatic scars given its minimally invasive nature and strong evidence base 1, 2.

TCA Peeling Comparison

When microneedling plus PRP was compared to microneedling plus 15% TCA peeling:

• Both combinations showed significant improvement over microneedling alone 5
• TCA combination showed slightly more epidermal thickening 5
• PRP combination offers the advantage of being autologous with no risk of chemical complications 5

Safety Profile and Adverse Effects

Common Side Effects (Mild and Temporary)

• 21.5% of patients feel stressed before treatment 2
• 11.2% report tenderness during first treatment, with only 2 patients rating it as mildly painful 2
• 1.9% report transient itchiness after first treatment 2
• Mild erythema, edema, and bruising (all temporary) 1
• Significantly shorter downtime with PRP-enhanced treatments compared to other modalities 1

Serious Adverse Effects

• No serious adverse effects reported in the evidence 2, 6
• PRP is autologous, eliminating risk of allergic reactions or disease transmission 6

Contraindications

• Active infection at the treatment site 4
• Known hypersensitivity to PRP components 4
• Avoid injecting over tattoos or permanent makeup 4

Post-Treatment Care

Immediate Post-Procedure (24 Hours)

• Avoid sunlight exposure 4
• Avoid heavily scented facial products 4
• Use gentle, non-drying cleansers 1, 4
• Apply only non-comedogenic products 1, 4

Ongoing Maintenance

• Continue gentle skincare routine 1
• Consider maintenance sessions every 6 months after initial treatment series 1

Critical Clinical Pearls

Why Combination Therapy Works

The synergistic mechanism involves microneedling creating controlled micro-injuries that trigger wound healing cascades, while PRP delivers concentrated growth factors (including TGF-β) directly into these channels to amplify collagen remodeling and tissue regeneration. 1

Timing is Everything

The single most important technical detail: PRP must be applied before microneedling, not after. Studies that applied PRP after microneedling showed no added benefit, while those applying PRP before showed significant improvement. 1

Patient Selection Factors

• Younger patients show better responses 4
• More recent scars respond better than older scars 4
• However, the evidence includes successful treatment of scars of various ages 2

Scar Type Response Hierarchy

For atrophic scars (though traumatic scars may differ):

• Rolling scars respond best 1, 4
• Boxcar scars show good response 1, 4
• Ice pick scars are most resistant 1, 4

Alternative Consideration: PRF vs PRP

Platelet-rich fibrin (PRF) may offer even better outcomes than PRP, showing 3-fold higher excellent outcome rates when combined with microneedling compared to PRP with microneedling 1. PRF preparation uses:

• Lower centrifugation speed: 700 rpm for 3 minutes 1
• No anticoagulant required 1
• Critical limitation: PRF clots within 20-40 minutes if left in syringe, requiring immediate use 1

For practical purposes in most clinical settings, PRP remains the more feasible option due to longer working time and established protocols, though PRF should be considered if rapid application is possible 1.