by: Daniel Clary - Vice President of AnteAge
PRP and MN (micro-needling) in Aesthetics
Microneedling with PRP (platelet rich plasma) was trademarked as the " vampire facial" and
popularized widely when Kim Kardashian had it done on her TV show. Many practitioners
offer PRP microneedling, which involves drawing blood, centrifuging it, taking the platelet layer
and then activating them so they release the growth factors and cytokines contained within
their alpha granules, which is where PRP's “effectiveness” comes from.
PRP is quite expensive and certainly not for everyone, especially those squeamish about blood and needles. We think there is a better way.
A little history: In the early 2000’s, the use of PRP extended into orthopedics to boost healing in
bone grafts and fractures. Continued success encouraged its use in sports medicine for
connective tissue repair. The first human study published by Mishra and Pavelko, associated
with Stanford University, supported the use of PRP for chronic elbow tendinosis in 2006. This
study reported a 60% improvement immediately, 81% at 6 months and 93% decrease in pain at
the final two year follow up. For injuries where a little boost in inflammatory response to
improve vascularity and increase oxygen delivery is good, PRP plays a positive role. Healing in
an inflammatory environment promotes fibrosis, or scar tissue. In the context of orthopedics,
you would rather have a fibrotic ligament than no ligament at all, right?
Aesthetic physicians jumped on the bandwagon a few years later. But does the evidence favor
the use of PRP in aesthetics? Unfortunately, no.
If you inherently understand the fundamentals of aging you know that when it comes to anti-
aging and facial aesthetics, the growing opinion is that inflammation is not desirable. In fact, it
is something to be avoided whenever possible.
That's why we are not fans of products containing pro-inflammatory ingredients such as fat stem cell conditioned media.
Applying products on a daily basis that promote inflammation is not anti-aging, it's the
PRP contains high concentrations of the very highly pro-inflammatory bio-signals TNF-
alpha, IL-1 beta, IL-6, and TGF-beta1, along with several other bio-signals that are beneficial in
certain scenarios, such as PDGF and VEGF. The effect then of applying PRP during
microneedling is to exacerbate inflammation. Remember, inflammation when accentuated,
persistent, or chronic, is what leads to fibrosis (scarring) and excess pigmentation in susceptible
individuals. As you can see, we're not fans of PRP although we do know it is popular
(remember, the physician gets paid handsomely for using it.)
So, what to do? (Beware, horn tooting time!) Several years ago, we developed a family of
microneedling solutions that are used exactly how PRP is used, at the time of and immediately
after microneedling. Our products are based on our old friend, bone marrow mesenchymal
stem cell conditioned media and hyaluronic acid. These are highly effective in quenching the
inflammatory response and promoting healing. Hundreds of thousands of treatments have
utilized these products without reports of an adverse event.
PRP is pro-inflammatory so OPPOSITE of anti-aging. It ads NOTHING beneficial to microneedling.
THE EVIDENCE / DATA:
Vet J. 2017 Jun;224:76-84. doi: 10.1016/j.tvjl.2017.04.005. Epub 2017 May 2.
Comparison of autologous bone marrow and adipose tissue derived mesenchymal stem cells,
and platelet rich plasma, for treating surgically induced lesions of the equine superficial
digital flexor tendon.
Several therapies have been investigated for equine tendinopathies, but satisfactory long term
results have not been achieved consistently and a better understanding of the healing
mechanism elicited by regenerative therapies is needed. The aim of this study was to assess the
separate effects of autologous bone marrow (BM) and adipose tissue (AT) derived mesenchymal stem cells (MSCs), and platelet rich plasma (PRP), for treating lesions induced in the superficial digital flexor tendon (SDFT) of horses. Lesions were created surgically in both SDFTs of the forelimbs of 12 horses and were treated with BM-MSCs (six tendons), AT-MSCs (six tendons) or PRP (six tendons). The remaining six tendons received lactated Ringer's solution as control. Serial ultrasound assessment was performed prior to treatment and at 2, 6, 10, 20 and 45 weeks post-treatment. At 45 weeks, histopathology and gene expression analyses were performed. At week 6, the ultrasound echogenicity score in tendons treated with BM-MSCs suggested earlier improvement, whilst all treatment groups reached the same level at week 10,
which was superior to the control group. Collagen orientation scores on histological examination suggested a better outcome in treated tendons. Gene expression was indicative of better tissue regeneration after all treatments, especially for BM-MSCs, as suggested by upregulation of collagen type I, decorin, tenascin and matrix metalloproteinase III mRNA.
Considering all findings, a clear beneficial effect was elicited by all treatments compared with
the control group. Although differences between treatments were relatively small. BM-MSCs
resulted in a better outcome than PRP and AT-MSCs.
J Dermatolog Treat. 2017 Aug 7:1-18. doi: 10.1080/09546634.2017.1365111. [Epub ahead of
Skin microneedling plus Platelet-Rich Plasma versus skin microneedling alone in the treatment of atrophic post acne scars: a split face comparative study.
Acne scarring is a permanent disfiguring sequel, which can take varied morphological forms.
Many therapeutic measures have been performed to improve acne scarring such
Our objective is to evaluate the efficacy and safety of microneedling alone versus microneedling in combined with platelet rich plasma in the treatment of post acne Methods:
The study included 35 patients with mild to severe post acne atrophic scar.
All thepatients received four sequential treatments of skin microneedling alone on the right side of
the face and skin microneedling followed by topical application of PRP on the left side of the
face with an interval of 3 weeks.
Two blinded dermatologists evaluated the clinical response according to qualitative global acne scarring system grading of Goodman & Baron. Patients are queried about their satisfaction with the treatment outcomes.
The study included 35 patients with a mean age of 24.7±6.8 years. There was a significant
improvement in the degree of scar severity before and after treatment on both sides.
Regarding patient's satisfaction grades there was a significant improvement after both
treatment modalities with insignificant differences between both treatment modalities.
Both microneedling and microneedling in combined with PRP showed satisfactory
!! PRP adds NOTHING to microneelding...so why bother? !!
Am J Sports Med. 2012 Jun;40(6):1274-81. doi: 10.1177/0363546512442334. Epub 2012 Apr 10.
Comparison of the acute inflammatory response of two commercial platelet-rich plasma
systems in healthy rabbit tendons.
Dragoo JL1, Braun HJ, Durham JL, Ridley BA, Odegaard JI , Luong R, Arnoczky SP .
Numerous studies have shown platelet-rich plasma (PRP) preparations differ with respect to
the inclusion of certain blood components, which may affect the host's cellular response.
This study evaluated the inflammatory effect of Biomet GPS III leukocyte-rich PRP (LR-PRP)
versus MTF Cascade leukocyte-poor PRP (LP-PRP) after intratendinous injection in an animal
model. The authors anticipated that LR-PRP would incite a greater acute inflammatory response
Controlled laboratory study.
A total of 17 skeletally mature New Zealand White rabbits were tested. In all cases, healthy
patellar tendons were treated. In the control animals, one patellar tendon was injected with 2
mL autologous whole blood, and the other was injected with 2 mL sterile saline. Seven total
tendons were injected with whole blood, and 7 tendons were injected with saline. In the
experimental animals, one patellar tendon was injected with 2 mL LR-PRP, and the other was
injected with 2 mL LP-PRP. Ten tendons were injected with LR-PRP, and 10 tendons were
injected with LP-PRP. Animals were euthanized at 5 or 14 days after injection. Tendons were
harvested and stained using hematoxylin and eosin and scored semi-quantitatively for total
white blood cells (WBCs), mononuclear cells (macrophages and lymphocytes),
polymorphonuclear cells (PMNs), vascularity, fiber structure, and fibrosis.
At 5 days after injection, tendons treated with LR-PRP had significantly greater overall tendon
scores (6.3 ± 1.79 vs 1.8 ± 1.64, P = .012), as well as mean scores for fiber structure (1.4 ± 0.22
vs 0.50 ± 0.50, P = .012), denoting disrupted composition, total WBCs (1.1 ± 0.89 vs 0.10 ± 0.22,
P = .014), mononuclear cells (macrophages and lymphocytes) (0.80 ± 0.45 vs 0.10 ± 0.22, P =
.014), vascularity (1.7 ± 0.27 vs 0.80 ± 0.16, P = .008), and fibrosis (1.0 ± 0.35 vs 0.3 ± 0.45, P =
.037) compared with tendons treated with LP-PRP. Otherwise, there were no significant
differences in mononuclear cells (P = .590), PMN cells (P = 1.00), total WBCs (P = .811),
vascularity (P = .650), or total tendon score (P = .596) in any of the treatment groups at 14 days.
Compared with leukocyte-poor Cascade PRP, leukocyte-rich GPS III PRP causes a significantly
greater acute inflammatoryresponse at 5 days after injection. There is no significant difference
in the inflammatory response or cellularity regardless of the injection type at 14 days after
Platelet-rich plasma injections are frequently prepared using commercial systems and are
administered for clinical treatment of chronic tendinopathy. It is important to characterize the
cellular responses elucidated by different injection preparations to further understand their
effect on tissue healing and aid clinical decision making. Future investigations are necessary to
apply these findings to the clinical setting. HIGHLY INFLAMMATORY
J Dermatolog Treat. 2016;27(3):285-9. doi: 10.3109/09546634.2015.1094178. Epub 2015 Oct 14.
Applications of platelet-rich plasma in dermatology: A critical appraisal of the literature.
Lynch MD 1 , Bashir S 1 .
Platelet-rich plasma (PRP) is an autologous blood-derived product enriched in platelets, growth
factors, chemokines and cytokines. Initial applications were predominantly in musculoskeletal and
maxillofacial fields, however in recent years, it has been used for a range of dermatological
indications including wound healing, fat grafting, alopecia, scar revision and dermal volume
augmentation. Here, we critically appraise the literature relating to the usage of PRP within
Dermatology. We have evaluated in vitro data, preclinical animal studies and human trials. We
conclude that, while the literature may be consistent with a modest benefit for specific
indications, there is not sufficient evidence supporting the efficacy of PRP to justify a role in
routine dermatological practice at the present time. However, since PRP is generally well
tolerated with few reported complications, further study may be justified in the context of organized
Q-value of cytokine concentration
between plasma and activated PRP