Love science.
This is a study in the Aesthetic Surgery Journal by Rigotti and colleagues to look at PRP changes in the skin. For those not in the know, there is controversy over if PRP is worth it. I am a huge fan of fat grafting, and previous studies have documented how there are histologic improvements in skin from doing fat grafting with stem cells and those changes are NOT seen using PRP. SEE BLOG HERE>
Aesthetic Surgery Journal March 2018, “Effect of the Use of Platelet Rich Plasma PRP in Skin with Intrinsic Aging Process.”
The authors state in previous papers they showed fat and stem cells improve the skin by decreasing breakdown of elastic fibers, with formation of new elastic fibers and an increase in the blood vessels. (In English, this is all good stuff for fighting aging of the skin.)
They made this study to analyze the histologic changes in the skin after injection of only PRP. The skin they chose was behind the ear, so sun damage wouldn’t affect the results.
Study:
- 13 patients
- Facelift candidates, ages 45-65.
- PRP was injected in the area behind the ear.
- Skin was analyzed before the procedure and 3 months after.
- Histology analysis by optical and electron microscope
Findings?
- After PRP injection the dermis thickened
- This was because elastic fibers and collagen was put down (yay!)
- BUT they said this was with a fibrotic aspect (uh oh)
- Significant regeneration was not seen in histology or ulstrastructural analysis (uh oh)
- There were sites of moderate inflammation and microangiopathy seen (uh oh)
Conclusion?
Treatment with PRP increased dermis thickness with a fibrotic aspect. In the long term, the presence of inflammation and microangiopathy could lead to precocious aging.
What does this mean?
Precocious aging is not good. They are saying that the thickness is due to scarring, and because of the inflammation and fibrosis, it will make the skin age faster. Before we go all crazy on this, they know the study is a small sample size. They did not get sun damaged skin purposefully, so the results may be different in that skin. They argue inflammation and fibrosis are bad for skin and aging.
The Retort to the journal article states the changes could be due to wound healing nearby (these were facelift patients) and they cannot state the dermis thickening is all fibrosis. They state there is no standard to PRP- the dosing, outcome measures, and controls. They state the fibrosis seen could be temporary.
What do I think?
I love fat. I see objective visible improvements in the skin. I see patients 7 years out where I injected fat in the cheek, and their cheek is pink, full, with great skin quality- noticeably different from the skin where I did NOT inject fat at the time. So I am a big believer in fat. As for PRP, it still falls into the “promising but not proven” category for me, though as I read more and more, I feel it is more hype than a real game changer.