What is Platelet Rich Fibrin ( PRF) ?

 

Platelet rich fibrin or PRF is a new generation of platelet isolate, also considered to be a bioactive surgical additive, which, in recent studies published in the Plastic & Reconstructive Surgery Journal, has shown to augment the ability of fat graft “take” or survival during fat transfer procedures. Aside from fat grafting, platelet rich fibrin, or PRF, has several aesthetic applications similar to platelet rich plasma (PRP).

How is Platelet Rich Fibrin Differ from PRP ? 

 

Platelet rich fibrin ( PRF) differs from platelet rich plasma (PRP) in a few important ways:  

Both PRF and PRP are generated from the patient’s blood samples, which are centrifuged or spun at high rates to separate out the “active ingredients” found in the PRF and PRP from other blood products.   

PRF is centrifuged at a much lower rate than PRP.  This does a few things:  First, the slower rate of spinning allows for more stem cells and white cells to remain in the in the “platelet rich” area. Therefore the platelet-concentrate found in PRF has more active cells that are able to participate in the healing and rejuvenating process.  Additionally, the concentration of platelets found in PRF is significantly higher than that seen in PRP, paving the way for more effective treatments.  

Lastly, and unlike PRP, because no anti-coagulant or blood thinner is used during the centrifugation process of the PRF, fibrin is generated in the sample, creating a gelatinous matrix or scaffolding, which securely contains the platelets and cells, allowing for a controlled and methodical release of growth factors in a “time-released” fashion, promoting wound healing, the generation of new collagen, and the formation of new blood vessels. 

 

What we know about Platelet Rich Fibrin (PRF) and platelet rich plasma ( PRP)

 

Platelet rich fibrin and platelet rich plasma are derived from a patient’s blood isolate known as the plasma which contains several proteins, among them are growth factors, which are critical in signaling new pathways for tissue development and regeneration. The growth factors are of interest because of their many beneficial uses in aesthetic medicine.

How we use PRP and PRF in Aesthetic Medicine

PRP and PRF have several uses in aesthetic and regenerative medicine. You may have heard of one common use, the Vampire Facelift ( popularized by Kim Kardashian), and others which may be foreign to you.  To get a better understanding of how PRP is beneficial to us, lets first dive a little deeper into the potential indications for PRP and PRF.

Platelet rich plasma can be utilized to treat several different aesthetic conditions in the face and body including fine lines and wrinkles, thinning skin, age-associated volume loss, skin aging, inflammation following cosmetic procedures, wounds and scars (both acute and chronic), as well as hair loss (known as androgenic alopecia).

Now that we know what conditions PRP can potentially treat, lets dive a little deeper and look at how we can implement PRP to treat these various conditions.  PRP is commonly injected into the superficial and deep skin in its native liquid form – common applications include injecting PRP into the scalp, which stimulates new hair growth and new blood vessel growth.  Although this does not create a permanent solution to hair loss, in our practice, I like to pretreat the scalp with PRP in order to create a more favorable environment for hair transplantation.  The injection of PRP into the skin, which I refer to as transdermal microtherapy, has various benefits to the skin including thickening the epidermal thickness, stimulating collagen growth and more organized collagen in the skin which mimics younger skin, as well as greater skin elasticity.

Platelet rich plasma can also be modified into a gel through a heating and cooling and multiple centrifugation process.  This type of PRP is referred to as PRP gel. In layman’s terms, the PRP gel is simply a highly concentrated version of standard PRP, consisting of growth factors, cytokines, chemokines, and the fibrin scaffolding.  Once in a gel form, the PRP may, again, be injected into the superficial and deep skin, and even into deeper tissue.

 

Common misconceptions about PRP and PRF

 

PRP and PRF  injections are commonly marketed on social media platforms to be replacements for injectable fillers such as Juvederm, Restylane, and Voluma –  To date, there are no studies that convincingly prove that PRP creates long-standing volume which injectable fillers accomplish predictably and successfully. More so, the value of PRP and PRF as an injectable into deeper tissue serves to be “trophic” or potentially stimulating tissue growth and regeneration as well as new blood vessel growth (angiogenesis).

Platelet Rich Fibrin as an Adipose Cell and Injectable Filler Amplifier

 

To expand a little more on its utility, PRP and PRF may also be mixed with other tissues and products.  Some examples include:  PRP can be mixed with stem cells, in doing so, magnifying the activation and effects of stem cells. 

PRP and PRF are commonly mixed with fat cells.  The advantage of mixing PRP and PRF with fat cells is that the PRP potentiates fat cell generation by as much as 20%, a feature which benefits us when performing fat transfer to the face and body because, under normal conditions, a significant amount of fat cells don’t make it through the transfer process for a multitude of reasons; hence, amplifying their survivability is of benefit. Lastly, the platelet rich plasma may be mixed with fillers. By mixing PRP with fillers, we now get the “trophic” advantages provided by the plasma, with the volumizing properties of the filler.  Indeed, this is a very potent treatment for specific areas of the face including tear troughs, and far superior over simply injecting filler alone. 

 

Platelet Rich Plasma as an Anti-inflammatory 

Lastly, PRP can be applied topically, after procedures that incite inflammation such as Fraxel laser, CO2, or Fractora treatments – its use here lends to creating a quicker healing process for the patient, and we see that clinically in that patients treated with PRP right after laser treatments tend to have a quicker, less red and inflamed recovery than those untreated. In my practice, I like to apply it to the tissue following facelift surgery which helps expedite the healing period.  

 

Why you should consider PRP Treatments

PRP, or platelet rich plasma, provides several healing benefits as reviewed above.  When utilized in the skin, we see improvements in skin thickness and greater organization of skin at a histologic level (when examined under a microscope), which translates to an improved tone and texture, both elements common in youthful skin.  Additionally, PRP serves to augment the functionality and survivability of stem cells and adipose (fat) cells during aesthetic surgical procedures. We also reviewed how PRP may be implemented and combined with fillers to augment and optimize its results through the addition of trophic effects.  Lastly, we found that PRP is helpful in reducing the inflammatory process following procedures such as laser resurfacing.  With so much beneficial utility in aesthetic treatments, and because its derived from the most natural resource (your own body) , it behooves us to consider this regimen into our de-ageing treatments.

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