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PRP Facelift: A Guide Through the Pros and Cons

Updated: May 2

A facelift, or rhytidectomy, is a procedure in aesthetic medicine that aims to mitigate the manifestations of facial aging through the repositioning and reshaping of facial and neck skin and, in some instances, the underlying musculature. This intervention primarily addresses skin laxity, wrinkles, and folds, with the ultimate objective of promoting a more youthful appearance.


Traditional surgical facelift techniques, while effective, are accompanied by a suite of potential limitations and complications. These include but are not limited to, extensive recovery times, the risks inherent to anesthesia, and the possibility of postoperative complications such as hematoma, nerve injury, and dissatisfaction with aesthetic outcomes. Such challenges underscore the necessity for advancements in minimally invasive procedures that promise comparable results with diminished risk profiles.


In this context, platelet-rich plasma (PRP) therapy emerges as an innovative approach within the domain of aesthetics. Leveraging the patient's autologous platelets to stimulate collagen production and cellular health [1], PRP therapy proposes a less invasive alternative with a focus on enhancing skin texture and volume. This modality does not directly replicate the effects of a traditional facelift but offers a complementary strategy aimed at improving skin quality and mitigating signs of aging with fewer risks and reduced downtime.


The purpose of this white paper is to provide a comprehensive evaluation of PRP facelifts for healthcare professionals. Through an exhaustive review of current literature and clinical outcomes, this document seeks to furnish healthcare providers with the critical insights necessary to appraise the utility and applicability of PRP therapy in the evolving landscape of aesthetic medicine.


Understanding Platelet Rich Plasma Therapy


PRP therapy is based on the autologous utilization of platelets, crucial components of blood integral to healing processes and tissue response to injury. This modality exploits the concentrated presence of platelets, harvested from the patient’s own blood, to potentially amplify the body's natural response mechanisms.


PRP Facelift

PRP Preparation


The methodology for preparing PRP commences with venipuncture to collect the patient's blood, which is then subjected to centrifugation. This process separates the blood into distinct layers, including red blood cells, platelet-poor plasma, and the buffy coat, which is rich in platelets. The buffy coat is further processed to enhance platelet concentration. The aim is to isolate a preparation with platelet counts exceeding baseline levels significantly, hypothesized to enhance the delivery of growth factors and cytokines pivotal for tissue response.


Mechanisms of Action


The theoretical foundation for PRP's efficacy in aesthetic concerns encompasses several interrelated mechanisms:


  • Collagen and Elastin Production


It is theorized that PRP can influence the production of collagen and elastin, which are crucial for maintaining the structural integrity and elasticity of the skin. This action could contribute to an improvement in the appearance of fine lines and the overall structure of the skin. [2]


  • Angiogenesis


PRP is also suggested to promote angiogenesis, the development of new blood vessels, which could improve blood supply and, consequently, the delivery of essential nutrients and oxygen to the skin. [3]


  • Skin Quality and Texture Improvement


Through the stimulation of collagen and elastin production as well as angiogenesis, PRP therapy may impact skin quality and texture, leading to enhanced skin tone, and volume. [4]

Although the primary focus of this document is on aesthetic applications, PRP's role extends into other areas of medicine where enhancement of the body's natural tissue response is desirable, including orthopedics and dentistry. [5] [6]


PRP Facelift Procedures: Techniques and Considerations


PRP facelift procedures have garnered attention for their nuanced approach to enhancing skin health and appearance. This section delineates the methodologies employed in PRP facelifts, explores adjunctive combination therapies, elucidates patient selection criteria, and outlines post-treatment protocols and potential side effects.


PRP Facelift

Techniques for PRP Facelift Procedures


PRP facelift techniques are characterized by the strategic administration of platelet-rich plasma into targeted areas of the face. The procedure involves precise injections at varying depths and volumes, tailored to address specific aesthetic concerns and anatomical considerations. Injection sites are typically chosen based on areas that would benefit from increased volume and improved skin quality, such as under-eye hollows, cheeks, and areas with fine lines and wrinkles. The depth of injection varies, with superficial injections aimed at improving uneven skin tone and texture and deeper injections targeting volume enhancement. Volume considerations are patient-specific, determined by the extent of the area being treated and the desired outcomes. [7]


Combination Therapies with PRP


Combining PRP with other aesthetic therapies can synergistically enhance outcomes. Hyaluronic acid (HA) fillers are frequently used in conjunction with PRP to provide immediate volumization and structure, while PRP is believed to facilitate longer-term improvements in skin quality [8]. Microneedling, another adjunctive technique, creates micro-injuries to the skin, theoretically enhancing the penetration and efficacy of PRP [9].


Considerations for Patient Selection


Selecting the appropriate patient is a cornerstone of optimizing outcomes and ensuring patient satisfaction. This selection process necessitates a holistic evaluation of the individual’s physiological characteristics, health status, and aesthetic aspirations. 


  • Age and Skin Health


Ideal candidates are those who are experiencing signs of aging but still retain a degree of skin elasticity. The health of the patient's skin, including factors like texture and integrity, plays a pivotal role in a good candidate and determining the potential efficacy of PRP facelifts.


  • Realistic Expectations


It is crucial for patients to have realistic expectations regarding the outcomes of PRP facelift procedures. Healthcare providers must ensure patients understand that while improvements in skin appearance and texture are achievable, results may vary and are not equivalent to those of surgical interventions.


  • Underlying Medical Conditions


Patients with certain medical conditions, such as blood disorders, acute infections, or certain chronic illnesses, may not be suitable candidates for PRP therapy. A thorough medical history and evaluation are imperative to mitigate risks and ensure patient safety.


Post-treatment Protocol and Potential Side Effects


Following PRP facelift procedures, patients may be advised to avoid strenuous activities and direct sun exposure for a short period of time. The typical post-treatment regimen emphasizes gentle skincare and hydration to support the healing process. Potential side effects include transient redness, swelling, bruising, and tenderness at injection sites, which generally resolve within a few days. Severe adverse effects are rare but can include infection, tissue damage, or allergic reactions, necessitating prompt medical attention.


Effectiveness and Safety of The "Vampire Facelift"


The scientific investigation into the effectiveness and safety of PRP facelifts is at a developmental stage, characterized by an array of methodologies and outcomes that illuminate the potential of PRP in aesthetic medicine yet simultaneously underscore the necessity for a more standardized approach to research.


PRP Facelift

Among the existing studies, one notable investigation documented the clinical outcomes of face and neck revitalization using PRP in a series of 23 patients over three months, revealing satisfactory results with no serious persistent side effects, albeit limited by the absence of a control group and a small sample size [10]. Another retrospective analysis focused on the impact of PRP on recovery times and aesthetic outcomes in facial rejuvenation procedures, finding that PRP significantly reduced recovery times in facial lipofilling procedures and improved aesthetic outcomes, as determined by an expert panel of plastic surgeons. However, this study's retrospective design and the lack of a standardized PRP protocol present challenges in fully endorsing these findings [11].


A double-blinded prospective trial comparing the efficiency of PRP with platelet-rich fibrin (PRF) in combination with fat grafts during facial lipostructure highlighted a preference for PRF over PRP, indicating lower resorption rates and suggesting nuances in the application of platelet concentrates that warrant further investigation. These studies collectively reflect a favorable safety profile for PRP facelifts, with minimal serious adverse effects reported, yet they also emphasize the critical need for more comprehensive research [12].


The call for future studies is clear, advocating for larger sample sizes, control groups, and standardized treatment protocols to unequivocally determine the efficacy and safety of PRP facelifts. As the body of evidence grows, it is anticipated that a more definitive understanding of PRP's role in facial aesthetic procedures will emerge, guiding clinical practice and optimizing patient outcomes in the realm of aesthetic medicine.


Comparing PRP Facelifts to Traditional Techniques


The traditional facelift techniques each target different anatomical features and concerns, offering a spectrum of options for aesthetic concerns.


  • Subcutaneous Lift


This surgical facelift targets the superficial layer beneath the skin, aiming to remove excess skin and tighten the remaining for a smoother appearance. It's suitable for addressing moderate signs of aging with less emphasis on deeper facial structures.


  • Superficial Musculoaponeurotic System (SMAS) Lift


This surgical facelift goes deeper than the subcutaneous lift to reposition and tighten the SMAS layer. This approach offers more durable results by addressing both skin and underlying muscle laxity, particularly for the lower face and jowls.


  • Deep Plane Facelift


This surgical facelift delves further into facial anatomy to reposition deeper tissues and muscles, offering a more comprehensive rejuvenation. It's particularly adept at addressing severe facial aging signs with long-lasting results.


  • Mid-Facelift


This surgical facelift concentrates on the midface, elevating sagging cheeks, and improving the under-eye area. This technique often incorporates volume-adding methods like fat grafting, providing a lifted and more youthful appearance to the central face.


  • Neck Lift (Cervicoplasty)


This surgical facelift specifically targets neck laxity and excess fat, tightening the platysma muscle, and removing sagging skin to refine the neck and jawline contour. Often performed alongside facelifts for a cohesive aesthetic improvement.


Let's compare PRP facelifts to these traditional surgical facelift techniques across several key dimensions:

Feature

PRP Facelift

Traditional Surgical Facelifts

Invasiveness

Minimally invasive; uses injections.

Invasive; requires incisions and tissue manipulation.

Downtime and Recovery

Minimal; typically a few days to a week for any swelling or bruising to subside.

Substantial; ranges from a few weeks to several months, depending on the technique and individual healing processes.

Cost

Lower; primarily due to the non-surgical nature and office-based procedure.

Higher; reflects the complexity, anesthesia, facility, and surgeon fees.

Potential Risks and Complications

Relatively low; mainly includes injection site reactions.

Higher; includes risks of anesthesia, infection, hematoma, nerve injury, and scarring.

Expected Outcomes and Longevity of Results

Improves skin texture and quality; effects last about 1-2 years.

Dramatic lifting and contouring effects; longevity varies from 5 to 15 years, depending on the specific procedure.


PRP facelifts function both as an adjunct to and an alternative to traditional surgical methods. For patients prioritizing less invasive modalities with reduced recovery periods, PRP facelifts offer a viable option, particularly applicable in the initial stages of aging or for individuals seeking improvements in skin quality and texture. When integrated with surgical facelift procedures, PRP has the potential to enhance skin conditions, which may in turn contribute to the durability of the outcomes achieved through surgical intervention. [13]


Ethical Considerations and Patient Communication


As PRP facelifts continue to be integrated into aesthetic practice, it is imperative that healthcare providers prioritize ethical considerations, particularly in patient communication. The ethical integrity of marketing claims about PRP facelifts must be closely monitored, reflecting the ongoing development of research in this area. Healthcare professionals are urged to base their patient communications and treatment recommendations on the most current, evidence-based information, ensuring claims about the benefits and limitations of PRP facelifts are both accurate and grounded in scientific validity.


Informed consent is a critical component of the ethical delivery of PRP facelifts. It extends beyond mere procedural formalities to embody a clear, comprehensive dialogue about the scope of PRP facelifts. This includes discussing the current understanding of potential outcomes, the limitations inherent in the procedure, and the spectrum of possible adverse effects. Such conversations are foundational to fostering an environment of trust and shared decision-making between healthcare providers and patients.


Potential Limitations and Risks


As PRP therapy garners attention across various medical and aesthetic fields, it's imperative for healthcare professionals to critically assess its limitations and the risks entailed. A thorough comprehension of these factors is pivotal for guiding informed patient consultations on PRP therapy's broad applications.


1. Limited Clinical Evidence


The employment of PRP therapy, while promising, is marked by a scarcity of extensive, longitudinal clinical studies. The substantiation of PRP's effectiveness across different treatment areas, along with a nuanced understanding of its potential side effects and the identification of optimally responsive patient profiles, is an active field of study. The variability observed in treatment efficacy, influenced by the health status and specific goals of individual patients, necessitates a prudent approach from practitioners. Staying abreast of emerging research and delivering a balanced evaluation of PRP therapy's potential and safety across its various applications is essential.


2. FDA Approval


The instruments and protocols for PRP preparation and application have received clearance from regulatory entities like the U.S. Food and Drug Administration. However, specific uses of PRP therapy lack explicit FDA endorsement. As PRP is derived from a patient's own biological materials, it falls outside the purview of drug regulation, affording healthcare providers discretion in its use, tailored to the unique requirements of their patients. [14]


3. Potential for Adverse Reactions


Despite PRP's autologous origin—which significantly reduces the chances of allergic reactions or rejection—there remains a possibility for adverse effects. These can encompass localized discomfort, injection site pain, infection risk, and other procedural complications. It is therefore crucial for healthcare providers to engage in detailed discussions with patients about these risks, ensuring a well-rounded understanding of the safety aspects of PRP therapy for diverse applications.


SELPHYL® Disclaimer


Instructions for the use of SELPHYL® can be found here and here.


SELPHYL® has not been approved by the FDA for subcutaneous, submucous, or intradermal injections in aesthetic medicine, and the safety and effectiveness of SELPHYL® for these conditions have not been established.


SELPHYL® is designed to be used for the safe and rapid preparation of autologous platelet-rich plasma (PRP) from a small sample of peripheral blood at the patient's point of care. The PRP is mixed with autograft and/or allograft bone prior to application to a boney defect to improve handling characteristics.


As of the time of writing, SELPHYL® has no known serious, life-threatening, or fatal risks apart from the adverse reactions described above.


SELPHYL® Limitations, Restrictions, Cautions, and Warnings


  • Prescription only.

  • Do not use the kit if the sterile packaging is damaged or compromised.

  • Follow universal safety precautions for blood collection and sharps disposal.

  • During blood draw, failure to align and properly seat tubes in the tube holder can result in a loss of vacuum and a loss of blood draw.

  • During PRP transfer, failure to align and securely seat tubes simultaneously in assembled blood transfer device tube holders can result in a loss of vacuum and the failure of PRP to transfer to the red-top PRFM tube.

  • Do not initiate the transfer of PRP into the red-top PRFM tube until the physician is ready to complete the procedure.

  • Do not reuse.


SELPHYL® Contraindications


These are not in FDA-required labeling and are part of SELPHYL®’s clinical evaluation for EU CE requirements.

  • Direct connection to a patient’s vascular system of circulating blood volume.

  • Other health conditions and diseases may also contraindicate the use of autologous PRP, including but not limited to low platelet count, sepsis, localized infection in the treatment area, anemia, malignancy with hematologic or bony involvement, and anticoagulation therapy.


Conclusion


PRP facelifts present a less invasive option for individuals seeking to address certain aspects of facial aesthetics, operating within the broader spectrum of aesthetic medicine. The modality's appeal is underscored by its utilization of autologous components, which may align with patient preferences towards minimally invasive procedures. However, the enthusiasm for PRP facelifts is tempered by the acknowledgment that the current landscape of research, while promising, remains in a state of flux. This underscores the critical need for further investigative rigor to delineate the parameters of efficacy, safety, and optimal application techniques.


Healthcare providers are enjoined to exercise discernment in patient treatment plan selection, ensuring that candidates for PRP treatments and facelifts are chosen based on objective criteria and a comprehensive assessment of individual patient profiles. As research continues to unfold, it is anticipated that new insights will refine and expand the utility of PRP, potentially introducing novel applications and enhancing patient care protocols.


About the Author:


Dr. Ali is a medical professional, journalist, and copywriter, currently partnering with Selphyl® to write medical-related articles.

References


  1. Selphyl. About PRFM. Selphyl. Published June 1, 2023. https://www.selphyl.com/about-prfm

  2. Lei X, Xu P, Cheng B. Problems and Solutions for Platelet-Rich Plasma in Facial Rejuvenation: A Systematic Review. Aesthetic Plast Surg. 2019;43(2):457-469.

  3. Xiao H, Xu D, Mao R, Xiao M, Fang Y, Liu Y. Platelet-Rich Plasma in Facial Rejuvenation: A Systematic Appraisal of the Available Clinical Evidence. Clin Cosmet Investig Dermatol. 2021;14:1697-1724.

  4. Tsai YW, Cheng CY, Hu S, Chang SL, Lin TM, Huang YL. Platelet-Rich Plasma Versus Platelet-Poor Plasma for Treating Facial Photoaging: a Double-Blind Randomized Controlled Splitting Face Study. Aesthetic Plast Surg. Published online January 22, 2024.

  5. Everts PA, van Erp A, DeSimone A, Cohen DS, Gardner RD. Platelet Rich Plasma in Orthopedic Surgical Medicine. Platelets. 2021;32(2):163-174.

  6. Xu J, Gou L, Zhang P, Li H, Qiu S. Platelet-rich plasma and regenerative dentistry. Aust Dent J. 2020;65(2):131-142.

  7. Chamata ES, Bartlett EL, Weir D, Rohrich RJ. Platelet-Rich Plasma: Evolving Role in Plastic Surgery. Plast Reconstr Surg. 2021;147(1):219-230.

  8. Ulusal BG. Platelet-rich plasma and hyaluronic acid - an efficient biostimulation method for face rejuvenation. J Cosmet Dermatol. 2017;16(1):112-119.

  9. Chawla S. Split Face Comparative Study of Microneedling with PRP Versus Microneedling with Vitamin C in Treating Atrophic Post Acne Scars [published correction appears in J Cutan Aesthet Surg. 2015 Jan-Mar;8(1):75]. J Cutan Aesthet Surg. 2014;7(4):209-212.

  10. Redaelli A, Romano D, Marcianó A. Face and neck revitalization with platelet-rich plasma (PRP): clinical outcome in a series of 23 consecutively treated patients. J Drugs Dermatol. 2010;9(5):466-472.

  11. Willemsen JC, van der Lei B, Vermeulen KM, Stevens HP. The effects of platelet-rich plasma on recovery time and aesthetic outcome in facial rejuvenation: preliminary retrospective observations. Aesthetic Plast Surg. 2014;38(5):1057-1063.

  12. Keyhan SO, Hemmat S, Badri AA, Abdeshahzadeh A, Khiabani K. Use of platelet-rich fibrin and platelet-rich plasma in combination with fat graft: which is more effective during facial lipostructure?. J Oral Maxillofac Surg. 2013;71(3):610-621.

  13. Alam M, Hughart R, Champlain A, et al. Effect of Platelet-Rich Plasma Injection for Rejuvenation of Photoaged Facial Skin: A Randomized Clinical Trial. JAMA Dermatol. 2018;154(12):1447-1452.

  14. Johns Hopkins Medicine. Platelet-Rich Plasma (PRP) Injections. Accessed April 8, 2024. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/plateletrich-plasma-prp-treatment


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