Platelet Rich Fibrin (PRF)
Platelet rich fibrin (PRF) is the 2nd generation of regenerative therapies that involves using your body's own cells to improve skin appearance and, in the case of injury or wounds, can encourage healing. PRF is a treatment that involves injecting a patient's own growth factors and stem cells back into their body to help heal damaged joints, tendons, ligaments, and muscles. PRF is commonly used to treat chronic injuries and conditions like arthritis, tendonitis, bursitis, and sports injuries. These injected cells then go to work repairing damaged tissue and promoting healing.
The Science of PRP/PRF
Platelet Rich Plasma (PRP) refers to a treatment technique using your own blood to assist with healing. PRP is a biologic therapy that has no donor (it's "homologous") and is not a medication - therefore it is not currently regulated by the FDA. PRP is a first generation regenerative therapy. While PRP has shown to be of benefit in many conditions, PRF has recently replaced PRP as the homologous treatment of choice.
What is the process involved in PRP?
The first step is to draw blood just like you would at any other doctor's office. Then, we take your blood and process it by removing the red blood cells and concentrating the plasma and the platelets. We use the resulting product, which is platelet rich plasma (PRP) or platelet rich fibrin (PRF). The resulting substance is then injected directly into an area where you wish to increase the rate of healing.
What can platelet rich plasma be used to treat?
The great thing about PRP and PRF is that they can be injected into nearly any part of the body to promote healing. Some of the conditions PRP is used to treat include:
There are more conditions that can be treated with PRP and PRF than just the ones listed above.
How does PRP and PRF work?
During processing of the blood, your platelets are concentrated. When platelets are concentrated in PRP/PRF, there is a 6-8 fold increase in growth factors within the treatment area. The increased concentration of growth factors is though to be the primary component that stimulates the healing process. When released from the platelet, the growth factors stimulate production of the body's stem cells. The growth factors also stimulate the differentiation of stem cells and other cell types that are involved in healing.
One of the most fascinating growth factors released is vascular endothelial growth factor (VEGF). This growth factor is important in the body's production of new blood vessels, providing the basis for its use in treating conditions such as erectile dysfunction and diabetic neuropathy. Another growth factor released is transforming growth factor-Beta (TGF-Beta), which is responsible for stimulating collagen production. The production of collagen is what makes PRP a novel treatment in dermatology and wound care.
Are there any contraindications to getting PRP injections?
Yes. Some of the contraindications include, but are not limited to severe anemia, active infection, severe kidney disease, active malignancy. Anyone should be evaluated by a licensed physician before undergoing platelet rich plasma injections. This includes a complete review of your medical and surgical history and may include getting laboratory evaluations in certain situations.
While not necessarily a contraindication, taking certain medications immediately before or after PRP injections will decrease the effectiveness of the procedure. Medications that can interfere with PRP include corticosteroids, NSAIDs (for example aspirin, ibuprofen, naproxen), and others. Notify your doctor of all medications prior to receiving PRP treatment.
What is the difference between PRP and PRF?
Platelet rich plasma and platelet rich fibrin are nearly identical, with one exception - in platelet rich fibrin (PRF), the platelets are delivered once in activated form. Once the platelets are activated they begin to create the fibrin matrix. When the strands of fibrin link with one another, they form a mesh in the healing process.
In PRP, the platelets are left in the plasma. In PRF, the platelets are delivered within the fibrin mesh.
How many times can I get PRP/PRF injections before they stop working?
Currently, there's no known limitation on the number of PRP injections a person can receive. Frequency of injections is dependent on the condition being treated, among other factors to consider.
Is there any published research on PRP and PRF in peer-reviewed medical journals?
Absolutely. In fact, research on regenerative treatments such as platelet-rich plasma and platelet-rich fibrin continue to be one of the most exciting and fastest growing areas of medicine.
A Final Note on PRP/PRF
Regenerative medicine procedures are a relatively new aspect of medicine. As a result, processing techniques are constantly improving and evolving. As a result, there are many people, even medical professionals, who use inaccurate terminology to describe regenerative medicine techniques. Often times, this is to make things easier for patients to understand. However, for others, it may be a mistake attributable to ignorance or worse, deceit.
When discussing regenerative medicine techniques with your doctor, be sure to insist that they are specific in regards to which treatment they recommend and why. There are different methods to prepare PRP and PRF and you should ensure that you are getting the most appropriate treatment for the issue being treated.
Research Published on PRP and PRF
Below is a small collection of studies published in the past that highlight some of the benefits of platelet-rich plasma and platelet-rich fibrin for a variety of issues. The research listed below is only a small portion of what has been published on this topic and is not intended to provide a comprehensive selection.
PRP for Knee Pain and Osteoarthritis of the Knee
Zeng W, Wang G, Liao X, Pei C. Efficacy of Intra-Articular Injection of Platelet-Rich Plasma Combined with Mesenchymal Stem Cells in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Int J Clin Pract. 2022 Sep 20;2022:2192474. doi: 10.1155/2022/2192474. PMID: 36263242; PMCID: PMC9553671.
Annaniemi JA, Pere J, Giordano S. Platelet-rich plasma versus hyaluronic acid injections for knee osteoarthritis: a propensity-score analysis. Scand J Surg. 2019 Dec;108(4):329-337. doi: 10.1177/1457496918812218. Epub 2018 Nov 25. PMID: 30474493.
Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29. PMID: 26033459.
Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. Am J Sports Med. 2017 Feb;45(2):339-346. doi: 10.1177/0363546516665809. Epub 2016 Oct 21. Erratum in: Am J Sports Med. 2017 Apr;45(5):NP10. PMID: 28146403.
Screpis D, Piovan G, Natali S, Pasqualotto S, Magnanelli S, Iacono V, Farinelli L, Grassi M, Zorzi C. The use of autologous platelet-rich fibrin matrix combined with meniscal repair in the treatment of parameniscal cyst: clinical results and cyst recurrence after 2-year of follow up. J Exp Orthop. 2021 Nov 30;8(1):110. doi: 10.1186/s40634-021-00423-1. PMID: 34846594; PMCID: PMC8633331.
PRP for Hair Loss
Sharma A, Chouhan K, Bhatia S, Dashore S. Platelet-Rich Plasma in Androgenetic Alopecia. Indian Dermatol Online J. 2021 Nov 25;12(Suppl 1):S31-S40. doi: 10.4103/idoj.idoj_328_21. PMID: 34976879; PMCID: PMC8664169.
PRF and PRP in Dermatology
Shashank B, Bhushan M. Injectable Platelet-Rich Fibrin (PRF): The newest biomaterial and its use in various dermatological conditions in our practice: A case series. J Cosmet Dermatol. 2021 May;20(5):1421-1426. doi: 10.1111/jocd.13742. Epub 2020 Oct 12. PMID: 32996229.
Mercuri SR, Vollono L, Paolino G. The Usefulness of Platelet-Rich Plasma (PRP) for the Treatment of Vitiligo: State of the Art and Review. Drug Des Devel Ther. 2020 May 7;14:1749-1755. doi: 10.2147/DDDT.S239912. PMID: 32440100; PMCID: PMC7213865.
PRP for Erectile Dysfunction and Peyronie's Disease
Schirmann A, Boutin E, Faix A, Yiou R. Tolerance and efficacy of platelet-rich plasma injections in Peyronie's disease: Pilot study. Prog Urol. 2022 Oct;32(12):856-861. doi: 10.1016/j.purol.2022.05.004. Epub 2022 Jun 28. PMID: 35778315.
Schirmann A, Boutin E, Faix A, Yiou R. Pilot study of intra-cavernous injections of platelet-rich plasma (P-shot®) in the treatment of vascular erectile dysfunction. Prog Urol. 2022 Jun 10:S1166-7087(22)00130-0. doi: 10.1016/j.purol.2022.05.002. Epub ahead of print. PMID: 35697553.