PRP Vs PRF: 3 Fundamental Differences
The core objectives of aesthetic treatment encompass the healing of wounds and the regeneration of tissues. In light of this, the utilization of autologous blood concentrates has come to the forefront. Initially, these concentrates were predominantly employed in oral maxillofacial surgery, but their effectiveness in both surgical and non-invasive aesthetic procedures has yielded impressive outcomes. This success points to a promising future for the domains of aesthetic and reconstructive medicine.
The practice of using autologous platelet therapy gained prominence during the 1990s, notably through the utilisation of platelet-rich plasma (PRP). It has since demonstrated its efficacy in various medical applications, before the subsequent evolution of autologous blood concentrate therapy in 2001, namely platelet-rich fibrin (PRF).
In this blog, we will delve into a comprehensive examination in the key differences between PRP and PRF, in terms of their composition, how they are derived and the benefits they bring. This information will prove valuable for aspiring surgeons as they decide between PRP and PRF, a choice that hinges upon the distinct requirements and objectives of the patient, as well as the area undergoing treatment.
1) Composition
PRP refers to the autologous plasma derived from a person's own blood, containing a significantly higher concentration of platelets compared to the normal baseline levels (usually 150,000 to 400,000 platelets per cubic microliter). The concentration of platelets in PRP typically ranges from 4 to 7 times the natural concentration.
PRF, a second-generation platelet concentrate was developed in 2001, to overcome the limitations of PRP. It is obtained without the use of anticoagulants and thereby totally autologous. The resulting product contains cell types (platelets, leukocytes, red cells), an extracellular fibrin matrix, and an array of bioactive molecules (predominately growth factors).
PRF provides not only the clinical advantages of PRP but also features a naturally occurring fibrin scaffold. This scaffold facilitates the formation of clots, acts as a supportive template for tissue regeneration, and maintains the presence of growth factors and stem cells. Growth factor signaling induced by injuries attracts Mesenchymal Stem Cells (MSCs) to the affected site, where these cells subsequently undergo differentiation. Surgical procedures and injections mimic local injuries, setting off the same signaling sequence. The application of PRF in conjunction with these treatments localizes and augments the regenerative processes activated by the body's natural response to injury.
2) How they are obtained
PRP is obtained by centrifuging the patient's blood before any medical procedure or surgery. To prevent clotting, the drawn blood is mixed with an anticoagulant, commonly citrate, which binds to calcium ions, thereby interrupting the clotting process. This anticoagulated blood remains stable for up to 8 hours. Following this, the next step involves centrifugation to separate the different components of blood: red blood cells, white blood cells, platelet-poor plasma, and PRP. Many commercial venipuncture tubes come equipped with gel separators that facilitate the separation process during centrifugation. The resultant plasma with an elevated platelet concentration is considered PRP. However, it's important to note that there's no established correlation between the platelet concentration and its effectiveness. Once prepared, PRP can be used immediately. Depending on the type of collecting venipuncture tubes and systems used, there may or may not be a need for additional activation.
In contrast to PRP, PRF is prepared by centrifuging whole blood without incorporating any additional substances. In the absence of anticoagulants, PRF spontaneously creates a gelatinous clot composed of a fibrin matrix. This clot confines the secretion of growth factors to the site of clotting. During tissue repair, fibroblasts recruited to the area restructure this fibrin matrix and initiate the synthesis of collagen. Consequently, the combined impact of growth factor secretion and fibroblast recruitment in PRF synergistically fosters collagen production and tissue rejuvenation.
Additionally, the gentle low-speed centrifugation employed for PRF tends to maintain the advantageous cellular components within the resulting PRF layer more effectively, while the high-speed centrifugation characteristic of the hard-spin phase in PRP preparation tends to relocate most cells towards the bottom of the container.
See below the figure for an illustration of the preparation of PRP vs PRF. (Taken from Karimi et al, 2019)
3) Benefits
PRF presents numerous advantages over PRP.
In the case of PRP, the release of growth factors is initially swift, resulting in transient, early-stage healing benefits that lack enduring progress. This transience can be attributed to the relatively brief lifespans of growth factors, in conjunction with their rapid and abundant release upon PRP activation. This phenomenon hampers prolonged effectiveness, as saturation of tissue receptors could hinder additional growth factors from binding before they degrade.
In contrast, PRF does not necessitate additives. Activation and the formation of fibrin clots are based on inherent properties of blood, and the timing of activation is comparatively well understood. Furthermore, PRF's wholly autologous nature mitigates the risk of immunogenic reactions and disease transmission.
A particularly noteworthy distinction lies in the extended release of growth factors by PRF, unlike the rapid release seen with PRP. Most growth factors are released over a span of up to 7 days in PRF, and some persist even longer. This prolonged release is thought to stem from PRF's composition, which aids in impeding the swift breakdown of growth factors, thereby facilitating their sustained secretion.
Additionally, the gradual polymerization and remodeling of the fibrin matrix within PRF, as opposed to the hasty and irregular polymerization seen in PRP, effectively preserves growth factors and other crucial cells. Growth factor concentrations generally tend to be higher in PRF than in PRP, demonstrated by PRF's notable efficacy in stimulating processes like angiogenesis, wound healing, and tissue regeneration.
See below the table for a summary of the key differences between PRP and PRF.
Reference:
The Benefits of Platelet-Rich Fibrin (2019)
Platelet-Rich Plasma for Skin Rejuvenation (2019)
Injectable platelet-rich fibrin for facial rejuvenation: A prospective, single-center study (2020)
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