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PRP vs PRF Therapy: Which One Is More Efficient?



Platelet-Rich Plasma (PRP) has been well known to treat various diseases in different specialties like dermatology, orthopedics, and dentistry. PRP contains high level of growth factors which have marked growth potential and induce faster healing. PRP has gained popularity in regenerative medicine due to the convenient availability of growth factors that only needs drawing blood. PRP is created by drawing a small sample of the patient's blood, typically from the arm. This blood sample is then processed in a centrifuge to separate and concentrate the platelets and growth factors. The resulting PRP solution is injected directly into the target area, such as an injured joint, damaged tendon, or the skin.


On the other hand, Platelet-Rich Fibrin (PRF) was developed for the purpose of removing anticoagulants for fear of hypersensitivity reaction and for better release of growth factors. A rapid and short centrifugation procedure is needed for separation of blood layers before clotting. A fibrin matrix is formed in the platelet-rich layer entrapping platelets and leukocytes in it. This matrix makes the release of growth factors slow and prolonged compared to PRP. PRF is prepared by drawing a small sample of the patient's blood, typically without anticoagulants, and then centrifuging it at a low speed. This centrifugation process separates the blood components into distinct layers, with the PRF layer containing a fibrin matrix that encapsulates a high concentration of platelets, leukocytes (white blood cells), and growth factors.


The efficiency of Platelet-Rich Plasma (PRP) therapy and Platelet-Rich Fibrin (PRF) therapy can vary depending on the specific medical condition being treated and individual patient factors. It's important to note that neither PRP nor PRF is universally more efficient than the other, as their effectiveness can differ in different clinical scenarios. Here are some factors to consider when evaluating their efficiency:


3 Factors to Evaluate PRP & PRF Efficacy


1. Rate of Growth Factor Release


PRP: PRP releases growth factors rapidly. PRP releases growth factors typically within the first few hours after application. This immediate release of growth factors can initiate and accelerate the early phases of the healing process. PRP's quick release of growth factors is advantageous in cases where a swift healing response is desired, such as acute injuries, surgical procedures, and certain dermatological applications. It can help reduce inflammation and promote tissue repair in the early stages of healing.

PRF: PRF is slower compared to PRP. PRF offers a slow and sustained release of growth factors due to its fibrin matrix. This sustained release occurs over a period of days to weeks due to the fibrin matrix that encapsulates the platelets and growth factors. This sustained release may be more suitable for tissue regeneration and prolonged healing, such as in dental procedures. PRF offers a slower and more sustained release of growth factors compared to PRP. This sustained release occurs over a period of days to weeks due to the fibrin matrix that encapsulates the platelets and growth factors. PRF's gradual release of growth factors makes it particularly suitable for tissue regeneration and prolonged healing. The sustained delivery of growth factors can support tissue repair and regeneration over an extended period.


2. Clinical Applications:


PRP: PRP has a broader range of clinical applications and is commonly used in orthopedics, sports medicine, dermatology, and more. Its versatility makes it suitable for various conditions. In dermatology, PRP can be used in:

a) Facial Rejuvenation: PRP is commonly used for facial rejuvenation treatments, often referred to as the "vampire facial." It involves drawing the patient's blood, processing it to obtain PRP, and then injecting or topically applying PRP to the face. PRP promotes collagen production, improves skin texture, reduces fine lines and wrinkles, and enhances skin tone and elasticity.


b) Hair Restoration: PRP is used to stimulate hair growth and thicken existing hair in cases of androgenetic alopecia (pattern baldness). PRP injections are administered into the scalp to promote hair follicle regeneration. PRP contains a variety of growth factors, including platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-beta). These growth factors play several roles in stimulating hair growth:

  • Increased Blood Flow: PRP promotes angiogenesis (the formation of new blood vessels), which improves blood flow to the hair follicles, delivering essential nutrients and oxygen.

  • Stem Cell Activation: PRP can activate dormant hair follicles and stimulate hair follicle stem cells, encouraging the growth of new hair.

  • Collagen and Tissue Regeneration: PRP helps repair damaged hair follicles and promotes the production of collagen, which strengthens hair shafts.

c) Scar Reduction: PRP can be applied to scars, including acne scars and surgical scars, to improve their appearance and texture. PRP contains growth factors that stimulate the production of collagen, a protein that helps heal and remodel scar tissue. Increasing collagen can lead to a smoother and more uniform scar. PRP promotes tissue regeneration by activating fibroblasts, which are cells responsible for producing collagen and rebuilding damaged tissue. In some cases, PRP can help reduce the hyperpigmentation or redness often associated with scars, such as post-inflammatory hyperpigmentation (PIH).


PRF: PRF is often used in dentistry and specific dermatological procedures. Its applications are more specialized. In dermatology, PRF can be used in:


a) Facial Rejuvenation: PRF can be used for facial rejuvenation to improve skin texture, tone, and elasticity. It is applied topically or injected into the skin, often in combination with micro-needling or other aesthetic treatments. PRF's slow and sustained release of growth factors can enhance collagen production, reduce fine lines, and promote overall skin health.


b) Scar Reduction: PRF can help improve the appearance of scars, including atrophic acne scars and surgical scars. When applied to scar tissue, PRF supports tissue remodeling, collagen synthesis, and a more even texture. This can lead to reduced scar visibility and improved skin tone.


c) Hair Restoration: PRF therapy is utilized to stimulate hair growth and improve hair thickness in individuals with conditions like androgenetic alopecia (pattern baldness). PRF is injected into the scalp to promote hair follicle activity and enhance hair growth.


d) Skin Rejuvenation: PRF can be applied to the skin to promote overall skin rejuvenation and address issues like sun damage, fine lines, and uneven skin tone. It can help restore a youthful appearance and enhance skin vitality.


e) Aesthetic Procedures:

PRF can complement various aesthetic procedures, such as dermal filler injections and botulinum toxin treatments. It may enhance the overall results of these procedures by promoting tissue regeneration and improving skin quality. PRF can be combined with dermal fillers to improve their longevity and the overall appearance of the treated area. When PRF is mixed with dermal fillers, it can provide a natural and longer-lasting effect. On some cases, PRF can be used in skin tightening treatment. PRF can be used to support these procedures by stimulating collagen production and enhancing the tightening effect.



3. Patient and Physician Preferences:

The choice between PRP and PRF may also depend on patient and physician preferences. Some patients may prefer PRF due to its preparation without anticoagulants, while others may opt for PRP because of its faster release. The effectiveness of PRP or PRF can vary from patient to patient. Factors such as the patient's overall health, the severity of the condition, and the location of treatment can influence the outcome. One thing for sure, the efficiency of both PRP and PRF can be supported by clinical evidence for specific conditions. The choice between the two may be influenced by the available research and the experience of the healthcare provider.


Past Research on PRP & PRF Comparison


1. The Comparison of Platelet-Rich Plasma Versus Injectable Platelet Rich Fibrin in Facial Skin Rejuvenation (2023)


The study involved 55 subjects, most of whom were female, with a mean age of 36.4 years. In this study, PRP and PRF were prepared for injection using the whole blood of each patient. PRP tubes contained anticoagulant sodium citrate, while PRF tubes did not contain any anticoagulant. Both PRP and PRF samples were centrifuged for 2 minutes at 2000 rpm to obtain approximately 4 to 5 ml of supernatant for injection.

Injections were administered in three facial regions bilaterally: frontal, canthal, and nasolabial. Local anesthetic cream with lidocaine and prilocaine was applied one hour before the procedures. Injections were divided into five equal parts within each region to prevent clotting, and injections were made immediately after preparation.


Skin evaluations were performed at baseline and follow-up visits at 1, 3, and 6 months using high-resolution UVA-light video camera and software. Skin parameters evaluated included skin smoothness (Sesm), skin roughness (Ser), scaliness (Sesc), and wrinkles (Sew). Other parameters evaluated included average spot size, average gradient, and desquamation index for the frontal region. Patient satisfaction and pain scores using a visual analog scale (VAS) were also assessed.


The study found that both PRP and PRF treatments led to significant improvements in the severity of various skin parameters. There were no significant differences between the two treatments in terms of changes in frontal and nasolabial parameters over time. However, PRF showed better (lower) scores for canthal smoothness and wrinkles compared to PRP, and this difference was statistically significant. The significant difference in canthal smoothness was observed at 3 months, while the difference in canthal wrinkles did not reach significance at any of the time points. Both PRP and PRF groups had similar frequencies of side effects. Lastly, patient satisfaction scores and pain scores were similar between the two groups.



2. Fluid Platelet-Rich Fibrin (PRF) Versus Platelet-Rich Plasma (PRP) in the Treatment of Atrophic Acne Scars: A Comparative Study (2023)


The study involved 30 adult patients with atrophic acne scars of different severities. They were randomly assigned to two groups: one group received PRP treatment, and the other group received Fluid PRF treatment. Both sides of the face were treated, with one side receiving the assigned treatment and the other side receiving a combined treatment of needling along with the assigned therapy.


PRP was prepared by drawing 10 ml of blood from each participant. The blood was centrifuged to separate PRP from platelet-poor plasma (PPP), and calcium chloride was added to activate PRP. Similarly, PRF was produced by centrifuging 10 ml of venous blood collected in a plain glass tube without anticoagulant. The upper layer of yellow to orange-colored fluid was collected as Fluid PRF. Local anesthetic cream was applied to the face 45 minutes before the treatment session. The treatment involved intradermal injections of PRP or Fluid PRF into the atrophic scars on one side of the face. On the other side, a derma electric-pen with needle cartridges was used to apply PRP or Fluid PRF topically over the affected areas, followed by needling. The treatment was initiated immediately after the preparation of PRF to prevent clot formation.

The therapeutic response was assessed using Goodman and Baron's global scarring grading system (GSGS) before treatment and four weeks after the last session. The improvement was classified into categories such as excellent, very good, good, or poor based on a quartile grading scale. Patients also rated their degree of improvement and pain on a scale of 0 to 10.


The study found that Both PRP and Fluid PRF treatments resulted in a significant improvement in acne scars on both sides of the face. The side treated with combined needling and either PRP or Fluid PRF showed a better improvement in acne scars compared to the side treated with PRP or Fluid PRF alone. Fluid PRF, either alone or combined with needling, demonstrated significantly better results in terms of improvement, skin texture, and skin laxity compared to PRP. Fluid PRF showed an earlier and more noticeable effect, with filling and lifting effects observed as early as the second day of injection. Side effects were mild and well-tolerated, with no significant differences between the PRP and Fluid PRF groups.


The study suggests that Fluid PRF, either alone or in combination with needling, is a promising and cost-effective treatment for atrophic acne scars. It demonstrated better results compared to PRP, with an earlier and more noticeable effect. However, further controlled trials are needed to confirm the effectiveness of Fluid PRF in the treatment of various skin conditions.



In summary, whether PRP or PRF is more efficient depends on the context and goals of the treatment. Both therapies have their advantages and are effective in promoting healing and tissue regeneration, but the choice should be made in consultation with a healthcare provider who can consider the specific condition and individual patient factors. Ultimately, the efficiency of either therapy is a case-by-case determination.


Reference:

The Comparison of Platelet-Rich Plasma Versus Injectable Platelet Rich Fibrin in Facial Skin Rejuvenation (2020)

Fluid Platelet-Rich Fibrin (PRF) Versus Platelet-Rich Plasma (PRP) in the Treatment of Atrophic Acne Scars: A Comparative Study (2023)

Optimized platelet-rich fibrin with the low-speed concept: growth factor release, biocompatibility, and cellular response (2017)

Platelet-rich Plasma use for facial rejuvenation: a clinical trial and review of current literature (2021)

Comparative release of growth factors from PRP, PRF, and advanced-PRF(2016)

 

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