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Semin Plast Surg 2019; 33(03): 155-161
DOI: 10.1055/s-0039-1693400
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Platelet-Rich Plasma: Principles and Applications in Plastic Surgery

Amjed Abu-Ghname
1   Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Aurelia Trisliana Perdanasari
1   Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Matthew J. Davis
1   Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Edward M. Reece
1   Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2019 (online)

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Abstract

Platelet-rich plasma (PRP) is an autogenously harvested liquid platelet concentrate extracted from a patient's peripheral blood that contains higher than baseline concentrations of growth factors and cytokines. This innovative new technology has demonstrated great promise in the field of plastic surgery, and its use has been evaluated in several clinical settings including wound healing, hair restoration, and skin rejuvenation. The goal of this article is to explain the biology behind PRP and to review the basic principles involved in its preparation. This will be followed by a discussion of some clinical applications of PRP in both aesthetic and reconstructive plastic surgery.

Keywords

platelet-rich plasma - PRP - growth factors - wound healing - skin rejuvenation - bone healing - hair growth
 

  • References

  • 1 Beasley LS, Einhorn TA. Role of growth factors in fracture healing. In: Canalis E. , ed. Skeletal Growth Factors. New York, NY: Lippincott Williams & Wilkins; 2000: 311-322
    Search in Google Scholar
  • 2 Bhanot S, Alex JC. Current applications of platelet gels in facial plastic surgery. Facial Plast Surg 2002; 18 (01) 27-33
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004; 91 (01) 4-15
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004; 62 (04) 489-496
    CrossrefPubMedSearch in Google Scholar
  • 5 Kevy SV, Jacobson MS. Comparison of methods for point of care preparation of autologous platelet gel. J Extra Corpor Technol 2004; 36 (01) 28-35
    PubMedSearch in Google Scholar
  • 6 Eppley BL, Pietrzak WS, Blanton M. Platelet-rich plasma: a review of biology and applications in plastic surgery. Plast Reconstr Surg 2006; 118 (06) 147e-159e
    CrossrefPubMedSearch in Google Scholar
  • 7 Becker RP, De Bruyn PP. The transmural passage of blood cells into myeloid sinusoids and the entry of platelets into the sinusoidal circulation; a scanning electron microscopic investigation. Am J Anat 1976; 145 (02) 183-205
    CrossrefPubMedSearch in Google Scholar
  • 8 Patel SR, Hartwig JH, Italiano Jr JE. The biogenesis of platelets from megakaryocyte proplatelets. J Clin Invest 2005; 115 (12) 3348-3354
    CrossrefPubMedSearch in Google Scholar
  • 9 Lichtman MA, Chamberlain JK, Simon W, Santillo PA. Parasinusoidal location of megakaryocytes in marrow: a determinant of platelet release. Am J Hematol 1978; 4 (04) 303-312
    CrossrefPubMedSearch in Google Scholar
  • 10 Buckwalter JA, Einhorn TA, Bolander ME, Cruess RL. Healing of the musculoskeletal tissues. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD. , eds. Fractures in Adults. Philadelphia, PA: Lippincott-Raven; 1996: 261-304
    Search in Google Scholar
  • 11 Anderson J. The cellular cascades of wound healing. In: Davies JE. , ed. Bone Engineering. Toronto, ON: Em Squared Inc.; 2000: 81-93
    Search in Google Scholar
  • 12 Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clin Dermatol 2007; 25 (01) 9-18
    CrossrefPubMedSearch in Google Scholar
  • 13 Conley CL. Hemostasis. In: Mountcastle VB. , ed. Medical Physiology. St. Louis, MO: Mosby; 2004: 1137-1146
    Search in Google Scholar
  • 14 Welsh WJ. Autologous platelet gel: clinical function and usage in plastic surgery. Cosmet Dermatol. 2000; 11: 13
    PubMedSearch in Google Scholar
  • 15 Wu PI, Diaz R, Borg-Stein J. Platelet-rich plasma. Phys Med Rehabil Clin N Am 2016; 27 (04) 825-853
    CrossrefPubMedSearch in Google Scholar
  • 16 Gonzalez AC, Costa TF, Andrade ZA, Medrado AR. Wound healing—a literature review. An Bras Dermatol 2016; 91 (05) 614-620
    CrossrefPubMedSearch in Google Scholar
  • 17 Woodward SC, Salthouse TN. The tissue response to implants and its evaluation by light microscopy. In: von Recum AF. , ed. Handbook of Biomaterials Evaluation. New York, NY: Macmillan Publishing Company; 1986: 364-378
    Search in Google Scholar
  • 18 Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. J Int Med Res 2009; 37 (05) 1528-1542
    CrossrefPubMedSearch in Google Scholar
  • 19 Araki J, Jona M, Eto H. , et al. Optimized preparation method of platelet-concentrated plasma and noncoagulating platelet-derived factor concentrates: maximization of platelet concentration and removal of fibrinogen. Tissue Eng Part C Methods 2012; 18 (03) 176-185
    PubMedSearch in Google Scholar
  • 20 Dohan Ehrenfest DM, Andia I, Zumstein MA, Zhang CQ, Pinto NR, Bielecki T. Classification of platelet concentrates (platelet-rich plasma-PRP, platelet-rich fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J 2014; 4 (01) 3-9
    CrossrefPubMedSearch in Google Scholar
  • 21 Lin J, Sclafani AP. Platelet-rich plasma for skin rejuvenation and tissue fill. Facial Plast Surg Clin North Am 2018; 26 (04) 439-446
    CrossrefPubMedSearch in Google Scholar
  • 22 Sclafani AP. Platelet-rich fibrin matrix for improvement of deep nasolabial folds. J Cosmet Dermatol 2010; 9 (01) 66-71
    CrossrefPubMedSearch in Google Scholar
  • 23 Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 2009; 27 (03) 158-167
    CrossrefPubMedSearch in Google Scholar
  • 24 Cieslik-Bielecka A, Gazdzik TS, Bielecki TM, Cieslik T. Why the platelet-rich gel has antimicrobial activity?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 (03) 303-305 , author reply 305–306
    CrossrefPubMedSearch in Google Scholar
  • 25 Werther K, Christensen IJ, Nielsen HJ. Determination of vascular endothelial growth factor (VEGF) in circulating blood: significance of VEGF in various leucocytes and platelets. Scand J Clin Lab Invest 2002; 62 (05) 343-350
    CrossrefPubMedSearch in Google Scholar
  • 26 Frautschi RS, Hashem AM, Halasa B, Cakmakoglu C, Zins JE. Current Evidence for clinical efficacy of platelet rich plasma in aesthetic surgery: a systematic review. Aesthet Surg J 2017; 37 (03) 353-362
    PubMedSearch in Google Scholar
  • 27 Choi BH, Zhu SJ, Kim BY, Huh JY, Lee SH, Jung JH. Effect of platelet-rich plasma (PRP) concentration on the viability and proliferation of alveolar bone cells: an in vitro study. Int J Oral Maxillofac Surg 2005; 34 (04) 420-424
    CrossrefPubMedSearch in Google Scholar
  • 28 Wahlström O, Linder C, Kalén A, Magnusson P. Variation of pH in lysed platelet concentrates influence proliferation and alkaline phosphatase activity in human osteoblast-like cells. Platelets 2007; 18 (02) 113-118
    CrossrefPubMedSearch in Google Scholar
  • 29 Sommeling CE, Heyneman A, Hoeksema H, Verbelen J, Stillaert FB, Monstrey S. The use of platelet-rich plasma in plastic surgery: a systematic review. J Plast Reconstr Aesthet Surg 2013; 66 (03) 301-311
    CrossrefPubMedSearch in Google Scholar
  • 30 Scharf RE. Drugs that affect platelet function. Semin Thromb Hemost 2012; 38 (08) 865-883
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Knezevic NN, Candido KD, Desai R, Kaye AD. Is platelet-rich plasma a future therapy in pain management?. Med Clin North Am 2016; 100 (01) 199-217
    CrossrefPubMedSearch in Google Scholar
  • 32 Amable PR, Carias RB, Teixeira MV. , et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther 2013; 4 (03) 67
    CrossrefPubMedSearch in Google Scholar
  • 33 Dugrillon A, Eichler H, Kern S, Klüter H. Autologous concentrated platelet-rich plasma (cPRP) for local application in bone regeneration. Int J Oral Maxillofac Surg 2002; 31 (06) 615-619
    CrossrefPubMedSearch in Google Scholar
  • 34 Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg 1997; 55 (11) 1294-1299
    CrossrefPubMedSearch in Google Scholar
  • 35 Liao H-T, Marra KG, Rubin JP. Application of platelet-rich plasma and platelet-rich fibrin in fat grafting: basic science and literature review. Tissue Eng Part B Rev 2014; 20 (04) 267-276 . Doi: 10.1089/ten.teb.2013.0317
    CrossrefPubMedSearch in Google Scholar
  • 36 Kakudo N, Minakata T, Mitsui T, Kushida S, Notodihardjo FZ, Kusumoto K. Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts. Plast Reconstr Surg 2008; 122 (05) 1352-1360
    CrossrefPubMedSearch in Google Scholar
  • 37 Cervelli V, Gentile P, Scioli MG. , et al. Application of platelet-rich plasma in plastic surgery: clinical and in vitro evaluation. Tissue Eng Part C Methods 2009; 15 (04) 625-634
    PubMedSearch in Google Scholar
  • 38 Gentile P, De Angelis B, Pasin M. , et al. Adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical evaluation for cell-based therapies in patients with scars on the face. J Craniofac Surg 2014; 25 (01) 267-272
    CrossrefPubMedSearch in Google Scholar
  • 39 Salgarello M, Visconti G, Rusciani A. Breast fat grafting with platelet-rich plasma: a comparative clinical study and current state of the art. Plast Reconstr Surg 2011; 127 (06) 2176-2185
    CrossrefPubMedSearch in Google Scholar
  • 40 Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85 (06) 638-646
    CrossrefPubMedSearch in Google Scholar
  • 41 Torres J, Tamimi F, Martinez P-P. , et al. Effect of platelet-rich plasma on sinus lifting: a randomized-controlled clinical trial. J Clin Periodontol 2009; 36 (08) 677-687
    CrossrefPubMedSearch in Google Scholar
  • 42 Gentile P, Bottini DJ, Spallone D, Curcio BC, Cervelli V. Application of platelet-rich plasma in maxillofacial surgery: clinical evaluation. J Craniofac Surg 2010; 21 (03) 900-904
    CrossrefPubMedSearch in Google Scholar
  • 43 Sand JP, Nabili V, Kochhar A, Rawnsley J, Keller G. Platelet-rich plasma for the aesthetic surgeon. Facial Plast Surg 2017; 33 (04) 437-443
    Thieme ConnectPubMedSearch in Google Scholar
  • 44 Asif M, Kanodia S, Singh K. Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol 2016; 15 (04) 434-443
    CrossrefPubMedSearch in Google Scholar
  • 45 Lee JW, Kim BJ, Kim MN, Mun SK. The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split-face trial. Dermatol Surg 2011; 37 (07) 931-938
    CrossrefPubMedSearch in Google Scholar
  • 46 Costa CR, Ramanadham SR, O'Reilly E, Coleman JE, Rohrich RJ. The role of the superwet technique in face lift: an analysis of 1089 patients over 23 years. Plast Reconstr Surg 2015; 135 (06) 1566-1572
    CrossrefPubMedSearch in Google Scholar
  • 47 Powell DM, Chang E, Farrior EH. Recovery from deep-plane rhytidectomy following unilateral wound treatment with autologous platelet gel: a pilot study. Arch Facial Plast Surg 2001; 3 (04) 245-250
    CrossrefPubMedSearch in Google Scholar
  • 48 Badran KW, Sand JP. Platelet-rich plasma for hair loss: review of methods and results. Facial Plast Surg Clin North Am 2018; 26 (04) 469-485
    CrossrefPubMedSearch in Google Scholar
  • 49 Giordano S, Romeo M, Lankinen P. Platelet-rich plasma for androgenetic alopecia: Does it work? Evidence from meta analysis. J Cosmet Dermatol 2017; 16 (03) 374-381
    CrossrefPubMedSearch in Google Scholar
  • 50 Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg 2006; 118 (06) 1458-1466 , discussion 1467
    CrossrefPubMedSearch in Google Scholar
  • 51 Trink A, Sorbellini E, Bezzola P. , et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol 2013; 169 (03) 690-694
    CrossrefPubMedSearch in Google Scholar
  • 52 Gupta AK, Carviel J. A mechanistic model of platelet-rich plasma treatment for androgenetic alopecia. Dermatol Surg 2016; 42 (12) 1335-1339
    CrossrefPubMedSearch in Google Scholar