Developing a Reproducible Procedure for Optimal Utilization of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Aesthetic Treatments: Efficacy Evaluation Using Ultrasound Imaging—A Single-Center Prospective Open-Label Randomized Study

Abstract

Objective. This single-center, prospective, open-label randomized study aimed to produce a repeatable procedure for isolating platelet-rich plasma (PRP), maximizing platelet recovery and concentration parameters from the collected material, and to assess the effectiveness of autologous platelet-rich plasma (concentrated platelet rich plasma C-PRP and platelet rich plasma low centrifugation concept PRP LCC) and platelet-rich fibrin (injectable platelet rich fibrin I-PRF and fluid platelet rich fibrin F-PRF) injections on skin density and thickness in facial aesthetic treatments. Methods. Twenty participants aged 30–60 underwent a series of three treatments (intervals: 4–6 weeks). The study encompassed the following two stages: a laboratory and a clinical one. In the first stage, the aim was to optimize centrifugation parameters (time and speed) of whole blood to produce the highest quality product for use in aesthetic treatments. Double centrifugation of blood produced the following four types of plasma fractions with different parameters: platelet-rich plasma (C-PRP and PRP LCC) and platelet-rich fibrin (I-PRF and F-PRF) each with two different platelet concentrations (202% in the first centrifugation and 148% in the second centrifugation). The total PLT recovery in the procedure was 76%, with an average of 32% in the first centrifugation and that of 44% in the second one. In the clinical stage, treatments involved C-PRP, PRP LCC, I-PRF, and F-PRF injections in the forehead, lower eyelid, and cheek areas. In ultrasound skin examination with randomly assigned measurements for each patient, a series of acoustic density values directly proportional to tissue density was obtained. Thickness of the skin was also determined (µm) by summation of the epidermis and dermis thickness. Measurements were made in the lateral forehead, lower eyelids, and cheek regions. Results. Statistical analysis elucidates the effectiveness of blood-derivatives therapy in the introduced regiment. The increase in skin density was statistically significant after the following treatment: three sessions in 4–6 week intervals, each consisting of 1 mL of C-PRP injections in the forehead area, 1 mL of I-PRF injections in the lower eyelid area, and 3.5 mL of PRP LCC and 3.5 mL of F-PRF injections in the cheek area. Furthermore, significant improvements in skin density were recorded in the cheek and forehead areas (F(3, 24) = 4.5170 with p = 0.011971 for cheeks and F(3, 24) = 9.2327 with p = 0.000305 for forehead). Lower eyelid skin density and thickness also increased significantly (F(3, 24) = 3.2653, p = 0.038881). No significant changes were noted in skin thickness in the forehead and cheek areas (F(3, 6) = 1.438771, p = 0.321616 for cheeks; F(3, 6) = 2.383248, p = 0.168172 for forehead). Patient satisfaction was high, as evidenced by a GAIS average score of 2.75. Conclusion. The study confirms the efficacy of C-PRP, PRP LCC and I-PRF, and F-PRF injections in increasing skin density and, to a lesser extent, skin thickness in specific facial areas. As a result of this research, ready-to-use kits (PLASMOO) for obtaining PRP and PRF were developed and put into production. These findings underscore the potential of autologous plasma and fibrin formulations in aesthetic medicine, which offer substantial improvements in skin quality and patient satisfaction. This trial is registered with ISRCTN10538865.