Injectable platelet‐rich fibrin for facial rejuvenation How long does PRF last? Is PRF better than PRP? What is PRF filler? What are PRF injections?
Aesthetic medicine practice has recently witnessed a proliferation in the number of injectable platelet concentrate products containing supra‐physiological quantities of platelets and autologous growth factors to stimulate tissue repair and skin rejuvenation. Growth factors contained within these plasma concentrates have emerged as a promising therapeutic modality by regulating important processes in skin rejuvenation, including angiogenesis, cell migration, cell proliferation, and collagen deposition.
platelet‐rich plasma (PRP) and plasma‐rich growth factors (PRGF) were the first plasma concentrates to be developed in 1998 and 1999, respectively. Both systems require addition of bovine thrombin or calcium ions during initial blood collection to activate platelet growth factor release followed by nonautologous anticoagulants to generate fluid concentrates after centrifugation. A two‐step centrifugation is required to produce PRP, which is predominantly composed of platelets and growth factors with a limited number of leukocytes. PRP is widely used across a range of medical and oral specialties, as a tool for tissue regeneration.
For facial skin aging, PRP use is associated with modest improvement in facial skin appearance, skin texture, and lines. However, the clinical evidence for PRP use in this indication is limited by heterogeneity in the preparation and administration techniques used, and lack of standardization in outcome measures. Despite the widespread use of PRP, concerns have been raised about the use of thrombin and anticoagulants that can impair wound healing by inhibiting the coagulation process.
To overcome some of the limitations of PRP, platelet‐rich fibrin (PRF), a second‐generation platelet concentrate was developed in 2001. It is obtained using a one‐step centrifugation process 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). Depending on the blood collection tube and centrifugation protocol used, solid gel and liquid forms of PRF can be developed. Solid PRF, produced using glass tubes has been successfully used in oral and maxillofacial surgery, with beneficial effects on bone and soft tissue regeneration, infection control, and patient satisfaction. In plastic surgery, solid PRF has demonstrable benefit in soft and bony tissue healing as well as fat graft survival rate. In 2014, an injectable fluid form of PRF (termed i‐PRF) was developed by modifying the relative centrifugal force (RCF).
By lowering the centrifugation speed and time, and by using plastic tubes (to reduce clotting times), the fibrin coagulation could be slowed at early time points thereby generating a liquid PRF. The resulting product contains fibrinogen and thrombin that remains fluid for about 20 minutes after centrifugation prior to fibrin formation, thereby making it a suitable injectable material for facial rejuvenation. The low speed of centrifugation, just enough to separate platelets from red blood cells, improves the characteristics of the resulting PRF with higher numbers of leukocytes and platelets, and increased growth factor concentration within the resulting fibrin matrix. Platelets and cytokines become trapped within the i‐PRF fibrin matrix after injection leading to a slow and gradual release of growth factors over time. intradermal injection of i‐PRF is a safe intervention that is associated with favorable objective facial skin aesthetic outcome and improved patient satisfaction.
