Microneedling with PRP

An established intervention coupled with a newer treatment may offer optimal results.

By Kim Nichols, MD, Emily Anne Palmer, MA, and Shaina Gregory
 

Microneedling is a dermatologist-trusted collagen-stimulating procedure that is surging in popularity again! This treatment, dubbed by Vogue magazine as “the next big thing in skincare,” has actually been in the field for quite some time.

Introduced in the 1990s, microneedling (MN) is a technique that involves using an instrument—a manual roller or an automatic pen—with numerous small needles (which can range from 0.25mm–2mm depending upon what issue is being treated) that penetrate the skin causing micro-injuries in the epidermis and superficial dermis. The injury that is triggered by the microneedle induces potassium release and stimulates neocollagenesis and revascularization. Studies have shown that microneedling induces increased production of vascular endothelial growth factor (VEGF), as well as increased production of fibroblast and epidermal growth factors.

Microneedling can be performed alone to provide improvement in signs of aging, scarring, uneven skin tone, and large pores. However, when it is used in conjunction with Platelet-Rich Plasma (PRP)—a technique called microneedling with PRP (PRP MN)—the results can be significantly better than those achieved with microneedling alone.

Background and Evidence

PRP is an autologous high concentration of platelets derived from blood plasma. It contains numerous growth factors, such as PGF, TGF-B, EGF, VEGF, FGF, and Insulinlike GF, and multiple cytokines that stimulate collagen and wound healing. The uses of microneedling with PRP MN are extensive, treating fine lines and wrinkles, mild skin laxity, scars, stretch marks, large pores, texture and tone, post-inflammatory hyperpigmentation (PIH), melasma, and hair loss. And it can be used on skin of all areas of the scalp, face and body.

Before.

After PRP MN.

A split-face study published in Journal of Drugs in Dermatology was done with 50 patients who suffered from acne scars.1 It was implied that both arms had the same duration of time and patients underwent the same amount of treatments.The study compared PRP MN to MN with distilled water. Both groups showed some improvement in scars, however the PRP MN group showed 62.2 percent improvement while the MN with distilled water subjects only had 45.84 percent improvement. These results support the increased benefits of PRP MN vs. MN alone.

The efficiency of PRP MN was shown in a split face study comparing its usefulness to MN with Vitamin C in treating atrophic acne scars.2 A total of 27 patients completed the treatment schedules over a six-month period with an interval of one month between the Vitamin C and PRP treatments. Each patient received four treatments of PRP MN on one side of the face and MN with Vitamin C on the other side. Patients who participated in the PRP study reported a higher incidence of excellent results when compared to the group that tested with Vitamin C. Twenty-one (78 percent) patients experienced good to excellent results from the PRP MN vs. 17 (63 percent) MN with Vitamin C patients who experienced the same results.

The PRP MN Procedure

PRP MN treatment begins with applying a topical anesthetic on the areas to be treated. Then the patient’s blood is drawn, centrifuged, and the PRP is extracted. After removal of the numbing cream, microneedling is begun and the PRP is applied immediately to deeply penetrate the new micro-openings in the skin. Additional direct pore injections of PRP can be applied to target pigmentation that contributes to skin discoloration.

The openings then close in as soon as 10-15 minutes. Minor side effects may include redness that can last for about three to five days. Some patients also experience petechiae after the procedure, which tends to subside along with the redness. Most side effects are non-lasting. The procedure is done with minimal discomfort or pain. Results typically start to show within three to four weeks after the procedure, based on dermatologist observations. After that period, it is recommended that patients return for their second treatment to ensure consistent results.

Kim Nichols, MD is a board-certified dermatologist and cosmetic surgeon in Greenwich, CT where she owns her own practice, NicholsMD of Greenwich. She is a graduate of Harvard University as well as the NYU Medical School.

Emily Anne Palmer, MA, is the Office Manager at NicholsMMD of Greenwich. She received her master’s degree in psychology from Columbia University and is an Education Committee Member Association of Dermatology Administrators and Managers (ADAM) organization.

Shaina Gregory is the Research Coordinator at NicholsMD. She is currently enrolled at the University of Connecticut where she will complete her BS in Psychology in the Spring of 2018.

1. Epstein, Gorana Kuka, Lauren Meshkov Bonati, and Tamara Lazic Strugar. “Microneedling in All Skin Types: A Review.” Journal of Drugs in Dermatology 16.4 (2017): 208-09. Print

2. Chawla, S. “Split Face Comparative Study of Microneedling with PRP Versus Microneedling with Vitamin C in Treating Atrophic Post Acne Scars.” Journal of Cutaneous and Aesthetic Surgery. U.S. National Library of Medicine, Oct.-Nov. 2014.

 

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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.