Is PRP pro inflammatory when microneedled into the skin?

Question

I'm doing some research on which products are the best for Microneedling and have come across some information that PRP is actually not great with microneedling because it is pro inflammatory and that most skin issues (rosacea, abnormal skin pigmentation, wrinkles, etc) are due to inflammation, which is less than ideal, so why would you want to induce more inflammation? Are human mesenchymal stem cells better because they are anti-inflammatory? I would love some expert opinions on this.

Amiya Prasad, MD · Answer

Thank you for your question. You are trying to understand how the inflammation that could be associated with microneedling can somehow aggravated by platelet-rich plasma (PRP). I can certainly see how you are using appropriate logic to define the skin condition such as rosacea, wrinkling, and pigmentation issues as having some degree of inflammation so you ask why platelet-rich plasma (PRP) would be useful compared to other potential modalities.
I can share with you a broad explanation of the role of inflammation when it comes to different cosmetic treatments.  A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I’ve been using PRP on patients many years, and in fact developed a hair treatment for male and female pattern hair loss using PRP and a material called extracellular matrix. 
Part of everything we do in medicine and the aesthetic field can be argued to have some type of inflammation.I would start by asking you to look at the skin conditions you want to treat, and determine if microneedling is the right treatment for you. 
Microneedling is based on a principle known as collagen induction therapy. The microneedling process is a controlled injury, and by definition that injury causes inflammation. When you look at the process of wound healing, everything from a simple cut, to extensive surgery or laser procedures, there are four phases: an initial hemostatic phase which is the sealing of vessels so there’s no bleeding, the inflammatory phase, the proliferative phase which is the wound healing response where collagen is produced and blood vessels are formed, then there’s the remodeling phase where all of this tissue is remodeled. The goal of any treatment we do is to see improvement.
Understand that microneedling can also be controlled in depth and aggressiveness, so there are different levels of inflammation. An expert in this area will always be mindful of staying on that line where a certain amount of inflammation is necessary, but will not worsen the condition. The line is staying on the side where you get benefit as opposed to getting damage. This challenge occurs in microneedling, lasers, and in a lot of different things we do as aesthetic specialists, so it’s about the judgement.
I can attest to the value of PRP with microneedling, as well as many other treatments. When I do any type of laser treatment like fractional CO2, or an ablative laser treatment, I use PRP to expedite the healing process, and do exactly the same with microneedling. PRP will not worsen inflammation, and helps recruit the wound healing factors in your skin to expedite healing. 
Understand that the conditions you describe like rosacea is an inflammatory condition that leads to very sensitive skin. Generally, I don't recommend any kind of aggressive microneedling in the areas where rosacea is active. That’s a situation where you do not want to add inflammation to an area that’s already actively inflamed. However, you can use lasers for vessels to help improve the appearance of skin that is flushed and has little vessels called telangiectasias. In that situation, you are using laser to induce a certain amount of inflammation that is helpful in targeting vessels.
It goes back to what is right for your skin, with microneedling being one option. If you are dealing with aging changes such as dyschromias, brown discolorations, or wrinkling, you have a wide range of options in addition to microneedling. The role of PRP in these conditions is as a useful tool to help expedite and improve the benefits of any treatment I do in a lot of different scenarios. For example, when you do a treatment such as an injectable filler, and you want add volume, and also improve skin quality, then you can inject PRP. You can deliver PRP through different devices, and the skin benefits.
I think it’s important for you to always be educated, and learn about the science and principles, but for a treatment plan you should consult with an expert. Consult with a physician who can guide you with what you want to solve before you decide that microneedling is the right thing for you. Often, people learn about different modalities, and they come in wanting that modality, not appreciating the wide range of options there are, and often miss the forest for the trees. It is very important to find a doctor who can educate you. 
As is often the case in my practice, I’ve become the primary care doctor for beauty for my patients, so we deal with a lot of facial aging and skin issues. Very often, when I evaluate my patients, I first take pictures, review the photos with them, then I talk about options where they can benefit. I use a very straightforward approach, starting with the foundation which is the bone structure, then volume, then work my way outward to the skin. 
Meet with someone with expertise in these areas you are interested in as PRP and microneedling, and see what’s their take on this. Understand there are many variables at play in managing inflammation, but I would not be concerned about the inflammatory effect of PRP, but rather the many benefits of PRP, and also understand the limitation and find a strategy that works best for you. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Carolyn Jacob, MD · Answer

Good question! PRP is not pro-inflammatory. These studies have not been done with human mesenchymal stem cells yet.

Is PRP pro inflammatory when microneedled into the skin?

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