What is the correct application of PRP after microneedling?

Question

After the skin is microneedled, what is the correct application of PRP on the face? Should it be massaged into the skin, or just poured on the skin? How long should PRP be left on the skin to be effective? I am going in for treatment of atrophic and indented acne scars.

Nelson Lee Novick, MD · Answer

Microneedling (a procedure I have been using for over twenty years), as a stand-alone treatment, is unlikely to yield significant improvement for any but the most superficial indented (atrophic, depressed) acne scars.  And PRP, which adds anywhere from 800-1000 to the bill in my neck of the woods, in a recent November, 2018 JAMA Dermatology study on its effects on skin texture, was shown to be "nominally, but not significantly better than saline injections."  So, I'm not sure whether it really makes any difference if the PRP is applied, sprayed on, or injected mesotherapy style. Since no photos or additional information was provided, I can only comment in general terms. "Field subcision," which addresses generalized acne-related facial atrophy, especially when accompanied by the use of a biostimulatory filler, is likely to yield substantial overall facial smoothing. Individual subcisions would be beneficial for elevating and smoothing of individual boxcar and rolling scars, and TCA CROSS can help to narrow dilated pores and ice pick scars. Finally, after the foregoing, medical microneedling to the point of pinpoint bleeding may be used to help better blend in tone and superficial texture the treated areas with the surrounding normal skin. For more information on these techniques, you can check out the archives of RealSelf.com. Make sure that you are consulting with a board certified aesthetic physician and do your due diligence when vetting so much of the currently hyped and relatively expensive devices and techniques, like fraxels and PRP, that have not as yet stood the test of time. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Tonya Boudreaux, MD · Answer

There are several PRP protocols that can be used so you will have to discuss prior to your treatment with your provider. In our practice, during your microneedling treatment, PRP can be injected and also used topically during the procedure. As your skin is being needled the PRP is applied to the skins surface and is entering the microchannels of the skin during your procedure and is usually applied to the skin immediately after to aid in quicker healing.
Hope this helps!

What is the correct application of PRP after microneedling?

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What is the correct application of PRP after microneedling?

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