Thank you for your question. I understand that you’re concerned about the crepiness of your skin, and you’d like to know how to restore lost fat after using Thermage, an at-home thermal heating device. PRP is a very significant part of my practice. I’m a Board-certified cosmetic surgeon, a Fellowship-trained oculofacial plastic and reconstructive surgeon, and I’ve been practicing in Manhattan and Long Island for over 20 years. I’m also the founder and developer of Trichostem™ Hair Regeneration, which is a non-surgical hair loss solution and alternative treatment to hair transplants, in which we also use PRP, in addition to extracellular matrix. It seems that you, like many others, have believed in the notion that heating the skin stimulates collagen, and subsequently tightens and makes skin look more youthful. While this is true to a certain extent, the real determining factors are how much heat, how high, and over what period of time. In my practice, PRP is used regularly for skin rejuvenation, and we see many patients like yourself constantly—people who have succumbed to the hype of the latest non-surgical skin tightening device. What usually ends up happening as they continue to use such devices is that their skin loses all that youthful volume and becomes thinner and crepier. This is because the heat projected into their skin invariably affects the layer of fat directly underneath. It believe that fat under the skin is critically important, not just as padding, but because its cellular activity and interaction with the skin is what keeps you looking younger. For example, when we do body liposuction on flanks or love handles, we always leave behind a thin layer of fat so that the skin does not ripple after the procedure. In some cases where liposuction is overdone, the skin becomes wrinkly. Comparatively, heating devices can do the same thing when overused. If you think about it, what happens when you heat fat? The fat gets cooked, and when that happens, it is no longer viable. In my practice, we have treated a particular patient with recurring infections due to a chronic biofilm. We treated her with platelet-rich plasma first, and then combined that with extracellular matrix, which is a wound-healing material, and we were able to build up the fat, build up the skin quality, and ultimately rehabilitate her skin in spite of the recurrent infections. With that said, I think PRP would be a good option for you. I don’t think you’ll be able to get back all the volume that you had prior to your procedure, but if you can address the skin quality, then you’ll be in a much better place. I suggest that you seek out experienced doctors who use PRP and get a sense of your own confidence in their experience, because when you a meet a doctor who knows their stuff, you can definitely feel it. I can tell you that in our practice, we truly understand and see the benefits of PRP. In fact, many of my own staff members regularly get PRP treatments to keep their skin looking youthful, and I don’t think there is a better supporting statement than that with regard to its value. I hope that was helpful and I wish you the best of luck! This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.