“PRP should be regarded as a biological normaliser. When we are young, we usually have wonderful skin which is rich in hyaluronic acid and stem cells, because fundamentally the skin is behaving normally with minimal effects of ageing or environmental factors.

If skin behaves normally, then its balance is right, its protection is right, it hydrates itself, and it repairs itself. It is only when any of those mechanisms are out of balance that you start to see damage outside of normal ageing.

PRP can generate an injury response in your body when it is placed in the skin or any given area and fundamentally sets up the start of a signalling cascade which causes the recruitment of cells to heal and repair the area. Senescent stem cells will be woken up, growth factors will be rallied, fibroblasts, transforming proteins, and cytokines will be enlisted to help form new cells in this area, to bring the integrity of that tissue back to a ‘normal’ phase. PRP

is not designed to make a ‘super you’, but a ‘normal you’, which is what we want as good aesthetic practitioners. We accept your ‘normal you’ may be better than your ‘current you’! Patients have problems with their skin because it is not behaving in the normal way that it should be, PRP can optimise and maintain normal. It will also stop free radical damage, stop the activity of inflammatory cytokines, making it a potent anti-inflammatory, which is why it helps in arthritis.

Clinical effects

Data and studies are showing increases in skin density from PRP treatment, one of the few treatments that does this directly and naturally. There is an increase in fibroblast proliferation in the skin, which is increasing elasticity. Similarly, anything that is behaving abnormally, like melanocytes, for instance, creating sunspots or uneven skin tone, can be brought back to normal by the actions of the PRP.

It normalises the function of the melanocytes resulting in a more even skin tone. PRP is also anti-inflammatory, so it reduces the damage from cytokines and free radicals in the area treated. Overall, it helps you to maintain skin at a better level, and the beauty of it is that it is natural.

Managing patient expectations is key and that begins with a good medical consultation. Be honest with your patients about the results you think you can achieve, the data that is out there, and what you hope they will gain from it. There is a lack of good, randomised, controlled trials for many of the indications for PRP, but not an absence, so know your literature and how to analyse the better-quality studies.

We are all guilty of reading abstracts rather than the body of a paper but given the variation in preparation and PRP systems it is especially important we scrutinise the methods, in terms of quality of PRP, protocols, concentration or number of treatment sessions, which may vary significantly between indications and systems. As a practitioner, you need to decide what you believe and what you practise, based on the evidence available to you. If you demonstrate what you know and admit what you do not, that builds trust and patients always respond positively to that even if they decide not to proceed with treatment!”

Mr Ansar Mahmood, Demystifying PRP. Consulting Room Journal Jan-March 2021