Facial aging reflects both intrinsic processes, including genetic and hormonal influences, and cumulative external exposures such as ultraviolet radiation, pollution, and smoking. Clinically, these changes may appear as loss of elasticity, wrinkling, laxity, irregular pigmentation, volume loss, or post-acne scarring [1]. Interest in minimally invasive regenerative procedures has therefore grown, and PRP has become one of the autologous treatments increasingly used in aesthetic practice.

PRP is produced from a patient’s own blood by centrifugation, creating a plasma fraction enriched with platelets, often to approximately 4 - 6 times the baseline concentration. The preparation contains growth factors including PDGF, VEGF, TGF-beta, and EGF, together with cytokines and fibrin that participate in tissue repair. Because it is autologous and can be delivered through relatively minor procedures, PRP has attracted particular interest for facial rejuvenation.

Clinical use of PRP predates its expansion into aesthetic medicine; it has been used in fields such as orthopedics and plastic surgery since the 1990s [2]. Facial applications have increased, but the evidence has remained difficult to compare because studies use different preparation methods, dosing schedules, and outcome assessments [3]-[5]. This review therefore examines the recent literature on biological mechanisms, clinical uses, efficacy, factors that may influence response, and the main limitations of PRP-based facial rejuvenation.

Throughout this review, the term “facial skin rejuvenation” is used broadly, while the clinical evidence is interpreted within four groups: photoaging and skin-quality outcomes (wrinkles, texture, elasticity, and laxity), periorbital or pigmentary concerns, atrophic acne scars, and volume-related concerns such as infraorbital hollows. Studies of neck rejuvenation are included only when they provide adjacent cervicofacial evidence and are not treated as primary facial outcomes.

We designed this article as a narrative review supported by a structured literature search and independent screening by two authors. It was not intended to meet the methodological requirements of a systematic review: no protocol registration, formal PRISMA process, quantitative meta-analysis, or formal risk-of-bias instrument was used. The findings should therefore be read as a structured narrative synthesis rather than an exhaustive systematic review.

The literature search was completed on February 15, 2026, using PubMed, Scopus, Web of Science, and Google Scholar. In PubMed, we used the following Boolean strategy: (“platelet-rich plasma” OR “PRP” OR “platelet rich plasma” OR “platelet-rich fibrin” OR “PRF”) AND (“facial rejuvenation” OR “skin aging” OR “anti-aging” OR “facial aging” OR “wrinkles” OR “skin laxity” OR “periorbital” OR “acne scars”) AND (“clinical” OR “efficacy” OR “mechanism”). Equivalent terms were adapted to the field syntax of Scopus (TITLE-ABS-KEY) and Web of Science (TS=). Google Scholar was searched using “platelet-rich plasma facial rejuvenation”, and forward citation tracking of key papers was used to locate additional potentially relevant studies.

Eligible publications evaluated PRP, PRF, or a closely related autologous platelet/plasma product for human facial rejuvenation, or supplied translational mechanistic evidence directly relevant to that use. We included papers reporting clinical, histologic, imaging, patient-reported, or mechanistic outcomes and limited the search to peer-reviewed English-language publications from January 2020 through February 15, 2026. Systematic reviews and meta-analyses were retained when they provided useful context. Editorials and letters without substantive data were excluded. Clinical studies were grouped in advance into photoaging/skin quality, periorbital or pigmentary concerns, atrophic acne scarring, and volume-related concerns; neck studies were handled as adjacent cervicofacial evidence. We also excluded unrelated non-facial indications, animal-only work, conference abstracts, duplicates, and reports without relevant data.

C.D.P. and K.S.T. independently screened the titles and abstracts of 124 unique records, with disagreements discussed with J.Z. Seventy-eight records were removed at this stage: 34 were off topic, 12 were animal studies, 18 were conference abstracts, 8 were duplicates, and 6 were non-English publications. Forty-six full texts were then assessed. Six did not meet the final criteria (four lacked substantive original or synthesis data and two were not sufficiently relevant to facial or cervicofacial rejuvenation), leaving 40 sources for the narrative synthesis. These counts are provided to make the selection process transparent; they should not be interpreted as evidence of an exhaustive PRISMA-conformant search.

We appraised study quality descriptively rather than applying a formal risk-of-bias tool. Much of the clinical literature consisted of small randomized or controlled split-face/split-site studies, pilot work, and single-center prospective studies. Most samples were in the range of about 10 - 40 participants, with relatively few larger cohorts, and follow-up commonly extended only from several weeks to 3 - 12 months. Evidence beyond one year was uncommon. These features, together with non-randomized designs and heterogeneous comparators and outcomes, limit the certainty of broad efficacy claims. Table 1 summarizes the design and principal findings of representative studies included in the synthesis.

Table 1.Study characteristics table.

PRP preparations are often described according to leukocyte content. Leukocyte-poor PRP (LP-PRP) contains fewer white blood cells, whereas leukocyte-rich PRP (L-PRP) retains more leukocytes and may therefore carry a different cytokine and inflammatory profile [9].

Platelet-rich fibrin (PRF) is a related autologous product prepared without anticoagulant. The resulting fibrin network can retain platelets and growth factors, providing a matrix that supports cell attachment and tissue remodeling while allowing more sustained mediator release [8][29].

The clinical literature does not point to a uniform PRP effect across all indications. In photoaging and general skin quality, a split-face study found improvement with PRP compared with saline [27], whereas a small double-blind comparison of PRP and PPP found improvement on both sides and only a modest PRP advantage on selected measures [39]. A separate single-session study reported short-term gains in perceived age, elasticity, and satisfaction [31]. Evidence in atrophic acne scarring is more clearly comparator-based: PRP/PRF used with microneedling performed better than saline-controlled microneedling in one randomized study [8], and PRP plus microdermabrasion was superior to PRP alone [7]. Periorbital and pigmentary findings are mixed. Tranexamic acid plus vitamin C performed better than PRP for periorbital hyperpigmentation in one split-site trial [11], while adding PRP to Q-switched ruby laser improved outcomes compared with laser alone [24]. A systematic review and meta-analysis reported short-term periorbital benefit and acceptable tolerability but also emphasized substantial protocol heterogeneity [15]. For infraorbital volume loss, PPP gel outperformed PRP [30]. Other comparative work reported PRP as non-inferior to adipose-derived exosomes for photoaged skin [38], while adding stromal vascular fraction to PRP-assisted lipofilling did not improve skin quality [21]. The practical message is that efficacy depends on the indication and on the treatment used as the comparator.

Another major limitation is the lack of a common treatment protocol. Studies differ in centrifugation method, platelet concentration, leukocyte content, activation, dose, treatment interval, and outcome measurement [3][16][32]. Favorable reports often used platelet enrichment in the approximate 4 - 6 times baseline range, leukocyte-poor products for facial treatment, and courses of about 2 - 4 sessions spaced 3 - 4 weeks apart [4][35], but these are recurring patterns rather than validated optimal parameters. No activation strategy has shown consistent clinical superiority. The best comparator-supported adjunctive signals in this review were seen with microneedling [8][28], fractional CO₂ laser [26][34], and microdermabrasion [7]. Even for these approaches, confidence is constrained by small samples, split-face or non-randomized designs, inconsistent outcomes, and short follow-up [5][38][39].

The adverse events actually reported in facial studies were mainly local and short lived: erythema, edema, tenderness, bruising, and injection-site discomfort usually resolved within days [23]. In the small double-blind PRP-versus-PPP photoaging trial, no severe adverse events were reported [39]. These observations are reassuring for short-term use, but small studies are poorly suited to detect uncommon complications.

Longer-term safety is harder to judge because follow-up beyond one year is uncommon. One prospective comparison found greater dermal fibrosis after PRP than after adipose-derived stromal cells on histologic assessment [25]; the clinical meaning and generalizability of that observation remain uncertain. Calcification and immunologic sensitization, in contrast, are theoretical concerns rather than established adverse outcomes in the facial studies reviewed here. Longer prospective surveillance is therefore needed before the effects of repeated long-term exposure can be characterized confidently [1].

Several limitations of this review also need to be kept in view. The search and screening process was structured, but the review was not conducted as a systematic review: there was no registered protocol, formal PRISMA process, risk-of-bias scoring, or quantitative meta-analysis. Restricting inclusion to English-language papers published from 2020 to 2026 may have omitted relevant earlier or non-English evidence. In addition, the synthesis combines primary clinical studies with selected reviews and translational mechanistic reports. Reporting the screening process improves transparency, but it does not remove selection bias. The 40 included sources should therefore be regarded as a focused qualitative evidence base rather than a complete systematic corpus.

Progress in this field will depend less on producing additional uncontrolled case series and more on making studies comparable. Standardized product characterization and treatment reporting, validated clinical and patient-reported outcomes, adequately powered randomized comparisons, and longer safety follow-up would make it easier to identify the facial indications for which PRP offers a meaningful advantage.

Several patient- and product-related variables may help explain why reported responses to PRP differ across studies.

Age is one possible modifier, although current evidence is preliminary. A single-center ultrasound study reported larger changes in skin density and thickness among younger participants than among older groups [40]. That finding is useful for hypothesis generation, but it does not define a validated age threshold or justify age-specific treatment schedules without confirmation in larger studies.

The way PRP is prepared directly affects the composition of the injected product. Double-spin techniques can produce higher platelet concentrations than single-spin methods, and many facial studies use preparations within an approximate 4 - 6 times baseline range. Leukocyte-poor PRP is often chosen to limit inflammatory exposure, but neither double-spin processing nor any particular leukocyte concentration has been shown to be clinically superior across facial indications. These variables are therefore best treated as reporting parameters rather than proven determinants of efficacy.

Activation also changes how platelet contents are released. Calcium salts and thrombin initiate activation through different mechanisms, while freeze-thaw processing may cause a more abrupt release of intracellular contents. None of these strategies has shown a consistent clinical advantage in facial rejuvenation. Oxygen-enriched PRP produced promising results in one small clinical comparison [16], but the approach remains experimental and requires independent replication.

Treatment schedules are similarly inconsistent. A common pattern is 2 - 4 sessions separated by about 3 - 4 weeks, and some reports suggest maintenance at 6 - 12 months [36]. Repeated treatment is therefore frequent in the literature, but the available evidence does not establish the best number of sessions, interval, or maintenance schedule for a specific indication.

Taken together, differences in patient characteristics and in the composition and delivery of PRP probably account for part of the variability between studies. More consistent reporting and standardized protocols would improve reproducibility and make cross-study comparisons more informative.

The main research gaps arise from the same issues that currently limit interpretation: inconsistent product characterization, short follow-up, limited mechanistic validation in human tissue, and relatively few direct comparative trials.

Preparation and treatment details need to be reported with enough precision for other investigators to reproduce the intervention. At a minimum, this includes centrifugation force and duration, anticoagulant, platelet and leukocyte counts, activation method, injected volume and depth, treatment interval, and any concomitant procedure. Without these details, the label “PRP” can refer to biologically different products.

Durability and long-term safety are also poorly defined. Most follow-up periods are measured in weeks or months and generally remain within one year. Larger prospective cohorts or registries extending for at least two years would provide better information on persistence of benefit, repeated-treatment exposure, and uncommon adverse outcomes.

Mechanistic work would be stronger if it were linked directly to treated human facial tissue. Studies combining standardized PRP characterization with histology, proteomics, transcriptomics, and validated clinical outcomes could test which proposed growth-factor or extracellular-vesicle pathways are actually active in vivo and whether they track with clinical response.

Patient-level modifiers deserve similar attention. Age, skin phenotype, baseline severity, smoking, sun exposure, and tissue quality may influence response, but the present literature cannot support validated individualized treatment algorithms. Adequately powered trials with prespecified subgroup analyses would be more informative than post hoc observations from small cohorts.

Newer platelet-derived products also require direct comparison with conventional PRP. These include lyophilized PRP, PRP/PRGF gels [2][19], injectable PRF, and optimized platelet extracts [20][22]. Their potential advantages in stability, delivery, efficacy, or tolerability should be demonstrated rather than assumed from shared biological origin.

Finally, more head-to-head trials are needed against established alternatives and clearly defined combination comparators. PRP has already been compared with adipose-derived cell products, autologous fat-based treatments, PPP/plasma gel, and other modalities [5][10][25], but many comparisons remain small or methodologically heterogeneous. Future studies would be most useful if they combine adequate statistical power with validated objective and patient-reported outcomes and consistent adverse-event reporting.

PRP has a credible biological basis for use in facial rejuvenation and appears to be well tolerated in the short term, but the clinical evidence is not equally strong across indications. Selected photoaging and skin-quality outcomes show favorable signals, and comparator-controlled studies support a role for PRP or PRF as an adjunct in some treatments for atrophic acne scarring. Periorbital pigmentary and volume-related results are less consistent; in individual trials, tranexamic acid plus vitamin C and PPP gel performed better than PRP. Proposed effects on collagen remodeling, angiogenesis, inflammation, pigmentation, and extracellular-vesicle signaling are supported by a mixture of clinical, histologic, and translational evidence, with limited direct pathway confirmation in treated facial tissue. Variation in PRP preparation, small or split-face study designs, non-uniform outcomes, and short follow-up still prevent firm protocol recommendations. Better product characterization, indication-specific randomized comparisons, validated outcomes, and longer safety surveillance are needed to define where PRP provides a clinically meaningful benefit.

No specific grant from a public, commercial, or non-profit funding agency supported this review.

Some of the evidence discussed in this review comes from groups affiliated with BTI Biotechnology Institute. These studies are relevant to the mechanistic and clinical literature, but claims of PRGF superiority remain insufficiently replicated by independent groups. The present review does not endorse a commercial PRP preparation system.

C.D.P. and K.S.T. independently conducted the literature screening and contributed to the qualitative synthesis and interpretation of the included evidence. J.Z. resolved disagreements during study selection and contributed to the interpretation and critical evaluation of the evidence. All authors critically revised the manuscript for important intellectual content, reviewed the final manuscript, and approved the version submitted for publication.