Meta-Analysis of the Efficacy of Platelet-Rich Plasma in Treating Skin Aging

Abstract

Background

Platelet-rich plasma (PRP), enriched with growth factors, shows promise in skin rejuvenation, yet lacks robust evidence.

Objectives

This meta-analysis aims to evaluate the clinical efficacy of platelet-rich plasma (PRP) in the treatment of skin aging.

Methods

Relevant randomized controlled trials (RCTs) published up to December 1, 2024, were identified by searching PubMed, Embase, CNKI, Wanfang Database, VIP and Cochrane Library. Data extraction and quality assessment were conducted independently by two researchers. RevMan 5.4 and STATA software were used to calculate overall effect sizes with 95% confidence intervals (CIs), and risk of bias was assessed.

Results

A total of 9 RCTs involving 358 patients were included. The meta-analysis showed that PRP interventions significantly improved subjective patient satisfaction, with a risk ratio (RR) of 1.34 (95% CI: 1.07-1.67, P = .01). PRP also demonstrated significant advantages over the control group in terms of objective efficacy, with an RR of 1.42 (95% CI: 1.01-2.00, P = .04). Differences between the PRP and control groups were statistically significant (P < .05). Although some studies reported that PRP might increase adverse effects, pooled analysis showed no significant difference between the two groups (RR = 1.21, 95% CI: 0.50-2.92, P = .67).

Conclusions

PRP, as a minimally invasive and low-risk treatment, has demonstrated efficacy in alleviating skin aging and improving skin texture. It shows promising clinical application potential.

Level of Evidence: 2 (Therapeutic)

Platelet-rich plasma (PRP) is a liquid platelet concentrate extracted from peripheral blood, containing growth factors and cytokines at concentrations higher than baseline levels.^1,2 This innovative technique has demonstrated significant potential in the field of plastic surgery, with its applications evaluated in various clinical settings such as wound healing, hair restoration, and bone regeneration. Although most studies suggest the positive effects of PRP, the evidence is largely limited to small-scale case studies or series, lacking rigorous clinical trial designs. Extensive randomized controlled trials (RCTs) are still needed to validate its long-term efficacy and safety.

Given the wound healing and tissue regeneration properties of platelet preparations, PRP is increasingly used as an adjunct in many skin rejuvenation procedures in plastic surgery. The combination of PRP with microneedling or fractional laser skin resurfacing is gaining popularity. Reports indicate that PRP can enhance patient satisfaction, promote collagen production, and reduce inflammation and pigmentation.^3,4

This study aims to perform a meta-analysis of the efficacy of platelet-rich plasma (PRP) in the treatment of skin aging. By synthesizing relevant research findings from both domestic and international studies, the study systematically investigates PRP's therapeutic effects on skin aging through literature retrieval, screening, data extraction, and data analysis. Additionally, it explores the influence of different outcome measures on the findings, providing valuable references for clinical practice.

METHODS

Literature Search Strategy

Based on the PICOS principle, keywords and free terms were selected to address the following aspects: population, intervention, comparison, outcomes, and study design. The study searched three major Chinese databases: CNKI, Wanfang Database, and VIP; and three major English databases: PubMed, Embase, and Cochrane Library. The search timeframe spanned from database inception to December 1, 2024, with no language restrictions. Additionally, manual searches of the references from included studies and relevant systematic reviews were conducted to supplement the data. Search terms included “Platelet-Rich Plasma”, “Plasma, Platelet-Rich”, “Platelet Rich Plasma”, “skin aging”, “Aging, Skin”, “Photoaging of Skin”, “Solar Aging of Skin”, “Skin Wrinkling”, “Skin Wrinklings”, and “Wrinkling, Skin”. The study strictly adhered to the PRISMA 2020 statement (Supplemental Table 1).

Inclusion and Exclusion Criteria

Inclusion Criteria

Participants: male and female adults aged 18 and older with healthy skin but varying degrees of skin aging (not limited to facial skin aging), with clearly defined and quantifiable evaluation criteria for skin aging in the studies.

Study design: RCTs with or without blinding.

Interventions and control groups: interventions involved direct PRP injection for skin aging treatment or PRP used in combination with conventional treatments. The preparation and application of PRP must be described, including centrifugation speed and time, to determine the type and dosage of PRP. Studies must include a clear control group, defined as either standard treatments or placebo controls (eg, saline injection).

Outcomes: the studies must report objective assessments or scoring by professionals, patient satisfaction, adverse reactions, or complication rates.

Exclusion Criteria

1. Non-randomized, non-controlled, retrospective studies, or studies without a control group.

2. Duplicate publications, incomplete data, or studies from which data could not be extracted or converted.

3. Studies without follow-up data or without quantified outcome assessments.

4. Studies with a sample size of fewer than 5 participants.

5. Animal experiments, reviews, case reports, individual analyses, conference abstracts, or studies irrelevant to this research.

6. Studies involving participants with severe skin diseases (eg, psoriasis, herpes simplex virus, vitiligo) or significant underlying health conditions (eg, systemic lupus erythematosus).

Data Extraction

Based on the inclusion and exclusion criteria, two researchers independently screened and extracted data using Endnote 20 (Clarivate Analytics, Philadelphia PA) reference management software and performed cross-validation. Discrepancies were resolved through arbitration by a third researcher. Data were extracted into Excel (Microsoft, Redmond, WA) and included the following: basic study information (first author's name, publication year, method of random sequence generation, sample size, follow-up duration, etc.); participant characteristics (average age, baseline skin condition, male-to-female ratio); intervention details (whether controls used a placebo, such as saline injections, or other therapies like laser-only treatment or autologous fat transplantation, PRP preparation methods, injection techniques, use of combination therapies, treatment frequency, and intervals between treatments); and study outcomes.

Quality Assessment of Studies

All included studies were RCTs, and the quality of the studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions’ risk of bias tool. Specific aspects evaluated included in Figure 1.

Figure 1.

Literature search flow diagram. A total of 464 studies were identified. Using the reference management software EndNote 20, 455 studies that did not meet the inclusion criteria were excluded. Finally, 9 studies were included for qualitative and quantitative analysis.^1,2,4-10

Statistical Analysis

Literature screening was performed using the reference management software EndNote 20. Data analysis was conducted using RevMan 5.4 and STATA 17.0 software. Heterogeneity among multiple similar studies was assessed through chi-square tests, Galbraith radial plots, and L'Abbé plots, while the degree of heterogeneity was quantified using the I² statistic. For dichotomous variables, risk ratios (RRs) and their 95% confidence intervals (95% CIs) were calculated. The I² statistic was used to evaluate the degree of heterogeneity among studies. When P ≥ .05 and I² < 50%, heterogeneity was considered low, and a fixed-effects model was applied for meta-analysis. When P < .05 or I² > 50%, heterogeneity was considered high, and a random-effects model was used. The Z-test was applied to determine the statistical significance of the combined effect sizes from multiple similar studies. If P ≤ .05, the combined effect size was considered statistically significant; otherwise, it was deemed not statistically significant. Publication bias in the meta-analysis results was assessed using funnel plots.

RESULTS

Literature Search Results

A total of 464 studies were identified. Using the reference management software EndNote 20, 455 studies that did not meet the inclusion criteria were excluded. Finally, nine studies were included for qualitative and quantitative analysis,^{1,2,3,5,6,11,12} The screening process is shown in Figure 1, Basic Information of Included Studies is shown in Table 1.

Table 1.

Study Details of Randomized Controlled Trials Included in the Meta-Analysis

Author	Year	Randomization method	Sample size (T/C)	Injection site	Gender (male/female)		Mean age
					T	C	T	C
Hui Q	2017	Random number table	13/13	Face	0/13	0/13	42.08 ± 7.37
Roohaninasab M	2024	Random number table	5/15	Orbital region	1/4	4/11	59.8 ± 3.8	55.8 ± 5.4
Pincelli T	2024	Randomization mentioned only	18/18	Hands	0/18	0/18	59 (Median age)
Gawdat H	2022	Envelope method	10/10	Neck	0/10	0/10	51.25 ± 5.95
Alam M	2018	Computer-generated	19/19	Face	2/17	2/17	46.37 ± 10.88
Shin MK	2012	Randomization mentioned only	11/11	Face	0/11	0/11	43.9 ± 7.3	43.6 ± 4.5
Na JI	2011	Randomization mentioned only	25/25	Arms	—		—
Feng J	2018	Randomization mentioned only	23/23	Face	0/23	0/23	—
Li L	2021	Randomization mentioned only	50/50	Face	11/39	10/40	47.13 ± 5.49	46.98 ± 6.14

Author	Year	Intervention		Follow-up duration	Treatment frequency	Outcome measures
		Experimental group	Control group
Hui Q	2017	Fractional Laser + PRP	Fractional Laser	3 months	Once	①②③
Roohaninasab M	2024	Fat Grafting + PRP	Fat Grafting	3 months	Once	①③④⑤
Pincelli T	2024	1mlPRP	1mlNS	24 weeks	Every 4 weeks for 3 sessions	①③④
Gawdat H	2022	Microneedling Radiofrequency + PRP	Microneedling Radiofrequency	6 weeks	Once a month for three sessions	①②③
Alam M	2018	3mlPRP	3mlNS	2 weeks, 3 months, 6 months	Once	①⑤
Shin MK	2012	Fractional Laser + PRP	Fractional Laser	1 month	Every 4 weeks, 3 sessions in total	①②③
Na JI	2011	Fractional Laser + PRP	Fractional Laser	28 days	Once	⑤
Feng J	2018	Fat Grafting + PRP	Fat Grafting	6-12 months	Once	①
Li L	2021	Fractional Laser + PRP	Fractional Laser	—	Once	① ⑤

T, treatment group; C, control group.

①Patient self-reported satisfaction; ②Objective evaluation efficacy rate; ③Adverse events; ④Skin thickness; ⑤Pigmentation.

Quality Assessment and Risk of Bias Analysis

The Cochrane Risk of Bias Tool was used to evaluate the quality and assess the risk of bias in the randomized controlled trials included in this study. The results indicated that none of the nine included studies were of low quality. Percentage Chart of Cochrane Risk of Bias for Included Studies is shown in Figure 2, and summary of Cochrane Risk of Bias for Included Studies is shown in Figure 3.

Figure 2.

Percentage chart of cochrane risk of bias for included studies. The chart illustrates the proportion of studies classified as having low, unclear, or high risk of bias across different methodological domains. The results indicated that none of the nine included studies were of low quality.

Figure 3.

Summary of cochrane risk of bias for included studies. Each column represents a single study, and each row represents one risk-of-bias domain. Color coding indicates the judgment of low, unclear, or high risk of bias. The results indicated that none of the nine included studies were of low quality.

Meta-Analysis Results

Subjective Satisfaction of Patients With Skin Aging Treated With Platelet-Rich Plasma

Heterogeneity test: seven studies were included for this outcome measure. Heterogeneity was assessed using a Galbraith radial plot (Figure 4) and an L'Abbé plot (Figure 5). The Galbraith radial plot showed that the treatment effects and their corresponding confidence intervals across the studies were well-concentrated, with no apparent heterogeneity observed. In the L'Abbé plot, the treatment group demonstrated significantly better efficacy than the control group, with most data points positioned above the diagonal line and distributed evenly. This indicated that PRP treatment for skin aging was effective and exhibited good consistency across studies.

Figure 4.

Galbraith radial plot of patient subjective satisfaction with PRP treatment for aging skin. Each point represents a study, with its position reflecting the standardized effect size and precision. The plot is used to assess heterogeneity across studies. The horizontal axis represents the precision of each study's effect size (1/standard error), and the vertical axis represents the standardized effect size (effect/standard error). Each point corresponds to a study. The central regression line indicates the overall pooled effect, while the two parallel lines mark the 95% confidence limits. Studies located within the confidence limits indicate no substantial heterogeneity.

Figure 5.

L'Abbé plot of patient subjective satisfaction with PRP treatment for aging skin. Each circle represents an included study, plotted according to the event rates in the treatment and control groups. The horizontal axis shows the mean satisfaction score in the control group, and the vertical axis shows the mean satisfaction score in the PRP group. The 45° diagonal line indicates equal results between groups. Points below the line suggest greater improvement in the PRP group, whereas points above the line suggest greater improvement in the control group. Most points cluster above the diagonal line, indicating that the PRP group demonstrated significantly better efficacy than the control group.

The heterogeneity statistic I² was 0, suggesting very low heterogeneity among the studies with no significant differences between the results of the included studies. The effect sizes reported in all studies were generally consistent, making them suitable for pooled analysis. Additionally, the Q-test yielded a P-value of .83, indicating that the heterogeneity among the included studies was not statistically significant. Therefore, a fixed-effects model was chosen for the meta-analysis.

Fixed-effects model meta-analysis: The pooled relative risk (RR) value from seven studies was 1.34 (95% CI: 1.07-1.67), which was statistically significant (Z = 2.59, P = .01). This indicated that PRP intervention for treating aging skin led to higher subjective patient satisfaction compared to the control group. Details were shown in the following forest plot (Figure 6).

Figure 6.

Forest plot of patient subjective satisfaction with PRP treatment for aging skin. Relative Risk (RR) was 1.34 (95% CI: 1.07-1.67); Z = 2.59, P = .01.

Through further visual analysis using the forest plot, all point estimates and their 95% CIs were above 1.0, with most effect sizes close to 1.34, providing additional support for the efficacy and consistency of PRP treatment.

Bias assessment: Publication bias was examined using a funnel plot. Symmetry in the funnel plot indicated the absence of publication bias. The funnel plot for this study was shown in Figure 7.

Figure 7.

Funnel plot of patient subjective satisfaction with PRP treatment for aging skin. The horizontal axis shows the relative risk (RR) of patient satisfaction, while the vertical axis represents the standard error of the log relative risk (SE of the log RR). Each point corresponds to an individual study. The distribution pattern is used to assess potential publication bias. The relatively symmetrical distribution of points suggests a low risk of publication bias.

From the funnel plot above, it could be inferred that the results of this analysis were minimally affected by selection or publication bias.

Objective Evaluation Efficacy of Platelet-Rich Plasma Intervention in Treating Skin Aging

Heterogeneity test: Three studies were included for this outcome measure. After performing the heterogeneity test, the I² value was 0, indicating very low heterogeneity between studies, with no significant differences among the results. The effect sizes reported by all studies were consistent, suggesting that a meta-analysis could be performed. Additionally, the Q test yielded a P value of .83, indicating that the heterogeneity between the selected studies was not statistically significant, allowing for the use of a fixed-effect model for the meta-analysis.

Meta-analysis using a fixed-effect model: The pooled RR value from the three studies was 1.42, with a 95% CI of 1.01-2.00, and the result was statistically significant (Z = 2.01, P = .04). This suggested that PRP intervention for treating aging skin had a significantly higher objective evaluation efficacy compared to the control group. The specific details could be seen in the forest plot below (Figure 8).

Figure 8.

Forest plot of objective efficacy evaluation for PRP treatment of aging skin. Relative Risk (RR) was 1.42 (95% CI: 1.01-2.00); Z = 2.01, P = .04.

Through further visual analysis using the forest plot, all point estimates and their 95% confidence intervals were above 1.0, with most studies having effect sizes close to 1.42, further supporting the efficacy and consistency of PRP treatment.

Bias assessment: Funnel plots were used to examine the presence of publication bias in this study. Symmetry in the funnel plot indicated the absence of publication bias. The funnel plot for this study was shown in Figure 9. From the above funnel plot, it could be inferred that the results of this analysis were minimally affected by selection or publication bias.

Figure 9.

Funnel plot of objective efficacy evaluation for PRP treatment of aging skin. The horizontal axis shows the relative risk (RR) of treatment efficacy, while the vertical axis represents the standard error of the log relative risk (SE of the log RR). Each point corresponds to an individual study. The distribution pattern is used to assess potential publication bias, and the relatively symmetrical distribution of points suggests a low risk of such bias.

Adverse Reactions of PRP Intervention in Treating Skin Aging

Heterogeneity test: Five studies were included for this outcome measure. Although the I² value was 24% and the Q test yielded a P value of .26, the star plot (Figure 10) shows that the treatment effects and confidence intervals of the studies werewidely scattered. The L'Abbé plot (Figure 11) also did not exhibit a clear clustering trend, with some studies’ points noticeably deviating from the diagonal. This suggested inconsistency among the study results. The presence of such heterogeneity may reduce the reliability of the fixed-effect model meta-analysis and affect the generalizability of the conclusions. Therefore, we considered using a random-effects model for the meta-analysis.

Figure 10.

Star plot of adverse reactions in patients with skin aging treated with PRP interventions. Each point represents an included study, with its position reflecting the standardized effect size and its precision. The horizontal axis represents the precision of each study's effect size (1/standard error), and the vertical axis represents the standardized effect size (log relative risk/SE). The central regression line indicates the pooled effect, and the dashed lines mark the 95% confidence limits. Studies outside the dashed lines may contribute to heterogeneity. The star plot shows that the treatment effects and confidence intervals of the studies are widely dispersed, indicating variability in the reporting of adverse reactions across studies.

Figure 11.

L'Abbé plot of adverse reactions in patients with skin aging treated with PRP interventions. Each circle represents an included study, plotted by the incidence of adverse events in the treatment and control groups. The horizontal axis indicates the adverse event rate in the control group, and the vertical axis indicates the rate in the PRP group. The 45° diagonal line denotes equal event rates between groups. Points above the line suggest higher rates in the PRP group, whereas points below indicate lower rates. The plot shows no clear clustering trend, with several points deviating markedly from the diagonal, reflecting heterogeneity among study results.

Meta-analysis using a random-effects model: The pooled RR value from the five studies was 1.21, with a 95% CI of 0.50-2.92. However, the Z value was 0.43 and the P value was .67, indicating that the adverse reactions of PRP intervention in treating aging skin patients were not statistically significant. The specific details are demonstrated by the forest plot shown in Figure 12.

Figure 12.

Forest plot of adverse reactions in PRP intervention for skin aging treatment. Relative Risk (RR) was 1.21 (95% CI: 0.50-2.92); Z = 0.43, P = .67.

DISCUSSION

While several systematic reviews and meta-analyses on PRP have been conducted, the use of PRP in skin rejuvenation remains insufficiently evaluated through a comprehensive synthesis of high-quality RCTs. This meta-analysis is the first to specifically target high-quality RCTs on PRP for skin rejuvenation. By systematically reviewing the latest literature up to the end of 2024, we included a total of nine studies comprising 358 participants, thereby enhancing the statistical power, representativeness, and clinical relevance of the findings. This study, through a meta-analysis of seven sets of research data, shows that PRP intervention for treating skin aging results in significantly higher patient satisfaction compared to the control group. The pooled RR value was 1.34 (95% CI: 1.07-1.67), with a P value of .01, suggesting that PRP, both alone and in combination with other treatments, significantly improves post-treatment patient satisfaction compared to placebo and other single treatments. Regarding objective evaluation efficacy, the combined results of three studies indicate that PRP treatment significantly outperforms the control group, with an RR of 1.42 (95% CI: 1.01-2.00) and a P value of .04. The forest plot further confirms the significant and consistent effect of PRP treatment. In the analysis of adverse reactions associated with PRP treatment for skin aging, we observed significant heterogeneity. Researchers such as Pincelli T^3,4,6,8 reported an increased incidence of adverse reactions with PRP, whereas Shin, M.K^1–5,12 observed fewer adverse reactions in the intervention group. Therefore, we employed a random-effects model for analysis. The pooled results demonstrated that the RR of adverse events with PRP therapy was 1.21 (95% CI: 0.50-2.92), with a Z-value of 0.43. Given the current level of evidence, no statistically significant difference in adverse event risk between the PRP and control groups could be established (P = .67). However, due to the wide confidence interval crossing the null value (RR = 1), the possibility of a clinically meaningful difference cannot be excluded. Further studies with larger sample sizes are warranted to strengthen the evidence.

Platelet concentrates were originally used in transfusion medicine to treat and prevent bleeding caused by severe thrombocytopenia. PRP has emerged as an innovative autologous blood product for enhancing tissue healing and regeneration. PRP's characteristic of a significantly higher platelet concentration than baseline physiological levels plays an important role in wound healing and tissue repair. PRP exerts its therapeutic effects by continuously releasing multiple growth factors, participating in the regulation of physiological processes related to tissue repair. These growth factors, as bioactive mediators, not only regulate key cellular events such as migration, proliferation, and differentiation but also promote extracellular matrix synthesis and enhance angiogenesis, providing support for tissue repair and regeneration.^1,2 In improving aging skin, PRP may have multiple mechanisms of action, including promoting dermal thickening, enhancing angiogenesis, repairing skin barrier function, and regulating the biological characteristics of skin cells. Research has shown that platelets contain α-granules that contain more than 30 bioactive substances, such as platelet-derived growth factor (PDGF), transforming growth factor (TGF)-β1, β2, and epidermal growth factor (EGF). Studies have found that TGF-β1 inhibits melanogenesis through delayed extracellular signal-regulated kinase activation. TGF-β suppresses the expression of paired box homologgenes (PAX), which play a role in UV-induced melanin formation. TGF-β1 also reduces the activity of tyrosinase, tyrosinase-related proteins, and the transcription factor promoter of the microphthalmia-associated transcription factor. Additionally, EGF reduces melanogenesis by inhibiting prostaglandin E2 expression and tyrosinase activity. PRP also increases tissue volume due to enhanced angiogenesis, collagen deposition, and extracellular matrix formation (hyaluronic acid), leading to improvements in skin texture and pigmentation. PRP stimulates fibroblast proliferation and collagen and elastin synthesis, thereby improving skin elasticity and firmness.^3,9,13,14 Moreover, PRP's antioxidant effects can effectively alleviate free radical damage caused by photoaging, promote keratinocyte renewal, and further optimize skin texture and barrier function.^10,15

Although this study's results suggest that PRP treatment for skin aging demonstrates high consistency in terms of efficacy and safety, there are still some limitations. First, the studies included in this meta-analysis were relatively few, and their sample sizes were small. In the meta-analysis of patient satisfaction, the authors used weighted statistical methods to maximize the inclusion of relevant studies, converting scattered patient satisfaction data and continuous variables from some studies into binary variables for consistency analysis with other studies. This may affect the generalizability and external validity of the results. Some studies had short follow-up periods, lacking long-term data on efficacy and safety. While many studies now demonstrate the benefits of topical and injectable PRP for facial wrinkles, acne scars, or photoaged skin, most of these are case reports or case series, with few randomized controlled trials. Moreover, the process or specific type of platelet product used was not mentioned in most of these studies. Furthermore, due to the lack of standardized clinical outcome measurement methods and differences in treatment protocols, dosages, frequencies, and outcome evaluation tools, the results of many studies were nearly impossible to compare effectively. As a result, the objective outcome measures could not be fully utilized, which represents a notable limitation of the study. Given the limitations of the current evidence, future research on PRP intervention for skin aging can strengthen the following areas: (1) standardizing the evaluation methods, tools, and criteria for assessing the efficacy of PRP in treating skin aging to facilitate statistical analysis and guide clinical practice more accurately; (2) most of the studies included in this meta-analysis involved the combination of PRP with other anti-aging therapies (such as high-frequency lasers, fat grafting, etc.). Future multi-center, large-sample clinical trials could explore the optimal timing, dosage, and sequence of different combinations; (3) long-term follow-up studies are crucial for assessing the sustained effects and safety of PRP treatment. Although PRP has shown significant short-term effects, its long-term efficacy and safety remain unclear. Long-term follow-up would help assess the persistent impact of PRP on the skin and monitor potential chronic adverse reactions.

CONCLUSIONS

This meta-analysis demonstrates that PRP therapy exhibits improved efficacy and favorable safety in improving skin aging. The results indicate that PRP intervention enhances patient-reported satisfaction and shows improved objective outcomes compared to control groups. However, given the current level of evidence, the potential difference in adverse event risks between PRP and control groups cannot be ruled out.

Supplemental Material

This article contains supplemental material located online at https://doi.org/10.1093/asjof/ojaf150.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

This study was funded by Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Grant #YS2024CG018.