PLATELET-BASED Regenerationeration

Dr Edward Robinson shares his experience with ACP liquid PRF and why he feels it is the future of platelet-based treatments

DR EDWARD ROBINSON

Dr Edward Robinson is a cosmetic physician and NHS anaesthetics doctor based in Cheshire. He specialises in skin and hair rejuvenation, with a particular focus on biostimulators and combination regenerative treatments. He is an associate member of BCAM and a key opinion leader for Arthrex and Sciton.

Regenerative aesthetics has become one of the most in-demand areas of medical aesthetics. While I haven’t personally seen a decline in fillers in my practice – in my view, they are still the gold standard for volumisation or reshaping – what I have seen is a shift in patients looking for long-term improvements in skin quality, hair health and overall vitality.

Skin health, in particular, has become the focus post-COVID, and people are drawn to treatments that feel natural, safe, and biologically in tune with their own bodies. For me, platelet-based therapies are at the heart of this.

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are nothing new – they have a long history in orthopaedics, sports medicine and wound healing – but recent advances in preparation systems, combined with our deeper understanding of platelet biology, mean these treatments are now better, safer, and more effective than ever before.

One of the reasons I feel so passionately about the power of PRP/ PRF is that I’ve experienced what they can do personally. Years ago, after struggling with biceps tendonitis that had resisted other therapies, I received PRP injections. The improvement was dramatic – pain relief, improved function and long-term recovery where other approaches had failed. Later, I used PRF (ACP) to maintain the results of my hair transplant, again seeing real-world evidence of its impact. That dual perspective, as both doctor and patient, has shaped the way I view regenerative medicine.

PRP VS PRF: UNDERSTANDING THE DIFFERENCE

The terms PRP and PRF are often used interchangeably, but there are important differences.

PRP is prepared by drawing blood, spinning it in a centrifuge, and extracting a plasma fraction enriched in platelets. These platelets are packed with alpha granules containing hundreds of growth factors, including platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-ẞ), and vascular endothelial growth factor (VEGF). When activated, they stimulate fibroblasts, promote angiogenesis, and trigger new collagen synthesis.

But not all PRP is equal. Spin blood in a diagnostic tube in a cheap centrifuge from Amazon, and you’ll get a straw-coloured plasma that might look like PRP, but it will often contain red and white blood cells. Both can be pro-inflammatory – red cells degrade and release free radicals, and leukocytes produce proteases and cytokines that can damage tissues. What we want in aesthetics is leukocyte-poor PRP with a high platelet concentration, not an inflammatory soup. That’s where medical-grade systems make a difference.

PRF is considered the “second generation.” Instead of using anticoagulants, the blood is spun at lower speeds, creating a fibrin matrix that traps platelets and leukocytes. This fibrin scaffold means the growth factors are released more slowly over time, prolonging the regenerative effect. In practice, this translates to fewer treatments needed and potentially longer-lasting results compared with PRP.

However, PRF is often produced as a gel. While this has benefits, particularly for wound healing or volumising applications (although I would argue the effects are short-lived for volumising), it can be harder to inject or use with microneedling. For aesthetic indications where we want to cover large areas evenly, that can be a limitation.

WHY I USE ARTHREX ACP®

This is where Arthrex’s Autologous Conditioned Plasma (ACP®) system stands out. ACP is essentially a liquid form of PRF, created with a unique double-syringe, closed system that requires only one spin. It gives me the best of both worlds: the sustained release and reduced inflammation of PRF, but in a liquid form that is easy to inject, microneedle, or combine with other treatments.

The Arthrex ACP® Double Syringe System is also backed by more than 200 published studies and 40 years of orthopaedic and regenerative medicine heritage. Unlike open systems, it never requires blood transfer between tubes, which reduces contamination risk. It’s anticoagulant-free, avoiding unnecessary additives, and consistently delivers a 2.5x platelet concentration with higher levels of key growth factors such as PDGF-AB, EGF and TGF-ß1. In short, it is reproducible, reliable, and safe. In aesthetics, where patient outcomes and safety underpin everything, that consistency really matters.

Before

After

FEMALE (63) CONCERNED WITH RHYTIDS, SKIN LAXITY AND PIGMENTATION. HYPERDILUTE RADIESSE WAS USED AS A ‘WASH’ IN THE MID AND LOWER FACE IN COMBINATION WITH POLYNUCLEOTIDES AND PRF (TWO TREATMENTS, FOUR WEEKS APART). BBL AND MOXI LASER WAS PERFORMED (TWO TREATMENTS FOUR WEEKS APART). TWO FURTHER TREATMENTS OF POLYNUCLEOTIDES AND PRF IN COMBINATION WERE PERFORMED UNDER THE EYES AND THROUGHOUT THE MID AND LOWER FACE (FOUR WEEKS APART). BEFORE AND AFTER PICTURES TAKEN 14 MONTHS APART.

INDICATIONS IN PRACTICE

I’ve been using ACP primarily for skin rejuvenation and hair restoration and as an adjunct to other regenerative treatments. What stands out is the consistency of results. Patients report improved skin quality, better texture and tone, and in hair applications, we’re seeing enhanced density and thickness.

• Skin quality

Patients with crepiness, thinning skin, fine lines, laxity or pigmentation often benefit from ACP treatments. Menopausal women, in particular, respond well, as declining oestrogen accelerates collagen loss. ACP stimulates fibroblasts, increases dermal thickness, and improves texture in a subtle but noticeable way.

• Hair restoration

Mild to moderate diffuse hair loss responds best, and interestingly, women often do particularly well, despite most marketing being aimed at men. ACP supports angiogenesis and follicle metabolism, improves hair density and thickness, and works beautifully pre- and post-hair transplant to optimise results.

COMBINATION TREATMENTS

Perhaps the most exciting application is combining ACP with other modalities. The demand for combination treatments is huge right now – and it makes sense. In medicine, we often combine agents to achieve more with less. I still work as an anaesthetist in the NHS, and I often use the analogy of balanced anaesthesia. When we put someone to sleep, we don’t rely on a single drug in massive doses. Instead, we give a small amount of an opiate like fentanyl, which makes the patient drowsy and comfortable, and then we use propofol to actually induce unconsciousness. If we used propofol alone, we’d need to give such a high dose that it could easily tip into unsafe territory. But in combination, each drug supports the other, allowing us to achieve the desired effect with lower doses and fewer risks.

The same principle applies in aesthetics. When we use regenerative treatments in combination – say ACP with microneedling, or PRF alongside RF or laser – we’re activating multiple pathways simultaneously. That doesn’t just stack the results, it makes them synergistic: the whole is greater than the sum of its parts. One treatment primes the environment, while the other drives the change, like putting fuel in the car and then turning the ignition.

This approach often means patients need fewer sessions overall, and they benefit from reduced downtime too. For example, combining ACP with an anti-inflammatory modality like exosomes can not only amplify regeneration but also make recovery quicker and more tolerable. For patients with busy lives, that’s a major advantage – they see better results without the inconvenience of prolonged redness, swelling or time away from work.

In my practice, I combine ACP with:

• Microneedling and RF microneedling

By creating controlled micro-channels in the skin, microneedling allows ACP growth factors to penetrate directly into the dermis, accelerating repair and collagen remodelling while cutting downtime. I use both mechanical devices, such as SkinPen , and radiofrequency microneedlingm (Morpheus8). The principle is the same: the device creates an environment for regeneration, while ACP provides the biology to drive it, resulting in smoother, healthier skin and quicker recovery.

• Lasers

In my practice, I routinely combine ACP with light and laser-based treatments such as BroadBand Light (BBL) and Moxi. Both of these technologies are excellent for superficial skin resurfacing, but they can also trigger a fair amount of inflammation. By adding ACP into the protocol, I find that inflammation and post-treatment downtime are significantly reduced. Patients recover more quickly, with less redness and swelling, while still achieving the rejuvenating effects of the device.

Before

After

FEMALE (39) CONCERNED ABOUT DIFFUSE HAIR LOSS. THREE TREATMENTS WITH COMBINATION ACP AND POLYNUCLEOTIDES INJECTED THREE WEEKS APART. PICTURES TAKEN FIVE MONTHS APART.

• Biostimulators

Another area where ACP works well is in combination with hyperdilute Radiesse. Normally diluted with saline to act as a collagen stimulator rather than a filler, I often replace part of that diluent with ACP. This way, patients benefit from both the mechanical scaffold of calcium hydroxyapatite microspheres and the regenerative growth factors of ACP. It’s a particularly effective approach for delicate, crepey areas such as the neck, where we want to stimulate new collagen and elastin without adding volume, leaving skin stronger, firmer and better supported.

• Polynucleotides

Polynucleotides (PNs) are gaining real momentum in aesthetics and they pair beautifully with ACP. Where ACP brings angiogenesis and platelet-derived growth factors, PNs offer antioxidant protection and DNA repair pathways. Together, they target distinct but complementary mechanisms, making them powerful for both hair restoration and skin rejuvenation. Patients see improvements in elasticity, texture and density, with the added benefit of long-term cellular protection.

PATIENT PREPARATION AND PRACTICAL CONSIDERATIONS

Because ACP relies on the patient’s own biology, their lifestyle and health matter. I advise patients to:

• Stay well hydrated – plasma volume drops when dehydrated

• Avoid alcohol before treatment

• Pause NSAIDs or antiplatelet drugs where possible

• Optimise nutrition and sleep to support platelet function. Contraindications mirror those for most injectables: systemic illness, anticoagulation, chemotherapy, or unrealistic expectations. Importantly, ACP should not be combined with lidocaine in the same syringe, as anaesthetic agents reduce platelet activity.

Side effects are minimal and usually limited to bruising, swelling or transient tenderness at injection sites. The biggest “risk” is simply a lack of response, which can occur in patients with poor platelet quality or advanced disease. Managing expectations is key: ACP is about gradual, regenerative improvement, not instant volumisation.

NATURAL AND REGENERATIVE AESTHETICS

One of the most common questions I get is: “Is this natural?” This is an interesting question. You could argue that ageing itself is natural and any attempt to reverse it is, by definition, unnatural, but patients like the reassurance that ACP is their own blood, with nothing foreign left behind in their tissues. With “filler fatigue” on the rise, and more patients saying they don’t want products sitting in their faces, the appeal of regenerative therapies is obvious.

I believe ACP represents a step forward in how we think about aesthetics. It is not about volume, but about improving skin function, stimulating repair, and enhancing overall quality. And because it is autologous, safe and reproducible, it fits perfectly into modern, holistic treatment plans.

CONCLUSION

PRP and PRF have long been proven in medicine, but in aesthetics, we’re only beginning to appreciate their full potential. In my own practice, ACP has become a cornerstone for both skin and hair treatments, either alone or in combination. As regenerative aesthetics continues to grow, I see ACP as part of a wider shift towards putting science-backed, patient-centred treatments back at the heart of aesthetic practice..