COMMERCIAL FEATURE
ADVANCES IN PRP
Dr Lisa Dinley considers why the future of regenerative aesthetics lies beyond platelet count
Platelet-rich plasma (PRP) is now a clinically-established option for skin rejuvenation, hair restoration and tissue repair, and our understanding of how it works has changed dramatically over the past decade. The conversation is no longer only about platelet concentration or growth factor release; increasingly, attention is turning to extracellular vesicles (EVs), including exosomes, and the sophisticated cellular communication they facilitate.
FROM PLATELET NUMBERS TO BIOLOGICAL FUNCTION
Early PRP protocols were based on a relatively simple premise: more platelets equated to better clinical results. As centrifugation systems developed, manufacturers focused on producing increasingly concentrated preparations. However, clinical experience soon demonstrated that this relationship was more complex. Considerable variability existed among preparation systems, with differences in platelet concentration, leukocyte content, activation protocols, and processing methods resulting in inconsistent outcomes. As a result, published studies often reported heterogeneous findings, making meaningful comparisons difficult.
Research subsequently turned towards understanding what platelets actually release upon activation. Growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) and insulinlike growth factor (IGF) were key mediators of tissue repair and regeneration.
While these discoveries furthered the field considerably, they still failed to explain the full regenerative potential observed clinically.
THE EXOSOME REVOLUTION
The next major advance has been the growing appreciation of extracellular vesicles, particularly exosomes.
Exosomes are membrane-bound vesicles released by activated cells. They transport proteins, lipids, messenger molecules and microRNA between cells, acting as natural biological delivery vehicles that coordinate healing and regeneration.
Rather than depending only on freely circulating growth factors, which are inherently unstable, exosomes protect their biological cargo until it reaches the target tissue, this may improve the efficiency and consistency of cellular signalling.
Increasingly, researchers believe that many of PRP’s regenerative effects may be mediated not simply by soluble growth factors, but by these extracellular vesicles.
WHY PREPARATION MATTERS
As our knowledge grows, so too does the importance of optimising PRP preparation. If extracellular vesicles are central to regenerative signalling, practitioners must ensure sufficient platelet activation to stimulate their release. Platelet count therefore remains important.
Companies such as Arthrex, which has been developing orthobiologic technologies since the 1980s, have contributed greatly to improving the standardisation of PRP preparation. Originally founded to improve surgical outcomes in orthopaedics,
Arthrex has continually refined its platelet processing technologies with an emphasis on reproducibility and clinical consistency.
Its ACP Max system, for example, utilises a larger blood volume and a double-spin centrifugation protocol to maximise platelet recovery and extracellular vesicle production. By processing approximately 90ml of blood, the system has demonstrated the ability to generate preparations containing billions of platelet-derived extracellular vesicles.
Future characterisation of PRP is therefore likely to include not only platelet counts but also extracellular vesicle content, growth factor profiling and potentially even microRNA analysis.
OPTIMISING THE PATIENT
While regenerative medicine becomes increasingly personalised, patient optimisation is equally important.
Platelet quality is influenced by total metabolic health, hydration, nutrition and lifestyle. Encouraging patients to arrive well hydrated remains fundamental, while emerging evidence also suggests that timing may affect treatment quality.
Platelets demonstrate peak physiological activity during the morning, making earlier appointments preferable for PRP procedures whenever practical.
Diet may also serve a role. High-fat meals immediately before treatment may temporarily increase circulating lipoproteins, thereby interfering with extracellular vesicle isolation and function.
Similarly, light exercise the day before treatment may improve circulation and platelet activity without inducing excessive physiological stress.
LOOKING AHEAD
One particularly exciting area is the combination of autologous PRP with carefully characterised exosome products.
In clinical practice, combining PRP with adjunctive exosome therapies has shown promise, particularly in hair restoration. While PRP delivers autologous growth factors and extracellular vesicles directly from the patient’s own platelets, supplementary exosome technologies can provide additional signalling molecules designed to support stem cell activation and tissue regeneration.
Ultimately, PRP is no longer simply about concentrating platelets, but about understanding the complex biology of intercellular communication, standardising preparation techniques and selecting technologies capable of delivering reproducible biological activity.
LISA DINLEY
Dr Lisa Dinley is a dental surgeon, aesthetic practitioner and owner of The Castle Clinic in Nottingham. She has completed three master’s degrees and is a member of the Elsevier advisory board. She has been a dentist for 28 years and has been practising aesthetic treatments for 18 years, with a particular interest in regenerative treatments.