Platelet rich plasma (PRP), platelet rich fibrin (PRF), and platelet rich fibrin matrix (PRFM) are all regenerative therapies that use your own blood products to help expedite wound healing and purport to improve the appearance of skin. These therapies harness the power of your own blood’s plasma (the yellow part of the blood after the red blood cells have been separated out), which contain platelets with high concentrations of growth factors.

Image via: https://rejuvieclinic.com/platelet-rich-plasma-prp/

These growth factors activate signals in your body to promote regenerative processes like the production of collagen, elastin, and blood vessels. However, while PRP has a long history of use in aesthetics and general medicine, PRF and PRFM are newer, more buzzy procedures. Here’s what you need to know:

PRP: During the process of PRP therapy, blood is drawn from a peripheral vein, spun down in a centrifuge in a special tube that has an anticoagulant, and the platelets with high concentrations of growth factors are separated from the red blood cell parts. The platelet rich plasma (PRP) is then drawn into syringes and can be injected or applied to prepped skin (via microneedling or laser). PRP has been around for many years, and actually gained popularity in the US for indications outside of aesthetics. In 2013 Kobe Bryant was one of the first Americans to seek out PRP treatment in Germany to repair damaged cartilage to his knee. Since that time, this treatment has really flourished and has been used for its ability to expedite the healing of orthopedic injuries, to expedite wound healing (e.g. after a laser procedure), to stimulate hair growth (e.g. for conditions like male and female pattern hair loss), and to rejuvenate skin. While there are many different systems and protocols for preparing and administering PRP, a few things remain constant. PRP is a safe procedure and it is relatively effective to temporarily rejuvenate skin, hair, and help repair wounds and certain musculoskeletal and orthopedic injuries. Its safety lies in the fact that it is 100% autologous (meaning, it is your own blood products) and administered as a liquid that has been treated with an anticoagulant that prevents a clot from forming.

The biggest issue I see with PRP is in the realm of expectations. This is not a treatment that will radically transform the skin. It should be considered as an adjuvant to whatever procedures you are doing. With post-procedural application of PRP, skin that has been lasered might heal a day or two more quickly. With micro needling or laser-assisted delivery of PRP, skin can look glowy / more radiant and less crepey for weeks to months (depending on a number of factors). And with micro-needling or injections into the scalp, hair can grow in both male and female pattern hair loss. However, the effects require maintenance.

PRF: I have fielded more questions about platelet rich fibrin (PRF also called by a brand name EZ Gel) in the past year than I have for any other procedure, Xerf notwithstanding. With respect to process, PRF is obtained in a manner similar to PRP, with the key difference being the absence of an anticoagulant. This means that PRF has the consistency of a gel. In reality, what is happening is that you are drawing blood and obtaining a blood clot to then inject into your skin. There are certain benefits to the fibrin matrix that forms around this clot in that it holds platelets and growth factors, thus theoretically allowing for the sustained release of these elements in your skin over a longer period of time than traditional PRP. With that, there might be a better improvement in wound healing and tissue regeneration, and there is a little bit of data to support that. Though to be honest, most of these data are in animal models and in individual cases or small case series. With respect to applications in intact skin, PRF is really in its infantile stages with less than 27 cases of patients in facial rejuvenation studies demonstrating improvement in the most recent meta-analysis (Qin et al Annals of Plastic Surgery 2025; PMID: 40167104 DOI: 10.1097/SAP.0000000000004267). A subsequent review of periocular rejuvenation demonstrated improvements in texture, wrinkles, and crepiness up to six months in about 50 additional cases (Sollitto et al J Cosmet Dermatol 2025; PMID: 41190633 DOI: 10.1111/jocd.70524).

While social media influencers extoll the virtues of PRF – and the potential is there - my experience has been that this is a treatment that is often administered to the hollows under the eyes as an alternative to filler. Firstly, to date, the data does not show that PRF has a volumizing effect in this area. Secondly, the periorbital skin is the thinnest and most unforgiving area of the entire body. In actual clinical practice we have seen multiple cases of PRF lumps, bumps, and intermittent swelling that persists for months – especially in the skin under the eye. While you may argue that the same thing can occur with soft tissue fillers, current hyaluronic acid fillers like Restylane, Juvederm, Belotero, and RHA have several distinct advantages. These include long track records of safety and efficacy and the ability to reverse their effects with a simple injection of an enzyme that dissolves hyaluronic acid.

PRFM: A relative of PRF, platelet rich fibrin matrix (PRFM) refers to the gel matrix that forms during the production of PRF. You can consider this to be an even thicker version of PRF. PRFM forms a scaffold that holds regenerative cells like growth factors and platelets and releases them over time. Like PRF, the evidence supporting the use of this product is extremely weak (45 patients in the Qin et al reference), but it theoretically offers the same benefits as PRP and PRF with the additional benefits of added volume and longevity. Many people are conceptualizing this as a “natural filler.” Again, like PRF, this is a gel / clot-like substance that cannot be removed if the aesthetic outcome is not ideal. I have not seen any adverse effects from it yet, but it is likely that it hasn’t quite gained a foothold in the market.

In general, all of these treatments are “natural,” time-limited in their duration, but only one of them has a track record of safe use. While the literature for PRF and PRFM is still emerging, the data appears to be positive to date with skin thickness and elasticity showing the most benefit. The sample size, again, is very small. PRP also seems to be able to expedite wound healing. You might want to consider it after a laser procedure, though it depends on how much you value a day or two of expedited healing. Often it is not a trivial amount of money to add-on to a procedure.

As a final note, it’s really hard to study these technologies, make comparisons, and derive conclusions as there is substantial variability to the methods by which these substances are obtained and applied. Practitioners use different types of machines, draw different amounts of blood, use different tubes with different spin times, different syringes, needles, etc. The number of variables can be overwhelming.

My Take Home:

At this point, I will be sticking to the traditional methods of increasing skin thickness – fractionated laser and topical retinoids, with the occasional use of PRP for people who understand its transient nature. Though you may want to experiment on yourself (and I do believe that trying new procedures that do not have a robust evidence base is self-experimentation), I will not be injecting PRF or PRFM until I see some more safety data and compelling aesthetic outcomes.

If you want to read more about the regenerative alphabet soup, OG beauty writer / queen Val Monroe has published a concomitant Substack that takes a deep dive into some of the other characters in this class, including PDRN and PRX. She is worth a follow.

Identify & Treat Any Underlying Skin Conditions:

First and foremost, ensure that you understand your skin. This means confirming if you are living with an inflammatory condition that causes discoloration (e.g. acne, eczema, and melasma are some of the most common ones) or if you merely have skin that is prone to discoloration. This is really the foundational step that will guide all of your treatments going forward. If you are unsure and you have active inflammation on your skin, it will behoove you to see a board certified dermatologist to get a diagnosis and medical treatment.

Skincare Essentials:

Once you understand your condition, a skincare regimen is necessary to keep things in check, but is not always sufficient. The two most critical steps of an anti-pigment skincare regimen are:

1. Tinted sunscreen

2. Vitamin A derivatives

Broad-spectrum, high SPF sunscreen protects against the development of sun damage including solar lentigines (sun spots), wrinkling, and all three of the most common types of skin cancer (basal cell, squamous cell, and melanoma). For people struggling with pigment, the addition of tint to their sunscreen offers additional protection from visible light, which is not blocked by traditional white and clear sunscreens. These only block ultraviolet light. Most of the light coming from the sun is actually visible light. Visible light can cause and worsen hyperpigmentation, even without the presence of ultraviolet light.

If you are struggling with pigment, I can’t stress enough how important it is to use sunscreen regularly and to repeat application every few hours, particularly in the summer months

Some unsponsored tinted sunscreen recommendations:

-La Roche Posay Anthelios UVMune 400 Tinted (EU product)

This sunscreen has the most superior filters in the market, including, Mexoryl XL, one of the most robust UV-A blocking filters that is not available in the US.

-Tizo:

Multiple shades, but often difficult to find other than online in certain doctors’ offices.

-EltaMD:

Multiple tinted options, including those for people who prefer mineral sunscreens.

Tinted sunscreen is notoriously difficult to formulate, so you might need to try a few before finding the one that matches your shade.

Vitamin A derivatives like retinol, retinal, and adapalene, as well as prescriptions (e.g. tretinoin, tazarotene, and trifarotene) offer robust effects with respect to skin tone, with prescription strength treatments being far superior. The original studies of tretinoin from the 1980s showed anti-acne efficacy, but also demonstrated that when used regularly over time (many months), these creams can even pigment and tone.

My favorite unsponsored OTC starter retinols:

-SkinBetter AlphaRet Overnight Cream

A very tolerable retinol for those with sensitive skin or those who wish to gradually introduce something over-the-counter before upgrading to Rx.

-Neutrogena Rapid Wrinkle Repair

The OG over-the-counter retinol. There are several varieties in the line.

Bonus - Antioxidants such as Vitamin C help to undo environmentally-induced free radical damage to the skin and improve the way that sunscreens function. They have some collagen building and anti-pigmentation effects as well, though those tend to be modest. Not all antioxidants are created equal; most have not been tested in any meaningful way. However, that is a topic for another day. These are my favorites, and they’re expensive for a reason. I’ll explain why in a following article

-Skinceuticals CE Ferulic

-SkinBetter Alto Defense Serum

While there are many other anti-pigment / lightening ingredients in the skincare sphere, sunscreen and vitamin A derivatives are the only ones with robust, repeated peer-reviewed scientific papers proving their efficacy.

Other non-prescription topicals can be helpful but offer mild to minimal results. There are so many ingredients in this sphere from common ones like niacinamide and tranexemic acid to more niche botanicals. Here is a representative before and after photo that I snapshotted from a very reputable company that is selling a lightening serum for approximately $150.

These photos are the ones being advertised by the company, so one would think that they’re putting their best foot forward. Hard to tell the difference, right? This is a telling example of an important take home point for me: nearly all of the safe, at-home lightening treatments are extremely modest in their effects. Some of the more robust OTC lightening creams (e.g. high percentage arbutin) can be quite irritating.

In Office Treatments:

If you are dealing with pigment and you wish to explore in-office treatments, it is essential that you (i) diagnose and treat underlying skin conditions and (ii) see a reputable practitioner. I would recommend not seeking the correction of pigment until you are certain that your skin is calm and any disease is quiescent. While there are exceptions, board certified dermatologists have the most training in both recognizing and treating skin diseases as well as the discoloration that might arise from skin inflammation.

I won’t go into extreme depth but there are many different ways to approach pigment in the office. Here are the top modalities to consider:

Prescriptions

Prescription lightening creams containing hydroquinone, kojic acid, azelaic acid, retinoids, and combinations of the above can be quite effective in removing superficial pigment from the skin. Conditions such as epidermal / superficial melasma and post inflammatory discoloration often respond well to time-limited use of these creams without the need for more expensive in-office treatments. These creams can differ widely in their percentages, effectiveness, and irritation potential, thus really do require a detailed understanding of your skin and a discussion of potential risks.

Chemical Peels

I could write a whole article about the art of chemical peels. This is an area of treatment in which experience matters. One should take caution before signing up for a peel without understanding what you’re getting yourself into. You may be looking at zero downtime; you may be looking at weeks of downtime. There are so many items to consider – the type of peel, the strength of the peel, the amount of time it sits on the skin, the vehicle in which it is applied (mask v liquid; gauze v sponge v pad v q tip), the amount of peel that is applied, how vigorously it is applied, the preparation of the skin both in the weeks before and immediately before in the treatment room (is is cleaned with alcohol or acetone or is the peel applied to gently-cleansed skin). There are really so many variables that make this an extremely nuanced topic, and one worthy of exploration on its own. Ask questions in your consultation to ensure that you understand everything.

Lasers

This is another huge topic, and one about which I often receive questions. In considering the treatment of pigment, there are two categories of lasers you might want to consider: resurfacing and pigment-specific lasers.

Resurfacing lasers target water molecules in the skin. Pigment may improve but is not the target. Resurfacing laser types include fractionated and unfractionated lasers. I like to think about fractionated lasers as treating the skin as a checkerboard and only treating the red squares. The black untreated squares allow for healing to occur with minimal downtime and fewer side effects. A controlled exfoliation occurs when water molecules are heated in the epidermis and sometimes the dermis. Depending on the depth and extent of the surface being treated, fractionated lasers can be instrumental in the removal of pigment and precancerous damage and in the building of collagen.

Image via https://maryland-plastic-surgery.com/medispa-lasers/laser-procedures/fractional-resurfacing/

Fully ablative / unfractionated lasers are less frequently used in contemporary medicine, but can have profound smoothing effects as they will remove an entire uniform layer of skin. They carry both substantial downtime and substantial risk, and are not the best choice for the removal of pigment.

Pigment specific lasers emit a particular wavelength that, when delivered to the skin, is preferentially absorbed by a specific target. The target can be a variety of things, including melanin (in sun spots, melasma, post-inflammatory discoloration, etc), unwanted tattoo pigment, hair, blood vessels, or even oil glands. If the correct laser wavelength is paired with the correct skin type and skin concern, these treatments can be remarkably effective at removing the target (e.g. pigment) while sparing the surrounding tissues from injury. In inexperienced hands (or in rare cases in experienced hands), there can be side effects such as blistering, scarring, or worsening of pigment. In expert hands, both resurfacing and pigment lasers can yield exceptional results. In the right patient, combining resurfacing and pigment lasers can yield even better outcomes.

When used very conservatively, certain pigment specific lasers can help melasma; other pigment specific lasers can be disastrous for melasma.

Let me know if you’d like to explore any of these topics in greater depth in the future.