The Journal of Craniofacial Surgery  Volume 28, Number 8, November 2017 Brief Clinical Studies

Platelet-Rich Plasma Increases

Pigmentation
Cagri A. Uysal, MD, PhD, and Nilgun Markal Ertas, MD

Abstract: Platelet-rich plasma (PRP) is an autologous solution of FIGURE 1. The view of perioral area (left) before PRP (right) after PRP. PRP,
plasma containing 4 to 7 times the baseline concentration of platelet-rich plasma.
human platelets. Platelet-rich plasma has been widely popular
in facial rejuvenation to attenuate wrinkles and has been practically
used. The authors have been encountering various patients of
increased hiperpigmentation following PRP applications that
were performed to attenuate the postinflammatory hiperpig-
mentation especially after laser treatment. The authors have
been using PRP for facial rejuvenation in selected patients and
in 1 patient the authors have encountered increased pigmentation
over the pigmented skin lesions that were present before the
application. The authors recommend that the PRP might increase
pigmentation especially in the face region and precautions
might be taken before and after the application. Platelet-rich
plasma should not be used for the treatment of post inflammatory
hiperpigmentation.

Key Words: Hiperpigmentation, pigmentation, plasma, platelet, rich

P latelet-rich plasma (PRP) is an autologous solution of plasma
containing 4 to 7 times the baseline concentration of human
platelets.1 It has been used for various dermatological conditions
including wound healing, anti-inflammatory, and cosmetic inten-
tions.2 Platelet-rich plasma has been used as a carrier in most of the
experimental studies with the advantages of supporting stem cells
and various treatment modalities.3 Platelet-rich plasma contains
various growth factors contained in alpha granules and dense
granules. Alpha granules contain 7 fundamental growth factors:
the platelet-derived growth factors (PDGFaa, PDGFbb, and
PDGFab), transforming growth factor beta (TGFb1 and 2), epi-
thelial growth factor, and vascular endothelial growth factor.2
The dense granules contain bioactive factors including serotonin,
histamine, dopamine, calcium, and adenosine.
Platelet-rich plasma has been widely popular in facial reju-
venation to attenuate wrinkles and has been practically used.
Platelet-rich plasma was reported to be used for the treatment of
infraorbital hiperpigmentation (dark circles) and also for treat-
ment of postinflammatory hiperpigmentation, especially seen
after peeling or laser applications.4 We have been encountering
various patients of increased hiperpigmentation following PRP
applications that were performed to attenuate the postinflamma-
tory hiperpigmentation, especially after laser treatment. There has
From the Department of Plastic and Reconstructive Surgery, Faculty of
Medicine, Baskent University, Ankara, Turkey.
Received May 6, 2016.
Accepted for publication May 29, 2016.
Address correspondence and reprint requests to Dr Cagri A. Uysal, MD,
PhD, Department of Plastic and Reconstructive Surgery, Faculty of
Medicine, Baskent University, Fevzi Cakmak Cad. 5. Sok. No: 48,
06490 Bahcelievler, Ankara, Turkey;
E-mail: cagriuysal@hotmail.com; cagriuysal@yahoo.com
The authors report no conflicts of interest.
Copyright # 2017 by Mutaz B. Habal, MD
ISSN: 1049-2275
DOI: 10.1097/SCS.0000000000002893
FIGURE 2. The view of face (left) before PRP (right) after PRP. Notice the increase
hiperpigmentation on the pigmented lesions. PRP, platelet-rich plasma.
been a misusage of PRP probably taking into consideration that
the modulation effect on inflammation of PRP might decrease
hiperpigmentation (Fig. 1). However, PRP has high potency of
increasing pigmentation with the effects of the growth factors and
cytokines. We have been using PRP for facial rejuvenation in
selected patients and in 1 patient we have encountered increased
pigmentation over the pigmented skin lesions that were present
before the application (Fig. 2).
Recent advances in cellular therapies have spread the clinical
application.5 The mesenchymal stem cell therapies and also PRP
have the potential of modulating the applied site with the paracrine
effects.2,5 However, this effect might lead to eventful results. We
recommend that the PRP might increase pigmentation especially in
the face region and precautions might be taken before and after the
application. Platelet-rich plasma should not be used for the treat-
ment of postinflammatory hiperpigmentation.
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2. Leo MS, Kumar AS, Kirit R, et al. Systematic review of the use of
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3. Uysal CA, Tobita M, Hyakusoku H, et al. Adipose-derived stem cells
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# 2017 Mutaz B. Habal, MD e793

Copyright © 2017 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.