Microneedling with Platelet-rich Plasma

Compare To Other Treatments

Compared to many other scar revision treatments, microneedling with PRP poses a low risk of side effects. The charts below show the chances of developing various side effects from this procedure.1-4 For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Pain*up to 100%
SHORT TERM Bleeding/oozing from wound**up to 100%
SHORT TERM Transient redness (erythema)†up to 29%
SHORT TERM Swelling immediately after procedure (edema)‡up to 19%

*Pain: Microneedling causes temporary pain or a burning sensation.

**Bleeding/oozing from wound: Bleeding or oozing from the wound is normal after microneedling with PRP and stops when a crust forms on the skin.

†Erythema: Mild skin redness after microneedling with PRP is normal and usually disappears after 2-3 days.3,4

‡Edema: Swelling after microneedling with PRP is normal and should disappear after 2-3 days at most.3,4

Possible/Rare Side Effects

SHORT TERM Acne flare-upup to 10%
SHORT TERM or LONG TERM Skin darkening (post-inflammatory hyperpigmentation)*up to 8%
SHORT TERM Burning sensationup to 5%
SHORT TERM Bruising or swelling of clotted blood inside skin (hematoma)up to 2%
SHORT TERM or LONG TERM Milia (small, raised, white bumps on the skin)**Less than 1%

*Post-inflammatory hyperpigmentation (skin darkening): This percentage is based on a single study.1 Other studies do not report any hyperpigmentation. In general, needling may carry a lower risk of post-inflammatory hyperpigmentation compared to other scar revision procedures. Post-inflammatory hyperpigmentation is more common in darker-skinned people.

**Milia (small, raised, white bumps on the skin): This side effect is based on a single study where one patient developed milia.1 Other studies do not report that microneedling with PRP causes this adverse effect.

Studies:   

Four studies have looked at the side effects of microneedling with PRP.

  • Study 1:

    • Authors: Asif et al.1
    • Total # of patients: 50
    • # of female patients: 25
    • # of male patients: 25
    • Age of patients: 17-32
    • Treatment: Microneedling with PRP
    • PRP: Isolated plasma was applied after microneedling as intradermal injection
    • Duration of treatment and follow-up: 3 treatments at 1-month interval, follow-up for 3 months
    • Side effects:
      • Postinflammatory skin darkening (hyperpigmentation): 8%
      • Acne flare-up: 2%
      • Bruising: 2%
      • Milia: 1%
      • Persistent erythema: less than 1%
  • Study 2:

    • Authors: Porwal et al.2
    • Total # of patients: 27
    • # of female patients: 16
    • # of male patients: 11
    • Age of patients: 18-40
    • Treatment: Microneedling with PRP
    • PRP: Isolated plasma was applied after microneedling as intradermal injection
    • Duration of treatment and follow-up: 3 treatments at 1-month interval, follow-up for 1 month
    • Side effects:
      • Swelling (edema): 28.85%
      • Redness (erythema): 19.23%
      • Postinflammatory skin darkening (hyperpigmentation): 5.77%
  • Study 3:

    • Authors: Ibrahim et al.3
    • Total # of patients: 35
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: 18-34
    • Treatment: Microneedling with PRP
    • PRP: Isolated plasma was applied after microneedling as intradermal injection
    • Duration of treatment and follow-up: 4 treatments at 3-week intervals, follow-up for 3 months
    • Side effects:
      • Post-treatment redness (erythema): incidence not reported
      • Post-treatment swelling (edema): incidence not reported
  • Study 4:

    • Authors: Amer et al.4
    • Total # of patients: 41
    • # of female patients: 28
    • # of male patients: 13
    • Age of patients: 20-40
    • Treatment: Microneedling with PRP
    • PRP: Isolated plasma was applied after microneedling as intradermal injection
    • Duration of treatment and follow-up: 4 treatments at 1-month intervals, follow-up for 1 month
    • Side effects:
      • Acne flare-up: 9.76%
      • Redness (erythema): 9.76%
      • Pain: 9.76%
      • Burning sensation: 4.87%

Study 1:  In a study published in 2016 in the Journal of Cosmetic Dermatology, Asif and colleagues performed skin microneedling + PRP on 50 patients with atrophic acne scars grade 2 to 4 classified based on Goodman’s Qualitative classification which grades scars from 1 to 4 based on their type, visibility, and depth. The patients received 3 sessions of treatment at 1-month intervals, and the researchers followed up with the patients for an additional 3 months. While the treatment was generally safe and well-tolerated, some patients experienced adverse effects. The most common side effect was postinflammatory hyperpigmentation (skin darkening). Patients who experienced this side effect were treated with topical 4% hydroquinone, a skin-lightening agent. At the 3 months post-treatment follow-up, no residual side effects were observed.1

Study 2: In a study published in 2018 in the Indian Journal of Dermatology, Porwal and colleagues treated 27 patients with atrophic scars with skin microneedling + PRP. All patients received 3 treatment sessions at 1-month intervals and were followed-up for 1 month after treatment. While no long-term side effects were reported, some patients experienced swelling and redness which disappeared a few days after the treatment.2

Study 3:  In a study published in 2018 in the Journal of Dermatological Treatment, Ibrahim and colleagues treated 35 patients with atrophic acne scars with skin microneedling and PRP. Each patient received 4 sessions of treatment at  3-week intervals and was followed up for 3 months after the last treatment. Side effects included post-treatment swelling and redness, but the exact number of patients who developed these side effects was not reported by the authors.3

Study 4:  In a study published in 2020 in the journal of Dermatologic Therapy, Amer and colleagues treated 41 patients with acne atrophic scars with skin microneedling + PRP.  The patients received 4 treatment sessions at intervals of 1 month and were followed up for another 1 month. Patients experienced mild-to-moderate post-treatment side effects such as redness, pain, and burning sensation. Four patients had an acne flare-up.4

References
  1. Asif M, Kanodia S, Singh K. Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol. 15(4), 434-43 (2016).
  2. Porwal S, Chahar YS, Singh PK. A Comparative Study of Combined Dermaroller and Platelet-Rich Plasma Versus Dermaroller Alone in Acne Scars and Assessment of Quality of Life Before and After Treatment. Indian J Dermatol. 63(5), 403-8 (2018).
  3. Ibrahim MK, Ibrahim SM, Salem AM. Skin microneedling plus platelet-rich plasma versus skin microneedling alone in the treatment of atrophic post acne scars: a split face comparative study. J Dermatolog Treat. 29(3), 281-6 (2018).
  4. Amer A, Elhariry S, Al-Balat W. Combined autologous platelet-rich plasma with microneedling versus microneedling with non-cross-linked hyaluronic acid in the treatment of atrophic acne scars: Split-face study. Dermatol Ther. 34(1), e14457 (2021).

Relevant Forum(s):