“For some of our darker-skinned patients, we sometimes use picosecond technology, or fractional nonablative technology, in particular the thulium laser. Or we can add to the RF microneedling with a very super cial CO2 fractional laser with low energies. We have a unit (SmartXide Tetra, DEKA) that gives a high peak-power pulse, so it creates a thulium-like injury.”
Dr. Hesseler says, “We’re still learning a lot about PRP and other platelet-rich products. The real value of this treatment option is that it’s been shown to be beneficial, yet also quite safe.” With adjunctive PRP for acne scarring, he says, several studies reflect not only better acne scar improvements, but also less postprocedural symptoms and higher patient satisfaction.
Dr. Tanghetti counters that good postprocedural wound care might work at least as well as PRP in reducing downtime. Without knowing all the nuances of whether and how researchers optimized wound care in each study, he says, he doubts the efficacy of PRP in this regard.
One day, say Drs. Hesseler and Shyam, dermatologists may use adjunctive PRP in additional treatment combinations and for additional therapeutic targets. If there were more of a consensus regarding PRP terminology and techniques, says Dr. Hesseler, “then platelet-rich products would certainly be investigated with other procedures as well.”
All sources agree that more research is needed. Recently, Huang et al. performed a meta-analysis of 11 acne-scarring studies involving PRP, including eight studies analyzed by Hesseler et al. The meta-analysis showed that in aggregate, the risk ratio (RR) of achieving at least 50% improvement with adjunctive PRP was 1.93 (microneedling: 3.6; CO2 laser: 1.3), and the RR of achieving at least 75% improvement was 3.21 (microneedling: 3.9; CO2 laser 3.3).3
Drs. Hesseler, Shyam and Huang report no relevant financial interests.
Dr. Tanghetti is a consultant for Cynosure, DEKA, Quanta, Cartessa and Aesthetics Biomedical but owns no stock in these companies.
1. Hsieh TS, Chiu WK, Yang TF, Wang HJ, Chen C. A meta-analysis of the evidence for assisted therapy with platelet-rich plasma for atrophic acne scars. Aesthetic Plast Surg. 2019 Sep 10. doi: 10.1007/s00266-019-01471-w. [Epub ahead of print]
2. Hesseler MJ, Shyam N. Platelet-richplasma and its utility in the treatment of acne scars: a systematic review. J Am Acad Dermatol.2019;80:1730-1745.
3. HuangIH, Huang YC. Comment on “Platelet-rich plasmaand its utility in the treatment of acne scars: a systematic review.” J Am Acad Dermatol. 2019 Sep 19. pii: S0190-9622(19)32761-6. doi: 10.1016/j.jaad.2019.09.024. [Epub ahead of print]