Platelet-Rich Fibrin in Facial Aesthetic Procedures: A Narrative Review of Healing and Rejuvenation Outcomes

Platelet-Rich Fibrin in Facial Aesthetic Procedures: A Narrative Review of Healing and Rejuvenation Outcomes

Author: Rodrigo M. Boos, DDS, MSc, EspHOF Affiliation: Independent Researcher Email: odonto33@gmail.com ORCID: 0009-0008-6302-1884

Abstract

The use of autologous platelet concentrates in facial rejuvenation and harmonization procedures has grown steadily over the past decade, driven by their low cost, biocompatibility, and lack of exogenous additives (1). Platelet-rich fibrin (PRF) — a second-generation platelet concentrate first described by Choukroun and colleagues (2) — releases mesenchymal cells, growth factors, and leukocytes at the application site, optimizing the tissue response to invasive and minimally invasive aesthetic procedures (3,4). When applied during the recovery period of procedures associated with edema, hematoma, pain, or infection, this optimized healing response has been reported to shorten recovery time and reduce the incidence of postoperative complications (5,6). This narrative review synthesizes evidence on PRF and its injectable form (i-PRF) as adjuvants in facial aesthetic recovery and rejuvenation, combining a foundational literature base (through 2021) with a structured update search (2022–2026) designed to test whether the field has since produced the long-term safety data and head-to-head comparisons the earlier literature lacked. Recent prospective studies using objective, ultrasound-based outcome measures corroborate the direction of effect reported by earlier clinician- and patient-rated studies, but the once-common claim that PRF is categorically superior to PRP is not supported by the best-available 2025 systematic evidence, which instead describes an indication-dependent trade-off between the two concentrates. Centrifugation protocol standardization remains an active area, with recent findings showing that equipment and consumables — not only nominal speed and time — materially affect the final product. Most consequentially, the absence of dedicated long-term (>12-month) safety data, already flagged by reviews published five years ago, persists in 2026 despite substantial growth in short-term efficacy literature; we identify this, together with a device-standardized head-to-head PRF-versus-PRP trial, as the field’s two highest-priority open studies.

Keywords: Platelet-rich fibrin; Injectable platelet-rich fibrin; Platelet concentrates; Facial rejuvenation; Wound healing; Aesthetic dermatology.

Introduction

Facial aesthetic and rejuvenation procedures have expanded steadily in both volume and technique, driven in part by increased spending on cosmetic care (7) and by a broader cultural investment in youthful facial appearance that extends even to dietary interventions marketed for skin outcomes (8). This expansion has not eliminated the tissue-level costs of intervention: recovery from facial aesthetic procedures can range from days to weeks, with recognized risks of edema, hematoma, pain, and infection (9). Reducing these costs — rather than the procedures themselves — is the specific problem this review addresses.

Autologous platelet concentrates have been proposed as an adjuvant to reduce this recovery burden. Platelet-rich fibrin (PRF), a second-generation concentrate obtained by centrifuging a patient’s own blood without anticoagulants or other additives, was first described by Choukroun and colleagues in France in the mid-2000s (1,2). Compared with first-generation platelet concentrates such as platelet-rich plasma (PRP), which require anticoagulants and gelling agents that can themselves provoke adverse tissue effects (4), PRF’s fully autologous composition has positioned it as a comparatively safe, low-cost, minimally invasive option (10,11).

Mechanistically, PRF forms a gelatinous fibrin matrix that confines growth factor secretion at the application site; fibroblasts recruited to this matrix reorganize it and initiate collagen synthesis (12,13). Platelet activation triggers a cascade of proteins involved in hemostasis, cell proliferation, extracellular matrix formation, angiogenesis, and chemotaxis (3,14) — the same signaling cascade that surgical injury itself activates, meaning PRF applied alongside a procedure concentrates and amplifies a regenerative response the body would otherwise mount more slowly and less predictably (15). An injectable form, i-PRF, obtained by altering the centrifugation protocol, has extended this mechanism into non-surgical and minimally invasive applications — including periorbital and nasolabial rejuvenation, dermal biostimulation, and scar treatment (4,16,17). This form is biologically distinct from whole blood, not merely more concentrated: i-PRF contains a higher proportion of lymphocytes and platelets than peripheral blood, and its three-dimensional matrix supplies monocytes and macrophages whose growth factors are specifically implicated in optimizing soft-tissue healing (18,19).

Two prior integrative reviews — Lins et al. (11) on orofacial aesthetic applications and Falcão et al. (20) on PRF in facial aesthetics and rejuvenation more broadly — synthesized this literature through 2021, both concluding that PRF shows consistent, favorable effects on healing and skin quality but that the evidence base was still young. That conclusion is now five years old. Given how quickly platelet-concentrate research has moved — a tenfold expansion in injectable-PRF-specific publications is documented over the following decade (21) — a synthesis limited to pre-2022 literature risks misrepresenting the current state of evidence, particularly on the two questions clinicians most need answered before recommending PRF to a patient: does it outperform PRP, and is it safe beyond the follow-up windows typically reported.

This review addresses that gap. We synthesize the foundational literature on PRF and i-PRF in facial aesthetic recovery and rejuvenation, verified against primary sources, and extend it with a structured search of literature published between 2022 and 2026 — explicitly testing whether the intervening years have produced (a) head-to-head comparisons against PRP, (b) refinements to centrifugation protocols, and (c) the long-term safety data that earlier reviews flagged as missing.

Methods

This is a narrative review, not a systematic review with formal risk-of-bias assessment; we describe our search strategy for transparency and to make its limits explicit rather than to claim PRISMA-level rigor. The review draws on two literature sets.

The first is a foundational set of primary studies on PRF, i-PRF, and related platelet concentrates published through 2021, originally assembled through a narrative search of PubMed, Google Scholar, and specialty facial-plastics and cosmetic-dermatology journals. Every reference in this set was re-verified against its primary source (publisher page, DOI resolution, and — where accessible — full text) as part of preparing this manuscript; corrections to publication year, author order, volume, or pagination identified during this verification are reflected in the reference list and noted where they affect a specific claim.

The second is a structured update search covering January 2022 through July 2026, conducted across PubMed, Google Scholar, Wiley Online Library, Cureus, MDPI journals, Periodontology 2000, the Journal of Cosmetic Dermatology, and Aesthetic Medicine, using combinations of the terms “platelet-rich fibrin,” “injectable PRF,” “i-PRF,” “facial rejuvenation,” “facial aesthetics,” “platelet-rich plasma comparison,” and “centrifugation protocol.” We prioritized randomized or prospective controlled studies, systematic reviews, and studies with objective outcome measures (e.g., high-frequency ultrasound skin-density measurement) over case series or expert opinion, and excluded studies whose primary source could not be independently verified — one candidate finding on PRF combined with nanofat grafting was excluded on this basis after its cited outcomes could not be traced to a locatable 2022–2023 primary study. We did not restrict inclusion to facial applications where a finding was mechanistically transferable from an adjacent tissue context (e.g., periodontal or oral surgical use of i-PRF), but we flag such cases explicitly in the text rather than presenting them as facial-specific evidence.

Discussion

Mechanistic and clinical evidence for PRF and i-PRF in facial healing and rejuvenation

The foundational literature is consistent on the direction of effect: PRF and i-PRF accelerate soft-tissue healing and improve markers of skin quality across a range of facial applications, from periorbital and nasolabial rejuvenation to acne-scar treatment and post-surgical recovery (3,5,6,16). What the 2022–2026 update search adds is not a new mechanism but better-measured evidence for the same one. Where the foundational studies relied largely on clinician- or patient-rated satisfaction, several recent prospective studies report objective, instrument-based outcomes: high-frequency ultrasound skin-density measurement has now been used across four independent studies to document statistically significant density gains after i-PRF or PRP-fraction injection in the forehead, periorbital, and cheek regions (22,23,24). A 2024 systematic review of seven studies (130 patients) found moderate, VISIA-confirmed improvement in skin texture, tone, and wrinkle depth after i-PRF injection, while explicitly characterizing the evidence as “promising but still limited” (25) — a hedge we adopt throughout this section rather than treat as resolved.

Two applications illustrate both the reach and the limits of the current evidence. First, i-PRF injection for superior sulcus hollowing — a periorbital indication not covered in the foundational literature — produced a statistically significant reduction in sulcus depth at three months in a 2026 cohort of 24 eyes, though the effect partially regressed by six months (26). Second, we searched specifically for evidence connecting PRF to three procedures the foundational literature named as promising adjuvant targets — polydioxanone (PDO) thread placement, submental liposuction, and subcision — and found none: 2022–2026 clinical studies pairing platelet concentrates with subcision use PRP, not PRF, and PDO+PRF material online is limited to clinic marketing content without a corresponding published study. These three applications should therefore be described as a research direction, not as evidence-supported indications, until dedicated studies exist.

A proposed hypothesis: PRF as an adhesion adjuvant in submental liposuction

Submental liposuction removes subcutaneous fat but does not itself create adherence between the overlying skin and the platysma and deep cervical fascia; standard practice manages the resulting potential space with external compression (chin straps, bandaging) for days to weeks while spontaneous fibrous adherence develops. We propose — as a theoretical hypothesis, not a tested indication — that intraoperative application of PRF to the undermined pocket could function analogously to a fibrin-based tissue adhesive, accelerating fibroblast-mediated re-adherence of the skin flap to the underlying tissue and potentially reducing reliance on prolonged external compression. This hypothesis draws on PRF’s established capacity to form a fibrin scaffold that recruits fibroblasts and organizes collagen synthesis at the application site (see “Mechanistic and clinical evidence,” above), not on any direct evidence for this specific indication — our structured search found none.

The closest supporting analogy comes from a mechanistically related but materially distinct biomaterial: commercial fibrin sealants (concentrated fibrinogen and thrombin, typically pooled or recombinant, not autologous) have reduced seroma formation and promoted flap adherence in anatomically comparable dead-space procedures, including a significant reduction in seroma rate in lipoabdominoplasty (3% versus 37% in controls) (27) and in latissimus dorsi flap donor sites (11.8% versus 35%) (28). These findings support the general principle that a fibrin-based matrix can promote adherence and reduce dead-space complications after a procedure that creates a subcutaneous cavity — but they were obtained with a different biomaterial. Commercial fibrin sealants combine concentrated, typically allogeneic or recombinant fibrinogen with added thrombin, producing rapid, dense clot formation; autologous PRF forms more slowly from the patient’s own unmodified blood and retains a cellular component (platelets, leukocytes) that fibrin sealants lack. The adhesive mechanism may not transfer directly, and whether PRF specifically improves skin-to-muscle adherence after submental liposuction has not, to our knowledge, been tested. We flag it here as a specific, testable hypothesis for future study, not as a supported application.

PRF versus PRP: a more nuanced comparison than the foundational literature suggested

The foundational literature framed PRF as categorically favorable to PRP, largely on mechanistic grounds — PRF’s autologous, additive-free composition and its capacity to secrete a greater number of growth factors (15). The 2022–2026 comparative literature complicates this. A field-wide systematic review across all of medicine (23 studies) found i-PRF outperformed PRP in 72% of included studies, with higher platelet concentration and more sustained growth-factor release (29) — a result that supports the mechanistic case but is not facial-specific. Within facial and periorbital applications specifically, the picture is closer to parity than superiority: a 2025 systematic review of 14 periorbital studies found PRF improved texture, wrinkling, and skin “crepiness” more than PRP, while PRP produced stronger and more durable results for hyperpigmentation, and concluded that current evidence does not support superiority of either method (30). An intra-patient randomized trial reached a similar conclusion by a different route: i-PRF showed a modest advantage over PRP only in the periorbital region and only at three months, with the difference disappearing by later follow-up (31). The clearest signal of PRF superiority we located is indication-specific rather than general: in acne-scar treatment, intradermal PRF produced “excellent” outcomes roughly five times more often than intradermal PRP (33.3% versus 6.7%) (32).

Taken together, the comparative evidence has moved from a mechanistic argument for PRF’s general superiority toward an indication-dependent picture in which PRF and PRP each outperform the other for specific outcomes. We treat this as a correction to the foundational literature’s framing, not merely an addition to it.

Centrifugation protocols: an active, and still unsettled, area of standardization

The relationship between centrifugation parameters and PRF composition was already established in the foundational literature: lower speeds and shorter times shift the product toward a liquid, platelet/leukocyte-rich preparation (i-PRF), while higher speeds and longer times produce a denser, more cellularly diverse matrix (200–400g for 5 minutes versus 400–700g for 8 minutes, respectively) (33) (Figure 4). A classification of named PRF variants by rotational speed and duration — leukocyte-rich PRF (L-PRF, 2,700 rpm/12 min), advanced PRF (A-PRF, 1,500 rpm/14 min), injectable PRF (I-PRF, 700 rpm/3–4 min), and concentrated growth factor (CGF, 2,400–2,700 rpm/12 min) — remains the reference framework we use in Table 1 (34).

Two developments since 2021 refine this picture rather than replace it. First, a decade-in-review of i-PRF documents continued evolution in isolation technique and in pre-injection handling (notably, cooling the preparation before injection), which the review frames as the most direct extension of the original low-speed centrifugation concept (21). Second, and more cautionary: a 2025 comparison across three centrifuge devices and three collection-tube types found that both equipment brand and tube material meaningfully altered fibrin characteristics and growth-factor release under otherwise identical speed/time protocols (35), and a 2026 ex vivo study found that shortening centrifugation time from 8 to 4 minutes at a constant low relative centrifugal force significantly increased leukocyte and platelet concentration (36). Read together, these findings mean that reporting rpm and minutes — the convention in Table 1 and in most facial aesthetic studies we reviewed — is not sufficient to guarantee a reproducible product across clinics; device and tube variables that are rarely reported in the facial aesthetics literature can be as consequential as the nominal protocol itself. We flag this as a methodological limitation of the field generally, not specific to any one study.

Combination with other biostimulators

Evidence on PRF combined with other injectable biostimulators is sparser and, where recent, still substantially dependent on older primary data. A 2024 case series (n=100) combining PRF with calcium hydroxyapatite (CaHA) as a dilution medium — rather than the manufacturer’s standard diluent — reported faster and more pronounced improvement in skin luminosity and quality, with no serious adverse events (37), and is the strongest direct 2022–2026 evidence for this theme. A broader 2024/2025 review synthesizes older findings that PRP combined with hyaluronic acid outperforms either agent alone, and that PRF combined with nanofat outperforms hyaluronic acid alone (32) — but the primary studies underlying those specific claims predate 2022 (notably two studies showing nanofat-derived stem cells combined with PRF improved facial contour remodeling and increased adipocyte longevity after autologous fat transplantation, an effect framed as protective against the visible skeletal thinning that can follow aggressive fat grafting alone (38,39)), so we cite this only as synthesis and context, not as new evidence. We were unable to verify, against a locatable primary source, a widely circulated claim of an 80-patient 2022–2023 study combining nanofat, PRF, and autologous fat transplantation; secondary sources describing it appear to conflate it with an unrelated 2017 study, and we have excluded it accordingly rather than propagate an unverifiable citation.

Safety and long-term outcomes: the gap that persists

This is the point on which the foundational and updated literature agree most starkly, and it is the central finding of this review. The foundational reviews through 2021 already flagged the absence of long-term safety data as the field’s main open question (11,20). Our structured 2022–2026 search found no systematic review, meta-analysis, or cohort study with follow-up beyond twelve months dedicated to PRF or i-PRF safety in facial aesthetic use. What exists instead is safety information reported incidentally, as a secondary outcome, inside efficacy studies with short follow-up windows — typically six months or less (26,30,32). Within that limited window, the signal is genuinely reassuring: reported adverse events are consistently mild and transient (localized pain, erythema, bruising), and we did not locate any 2022–2026 case report of a serious PRF-specific complication (granuloma, late-onset nodule, infection) in facial use — the serious-complication reports we found in this period involve PRP, not PRF. But reassuring short-term data is not the same evidence as long-term safety data, and five years after the foundational literature named this gap, it remains open.

Limitations

This review has several limitations that bear directly on how its conclusions should be used.

First, it is a narrative review conducted and screened by a single author, not a systematic review with independent duplicate screening, formal risk-of-bias assessment, or meta-analytic pooling of effect sizes. Studies were prioritized for methodological strength (randomized or prospective design, objective outcome measures) where possible, but the selection process itself carries a higher risk of selection bias than a PRISMA-conforming systematic review would.

Second, the 2022–2026 studies underlying the update search are predominantly small (typical sample sizes of 10–24 patients), a limitation the update search inherited rather than resolved. Statistically significant findings from underpowered single-center studies should be read as hypothesis-generating rather than confirmatory, even where — as with the ultrasound-based density studies — the outcome measure itself is objective.

Third, centrifugation parameters are reported inconsistently across the literature this review draws on: some studies report relative centrifugal force (g), others rotational speed (rpm) without the rotor radius needed to convert between the two, and — as discussed above — device and tube variables that affect the final product are rarely reported at all. Table 1 and Figure 4 should therefore be read as a reference framework, not as parameters guaranteed to reproduce identical outcomes across different equipment.

Fourth, and most importantly, this review cannot resolve the long-term safety question it identifies as the field’s central gap — no amount of synthesis substitutes for the dedicated long-term safety study that does not yet exist. Statements in this review about PRF’s safety profile should be understood as accurate within the follow-up windows actually studied (generally ≤12 months), not as a general safety claim.

Fifth, Figures 1 through 3 document the author’s own procedural technique for illustrative and pedagogical purposes; they are not a clinical case series with documented patient outcomes and should not be read as evidence of efficacy.

Sixth, the submental liposuction hypothesis proposed in the Discussion (PRF as an adhesion adjuvant) is the author’s own theoretical proposal, grounded in PRF’s known mechanism and in analogy to a materially different biomaterial (commercial fibrin sealant); it has not been tested with PRF in this indication and should be read as a direction for future research, not as a supported clinical application.

Seventh, the search was conducted in English, Portuguese, and Spanish-language sources within indexed databases; relevant findings published in other languages or in non-indexed regional journals may have been missed.

Conclusion

The evidence for PRF and i-PRF as adjuvants in facial aesthetic healing and rejuvenation has grown more precise, not more dramatic, since the foundational literature was last synthesized in 2021. Recent prospective studies using objective, instrument-based outcome measures — principally high-frequency ultrasound — corroborate the direction of effect the earlier literature reported by clinician and patient rating alone. At the same time, the comparative claim that PRF is categorically superior to PRP no longer holds: the best-available 2025 systematic evidence describes an indication-dependent trade-off rather than a general advantage for either concentrate. Centrifugation protocol standardization remains active, with 2025–2026 findings showing that equipment and consumables, not just nominal speed and time, materially affect the final product — a variable the facial aesthetics literature does not yet report consistently. Most consequentially, the absence of dedicated long-term safety data — already flagged by reviews written five years ago — persists into 2026 despite substantial growth in short-term efficacy literature. We recommend that PRF and i-PRF continue to be used within the evidence window actually established (adjunctive use, outcomes followed for up to twelve months) and propose two specific priorities for the field: a long-term (≥24-month) prospective safety study, and a device-standardized, head-to-head PRF-versus-PRP trial in facial aesthetic indications — the two studies whose absence this review’s search process makes concrete rather than merely asserts.

Acknowledgements

During the preparation of this work, a generative AI tool was only used for language editing and refinement. The tool was not used to generate the intellectual content, arguments, or conclusions.

Footnote

Reporting Checklist: Not applicable — this is a narrative review, not a systematic review or meta-analysis, so PRISMA does not formally apply; the search strategy is nonetheless described in the Methods section for transparency.

Data Sharing Statement: No original dataset was generated. The literature search strategy (databases, date ranges, search terms) is fully described in the Methods section to support reproducibility of the update search.

Funding: None.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form. The author has no conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Figures 1–3 document the author’s own procedural technique; no identifiable patient data is included.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/.

Abbreviations

• A-PRF: advanced platelet-rich fibrin
• CaHA: calcium hydroxyapatite
• CGF: concentrated growth factor
• DOI: digital object identifier
• HA: hyaluronic acid
• i-PRF: injectable platelet-rich fibrin
• L-PRF: leukocyte-rich platelet-rich fibrin
• ORCID: Open Researcher and Contributor ID
• PDO: polydioxanone
• PRF: platelet-rich fibrin
• PRP: platelet-rich plasma
• RCF: relative centrifugal force
• RCT: randomized controlled trial
• rpm: revolutions per minute

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Figures and Table

Figure 1. Blood collection for centrifugation. Source: Author’s personal collection (2021); © Rodrigo M. Boos, first published in this article. Reproduction permitted with attribution to the published citation of this manuscript in Healthtech Science Journal.

Figure 1

Figure 2. Detail of the collected material placement in the centrifuge. Source: Author’s personal collection (2021); © Rodrigo M. Boos, first published in this article. Reproduction permitted with attribution to the published citation of this manuscript in Healthtech Science Journal.

Figure 2

Figure 3. Aspiration of the platelet aggregate after centrifugation. Source: Author’s personal collection (2021); © Rodrigo M. Boos, first published in this article. Reproduction permitted with attribution to the published citation of this manuscript in Healthtech Science Journal.

Figure 3

Figure 4. Different centrifugation protocols and their results. Source: Adapted from Miron et al. (33), BMC Oral Health — published open access under CC BY 4.0 (BioMed Central’s standard license for all research articles), so reproduction with attribution requires no separate permission.

Figure 4

Table 1. Centrifugation protocols used for common PRF types. Source: Adapted from Kumar et al. (34), Indian Journal of Dental Advancements.

Note: Kumar et al. (34) also report protocols for T-PRF and AFG, not reproduced here as they fall outside this review’s scope. Values are reported in revolutions per minute (rpm) as in the source classification; relative centrifugal force (RCF, in g) depends on rotor radius and is not directly convertible without equipment-specific data (see Discussion, “Centrifugation protocols,” and Limitations).