Tissue Eng Part B Rev. 2017 Feb;23(1):83-99. doi: 10.1089/ten.TEB.2016.0233. Epub 2016 Oct 10.
Platelet-Rich Fibrin and Soft Tissue Wound Healing: A Systematic Review.
Miron RJ1, Fujioka-Kobayashi M1,2,3, Bishara M4, Zhang Y5, Hernandez M1, Choukroun J6.
Author information:
1 Department of Periodontology, Nova Southeastern University , Fort Lauderdale, Florida.
2 Cranio-Maxillofacial Surgery, Bern University Hospital , Inselspital, Bern, Switzerland .
3 Department of Oral Surgery, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan .
4 West Bowmanville Family Dental , Ontario, Canada .
5 Department of Oral Implantology, University of Wuhan , Wuhan, China .
6 Pain Clinic , Nice, France.



The growing multidisciplinary field of tissue engineering aims at predictably regenerating, enhancing, or replacing damaged or missing tissues for a variety of conditions caused by trauma, disease, and old age. One area of research that has gained tremendous awareness in recent years is that of platelet-rich fibrin (PRF), which has been utilized across a wide variety of medical fields for the regeneration of soft tissues. This systematic review gathered all the currently available in vitro, in vivo, and clinical literature utilizing PRF for soft tissue regeneration, augmentation, and/or wound healing. In total, 164 publications met the original search criteria, with a total of 48 publications meeting inclusion criteria (kappa score = 94%). These studies were divided into 7 in vitro, 11 in vivo, and 31 clinical studies. In summary, 6 out of 7 (85.7%) and 11 out of 11 (100%) of the in vitro and in vivo studies, respectively, demonstrated a statistically significant advantage for combining PRF to their regenerative therapies. Out of the remaining 31 clinical studies, a total of 8 reported the effects of PRF in a randomized clinical trial, with 5 additional studies (13 total) reporting appropriate controls. In those clinical studies, 9 out of the 13 studies (69.2%) demonstrated a statistically relevant positive outcome for the primary endpoints measured. In total, 18 studies (58% of clinical studies) reported positive wound-healing events associated with the use of PRF, despite using controls. Furthermore, 27 of the 31 clinical studies (87%) supported the use of PRF for soft tissue regeneration and wound healing for a variety of procedures in medicine and dentistry. In conclusion, the results from the present systematic review highlight the positive effects of PRF on wound healing after regenerative therapy for the management of various soft tissue defects found in medicine and

Facial Plast Surg. 2009 Nov;25(4):270-6. doi: 10.1055/s-0029-1242033. Epub 2009 Nov 18.
Applications of platelet-rich fibrin matrix in facial plastic surgery.
Sclafani AP1.
Author information:
Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary, New York, New York 10003, USA.



Platelet concentrates enjoyed some clinical popularity in facial plastic surgery several years ago. However, interest waned
due to expense, amount of blood required, equipment, space, and staff needed, and lack of clinically significant benefit. A
novel, simple method of preparing an autologous platelet derivative (Selphyl; Aesthetic Factors, Princeton, NJ) allows rapid
and inexpensive generation of a platelet-rich fibrin matrix (PRFM) that can be used to enhance healing after facial procedures
as well as to rejuvenate the face without tissue manipulation. PRFM provides autologous, natural, but concentrated platelet
growth factor release and stimulation of surrounding tissue. This article describes its use for cosmetic facial applications.
PMID: 19924600 [Indexed for MEDLINE



J Cosmet Dermatol. 2010 Mar;9(1):66-71. doi: 10.1111/j.1473-2165.2010.00486.x.
Platelet-rich fibrin matrix for improvement of deep nasolabial folds.
Sclafani AP1.
Author information:
Division of Facial Plastic Surgery, The New York Eye & Ear Infirmary, New York, New York 10003, USA.



Dermal augmentation continues to grow as an aesthetic facial procedure. Many exogenous filler materials rely on an autologous
fibrotic response for volume augmentation.
To evaluate the efficacy of a single injection of autologous platelet-rich fibrin matrix (PRFM) for the correction of deep nasolabial
folds (NLFs).
Whole blood was obtained from 15 adults, and an activated autologous PRFM produced using a proprietary system (Selphyl;
Aesthetic Factors, Inc., Wayne, NJ, USA) was then injected into the dermis and immediate subdermis below the NLFs. Subjects
were photographed before and after treatment; NLFs were rated by the treating physician before and after treatment using the
Wrinkle Assessment Scale (WAS) and patients rated their appearance at each post-treatment visit using the Global Aesthetic
Improvement Scale. Patients were evaluated at 1, 2, 6, and 12 weeks after treatment.
All patients were treated to maximal (no over-) correction, with a mean reduction in WAS score of 2.12 +/- 0.56. At 1 week after
treatment, this difference was 0.65 +/- 0.68, but rose to 0.97 +/- 0.75, 1.08 +/- 0.59, and 1.13 +/- 0.72 at 2, 6, and 12 weeks after
treatment, respectively (P < 0.001). No patient noted any fibrosis, irregularity, hardness, restricted movement, or lumpiness.
PRFM can provide significant long-term diminution of deep NLFs without the use of foreign materials. PRFM holds significant
potential for stimulated dermal augmentation.



Aesthetic Plast Surg. 2015 Aug;39(4):495-505. doi: 10.1007/s00266-015-0504-x. Epub 2015 Jun 5.
Platelet Preparations for Use in Facial Rejuvenation and Wound Healing: A Critical Review of Current Literature.
Sclafani AP1, Azzi J.
Author information:
Department of Otolaryngology, Weill Cornell Medical College, 1305 York Avenue, 5th Floor, New York, NY, 10021, USA,

Comment in
– Use of Platelet Preparations in Facial Rejuvenation and Wound Healing Remains Unproven. [Aesthetic Plast Surg. 2016]



In facial plastic surgery, the potential for direct delivery of growth factors from platelet preparations has been of particular
interest for use in facial rejuvenation, recovery after facial surgery, and wound healing. A literature search was conducted
through PubMed for the terms PRP, PRFM, platelet-rich plasma, platelet-rich fibrin matrix, platelet preparations, platelet
therapy, growth factors, platelet facial, platelet facial rejuvenation, platelet wound healing, platelet plastic surgery. Articles
pertaining to the use of platelet preparations in facial surgery and wound healing in plastic surgery after 2001 were included.
Thirteen in vitro studies showed use of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) had a significant
effect on cellular activity. Twenty-four out of 28 animal studies exhibited favorable results with use of a platelet preparation,
including five of six studies that showed enhanced fat graft survival with addition of a platelet preparation. Twenty-three
case series and clinical trials were identified, only two of which showed no differences. Twenty-one reported favorable
results with use of various platelet preparations. A total of 47 studies used PRP, four studies evaluated Leukocyte-rich PRP,
and fourteen studies used PRFM. The vast majority of studies examined show a significant and measurable effect on cellular
changes, wound healing, and facial esthetic outcomes with use of platelet preparations, both topical and injectable. One must
also consider possible publication bias against null results that may have had an influence on the data that were available for
review. However, the preponderance of studies suggests that platelet preparations might represent an as-of-yet untapped
adjunct in facial plastic surgery.

PMID: 26044392 [Indexed for MEDLINE]


Cicione, Claudia, Giuseppe Di Taranto, Marta Barba, Maria A. Isgrò, Alessio D’Alessio, Daniele Cervelli, Fabio V. Sciarretta, Sandro Pelo, Fabrizio Michetti, and Wanda Lattanzi. 2016.
»In vitro validation of a closed device enabling the purification of the fluid portion of liposuction aspirates.«
Plastic & Reconstructive Surgery, April

Gentile P, Scioli MG, Orlandi A, and Cervelli V. 2015.
»Breast Reconstruction with Enhanced Stromal Vascular Fraction Fat Grafting.«
Plast Reconstr Surg – Glob Open. 3 (6), June

Condé-Green A, Kotamarti VS, Sherman LS, Keith JD, Lee ES, Granick MS, Rameshwar P. 2016.
»Shift toward Mechanical Isolation of Adipose-derived Stromal Vascular Fraction: Review of Upcoming Techniques.«
Plast Reconstr surgery Glob open. 4 (9), September

Sciarretta, F. 2013.
»Adipose tissue stromal vascular fraction: A new method for it’s regenerative application in one step chondral defect repair.«
Journal of Science and Medicine in Sport 16 (62)

Sciarretta, FV, and C Ascani. 2015.
»Adipose Tissue and Progenitor Cells for Cartilage Formation.«
Sports Injuries: Prevention, 10. June


Aesthetics (face)

Park Byung-Soon, Kyoung Ae Jang, Jong-Hyuk Sung, Jeong-Soo Park, Yong Hyun Kwon, Kea Jeong Kim, and Won-Serk Kim. 2008.
»Adipose-Derived Stem Cells and Their Secretory Factors as a Promising Therapy for Skin Aging.«
Dermatologic Surgery 34 (10), 4. July.

Dhong, Eun-Sang, Na-Hyun Hwang, Deok-Woo Kim, Gangaraju Rajashekhar, Brian
H. Johnstone, and Keith L. March. 2012.
»Morphologic Changes in Photodamaged Organotypic Human Skin Culture After Treatment of Autologous Adipose-Derived Stromal Cells.«
Journal of Craniofacial Surgery, May: 805-811.

Wei, Hua, Shi-Xing X Gu, Yi-Dan D Liang, Zhi-Jie J Liang, Hai Chen, Mao-Guang G Zhu, Fang-Tian T Xu, Ning He, Xiao-Juan J Wei, and Hong-Mian M Li. 2017.
»Nanofat-Derived Stem Cells with Platelet-Rich Fibrin Improve Facial Contour Remodeling and Skin Rejuvenation after Autologous Structural Fat Transplantation.«
Oncotarget 8 (40), 5. September 5

Spiekman M, van Dongen JA, Willemsen JC, Hoppe DL, van der Lei B, Harmsen MC. 2017.
»The power of fat and its adipose-derived stromal cells: emerging concepts for fibrotic scar treatment.«
J Tissue Eng Regen Med. 4 (7), 3. February

Gentile, Pietro, Barbara Angelis, Mehtap Pasin, Giulio Cervelli, Cristiano Curcio, Micol Floris, Camilla Pasquali, et al. 2014.
»Adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical evaluation for cell-based therapies in patients with scars on the face.«
J Craniofac Surg. 25 (1), January

Spiekman, Maroesjka, Ewa Przybyt, Josée A A Plantinga, Susan Gibbs, Berend van der Lei, and Martin C Harmsen. 2014.
»Adipose Tissue-Derived Stromal Cells Inhibit TGF-β1-Induced Differentiation of Human Dermal Fibroblasts and Keloid Scar-Derived Fibroblasts in a Paracrine Fashion.«
Plastic and Reconstructive Surgery 134 (4), 3. October

Park B, Kim W. 2017.
»Adipose-Derived Stem Cells and Their Secretory Factors for Skin Aging and Hair Loss.«
Farage M., Miller K., Maibach H. (eds) Textbook of Aging Skin. Springer.

Borovikova AA, Ziegler ME, Banyard DA, et al. 2018.
»Adipose-Derived Tissue in the Treatment of Dermal Fibrosis.«
Ann Plast Surg. 1, January

Aesthetics (hair)

Park B, Kim W. 2017.
»Adipose-Derived Stem Cells and Their Secretory Factors for Skin Aging and Hair Loss.«
Farage M., Miller K., Maibach H. (eds) Textbook of Aging Skin. Springer.

Park, Byung-Soon, Won-Serk Kim, Joon-Seok Choi, Hyung-Ki Kim, Jong-Hyun Won, Fumio Ohkubo, and Hirotaro Fukuoka. 2010.
»Hair Growth Stimulated by Conditioned Medium of Adipose-Derived Stem Cells Is Enhanced by Hypoxia: Evidence of Increased Growth Factor Secretion.«
Biomedical Research 31 (1), February

ADIPOSE / PRF references and abstracts


Int Wound J. 2017 Feb;14(1):112-124. doi: 10.1111/iwj.12569. Epub 2016 Feb 1.
The regenerative role of adipose-derived stem cells (ADSC) in plastic and reconstructive surgery.
Naderi N1,2, Combellack EJ1,2, Griffin M3, Sedaghati T3, Javed M1,2, Findlay MW4, Wallace CG5, Mosahebi A3,6, Butler PE6,
Seifalian AM3, Whitaker IS1,2.
Author information:
Reconstructive Surgery & Regenerative Medicine Group, Institute of Life Sciences (ILS), Swansea University Medical School,
Swansea, UK.
Welsh Centre for Burns & Plastic Surgery, ABMU Health Board, Swansea, UK.
UCL Centre for Nanotechnology and Regenerative Medicine, University College London, London, UK.
Plastic & Reconstructive Surgery, Stanford University Medical Centre, Stanford, CA, USA.
Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, Exeter, UK.
Department of Plastic Surgery, Royal Free NHS Foundation Trust, London, UK.



The potential use of stem cell-based therapies for the repair and regeneration of various tissues and organs offers a paradigm
shift in plastic and reconstructive surgery. The use of either embryonic stem cells (ESC) or induced pluripotent stem cells
(iPSC) in clinical situations is limited because of regulations and ethical considerations even though these cells are theoretically
highly beneficial. Adult mesenchymal stem cells appear to be an ideal stem cell population for practical regenerative medicine.
Among these cells, adipose-derived stem cells (ADSC) have the potential to differentiate the mesenchymal, ectodermal and
endodermal lineages and are easy to harvest. Additionally, adipose tissue yields a high number of ADSC per volume of tissue.
Based on this background knowledge, the purpose of this review is to summarise and describe the proliferation and
differentiation capacities of ADSC together with current preclinical data regarding the use of ADSC as regenerative tools in
plastic and reconstructive surgery.

PMID: 26833722


Methods Mol Biol. 2018;1773:107-122. doi: 10.1007/978-1-4939-7799-4_9.
Adipose-Derived Stromal Vascular Fraction Cells and Platelet-Rich Plasma: Basic and Clinical Implications for Tissue Engineering Therapies in Regenerative Surgery.
Gentile P1,2, Cervelli V3.
Author information:
Department of Plastic and Reconstructive Surgery, University of Rome «Tor Vergata», Rome, Italy.
Catholic University, Tirane, Albania.
Department of Plastic and Reconstructive Surgery, University of Rome «Tor Vergata», Rome, Italy.



Cell-based therapy and regenerative medicine offer a paradigm shift in regard to various diseases causing loss of substance or volume and tissue or organ damage. Recently, many authors have focused their attention on mesenchymal stem cells for their capacity to differentiate into many cell lineages. The most widely studied types are bone marrow mesenchymal stem cells and adipose derived stem cells (ADSCs), which display similar results. Based on the literature, we believe that the ADSCs offer advantages because of lower morbidity during the harvesting procedure. Additionally, platelet-rich plasma can be used in this field for its ability to stimulate tissue regeneration. The aim of this chapter is to describe ADSC preparation and isolation procedures, preparation of platelet-rich plasma, and the application of ADSCs in regenerative plastic surgery. We also discuss the mechanisms and future role of ADSCs in cell-based therapy and tissue engineering.

PMID: 29687384


Rev Laryngol Otol Rhinol (Bord). 2007;128(4):255-60.
[The relevance of Choukroun’s platelet rich fibrin (PRF) during facial aesthetic lipostructure (Coleman’s technique): preliminary results].
[Article in French]
Braccini F1, Dohan DM.
Author information:
AP-HP Hôpital Albert Chenevier-Henri Mondor, Département de Chirurgie Orale, 40 Rue de Mesly, 94000 Créteil, France.



To evaluate the interest of fibrin PRF clots, a concentrate of platelets and immune factors, for the optimization of the adipocyte graft according to the technique of facial lipostructure described by S. Coleman.
Between May 2005 and June 2006, 32 patients (7 men and 25 women) benefited from a Coleman lipostructure with the use of PRF. The average age was 59 years (39 to 72 years). Lipostructure was used alone in 22 patients and associated with a face lift and/or a blepharoplasty in 10 patients. Before the adipocyte graft, a mixture of PRF and greasy supernatant (resulting from the purification of the sample of adipocytes) is deposited on the zones to be grafted in the same way as for lipostructure. For 2 patients, the pretreatment of the site to be grafted with PRF was unilateral. Patients were followed-up for one year.
In this series, all the patients were satisfied with the result with minimal associated resorptions. No massive resorption requiring a resumption of lipostructure was noted. In the 2 patients treated with unilateral use of PRF, one notes a light asymmetry, the hemi-face treated with PRF appearing more stable than the side without PRF. No important residual oedema or echymosis were seen on the 3rd post-operative week.
By offering a matricial support to angiogenesis and by stimulating the proliferation of pre-adipocytes, the PRF could have a beneficial role on the cicatrization and the consolidation of an adipocyte graft. Further studies are necessary to validate the interest of the PRF during aesthetic lipostructures. The potential uses in plastic surgery of such a biomaterial, easy and fast to produce, without any overcost and with no risk, are very numerous and require from now on to be tested and validated methodically.


Stem Cell Res Ther. 2015 Nov 5;6:215. doi: 10.1186/s13287-015-0217-8.
Adipose tissue-derived mesenchymal stem cells and platelet-rich plasma: stem cell transplantation methods that enhance stemness.
Tobita M1, Tajima S1, Mizuno H2.
Author information:
Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 1138421, Japan.
Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 1138421, Japan.



Because of their ease of isolation and relative abundance, adipose-derived mesenchymal stem cells (ASCs) are a particularly attractive autologous cell source for various therapeutic purposes. ASCs retain a high proliferation capacity in vitro and have the ability to undergo extensive differentiation into multiple cell lineages. Moreover, ASCs secrete a wide range of growth factors that can stimulate tissue regeneration. Therefore, the clinical use of ASCs is feasible. However, the potential of ASCs differs depending on the donor’s medical condition, including diseases such as diabetes. Recent studies demonstrated that ASCs from diabetic donors exhibit reduced proliferative potential and a smaller proportion of stem cell marker-positive cells. Therefore, to ensure the success of regenerative medicine, tissue engineering methods must be improved by the incorporation of factors that increase the proliferation and differentiation of stem/progenitor cells when autologous cells are used. Platelet-rich plasma (PRP), which contains high levels of diverse growth factors that can stimulate stem cell proliferation and cell differentiation in the context of tissue regeneration, has recently been identified as a biological material that could be applied to tissue regeneration. Thus, co-transplantation of ASCs and PRP represents a promising novel approach for cell therapy in regenerative medicine. In this review, we describe the potential benefits of adding PRP to ASCs and preclinical and clinical studies of this approach in various medical fields. We also discuss the mechanisms of PRP action and future cell-based therapies using co-transplantation of ASCs and PRP.
PMCID: PMC4635588 Free PMC Article