The regenerative power of platelets has taken center stage with the impressive array of life-changing platelet-rich plasma (PRP) therapies available in today’s market. With innovations in platelet concentration therapy, next generation platelet-rich plasma therapies like PRF and PRFM treatments have emerged.
In recent years, PRF, also known as platelet-rich fibrin, has garnered the spotlight, with many claiming that PRF is superior because it’s a second-generation platelet concentrate. Most recently, the newest term being bandied about is PRFM (platelet-rich fibrin matrix), touted as the ultimate option for hair regrowth or the surgery-free facelift.
Which is the best option? The question we should be asking may not be that simple. We believe each has its own place in the regenerative medicine field.
The preparation of PRP involves spinning a sample of blood from the patient at high speeds in the centrifuge, isolating the red blood cells from the platelets. The resulting PRP solution contains almost pure platelet-rich plasma which can be effectively used for a wide variety of aesthetic and medical therapies.
Now, PRF and PRFM are both derivatives of PRP therapy. Similar to PRP, PRF and PRFM utilize the patient's own blood, but the processing method differs.
Obtained by centrifuging the blood without anticoagulants, PRF is an autologous blood product that results in a fibrin clot containing regenerative platelets. PRFM combines the benefits of the first two but utilizes a matrix or scaffold-like substance to maximize growth factors and platelet concentration while eliminating red blood cells and white blood cells.
While platelet concentration in PRP is higher than in either PRF or PRFM, preparation of PRP removes stem cells, white blood cells, and the other regenerative substances. In contrast, PRFM and PRF maintain a steady leukocyte count, which is helpful in providing other benefits when it comes to tissue and bone regeneration. With the addition of substances like calcium chloride, a PRP solution can be transformed into a fibrin matrix, which is what defines PRFM.
PRP extracts more liquid plasma, and thus more platelets can be extracted from any given blood sample. However, the greater longevity and concentration of platelets remaining trapped in the fibrin in the injected area using PRF makes it competitive in terms of results.
To understand the advantages and disadvantages of each, let’s look at their differences in processing and application.
In general, PRP extraction protocols can be divided into 2 parts as follows:1
At this point, you might be asking: Why use anticoagulants?
Anticoagulants play a crucial role in processing PRP. Sometimes blood samples can’t be processed immediately for various reasons, such as the availability of necessary equipment. In such a case, anticoagulants are necessary to keep the blood from clotting. Once blood starts clotting, the chances of deriving a workable PRP solution decrease. However, since these anticoagulants are considered additives and not derived from the patient.
Now let’s look at PRF processing. Unlike PRP, PRF is obtained by centrifuging blood without the use of any additives like anticoagulants. Without an anticoagulant, PRF forms a fibrin matrix gelatinous clot in the test tube. This fibrin matrix helps confine growth factor secretion to the injection site. Research also indicates that fibroblasts reorganize this fibrin matrix to promote collagen synthesis.3 The centrifugation speed is also much lower than that used for PRP, which is thought to protect cells from damage.
PRF and PRFM also contain a type of immune cell called leukocytes, which secrete signaling factors that encourage tissue repair and stem cell recruitment. PRP can be leukocyte-rich as well, though some clinicians prefer leukocyte-poor PRP under certain circumstances. In a recent study involving patients with osteoarthritis of the knee, the investigators observed no differences in the effects of leukocyte-rich and leukocyte-poor PRP.4
What does PRFM processing look like? It is a simple procedure similar to PRP processing:
At the end of the run, the Platelets and the Plasma will be on the top chamber of the tube and the red blood cells on the other end. Push the bottom of the tube to sequester the platelets and the plasma. The platelets will be sedimented at the bottom of the top chamber of the tube.
Using a 10 cc syringe with a long needle, remove about 6 cc of the Platelet-Poor Plasma (PPP) from the top chamber slowly (without shaking it) leaving 4 cc at the base. Keep this PPP available as it will be needed later.
Shake and mix the remaining 4 cc – this is the Platelet-Rich Plasma.
Load and prime another 10 cc syringe with the coagulation activator 0.08 cc 10% calcium chloride. (Take a 1 cc syringe marked off in tenths, fill up four out of five little tick-marks between 0 and the first tenth (0.1) mark and that’s 0.08 cc)
Draw the 4cc Platelet-Rich Plasma into the syringe with calcium chloride. Now, 4cc of PRFM has been obtained.
The PRFM can be injected intra-dermally using a 30-gauge needle or sub-dermally using a 27-gauge needle within 10 minutes – this is the time period that PRFM can remain in liquid form after coming in contact with calcium chloride.
Once injected, the combination of calcium chloride and body temperature will start the polymerization of Platelet-Rich Fibrin Matrix and a natural filler will be formed in the injected area.
Another major difference lies in the kinetics of PRP and PRF. With PRP, the initial release of growth factor occurs rapidly, which means earlier healing benefits. Kobayashi and colleagues compared PRP, PRF, and advanced PRF (A-PRF), and found that PRP released a significantly higher number of proteins at earlier time points compared to PRF and A-PRF. On the other hand, PRF displayed a steadier release of growth factors over the 10-day observation period.5
Some argue that the benefits of PRP, while rapid, are short-lived. But there are many studies demonstrating that this is simply untrue. In one study involving 31 patients with lateral epicondylitis, positive effects of PRP injections were seen even several years afterwards.6
Another study looking at the effect of PRP for osteoarthritis of the knee reported that 85% of patients had clinically meaningful improvements at their 6- and 12-month follow-up visits.7
The results from these studies show that PRP can be quite effective, even long-term.
A significant advantage of doing the PRFM facelift is the presence of growth factors in the fillers. These growth factors are natural substances in the body that are capable of triggering an increase in the production of endothelial cells and fibroblasts. This platelet-rich fibrin matrix is a 3-dimensional cross-linked fibrin matrix that binds both platelets and growth factors enabling a sustained release of growth factors over about seven days. The growth factors are one reason why micro pigmentation is recommended as part of the facelift – it triggers a healing response, and the influx of autologous growth factors accelerates and deepens the healing results.
PRFM and PRF treatments leverage the healing process by extracting the platelets and combining them in a platelet concentrate that is biocompatible with your cells. The resulting compound contains large amounts of growth factors, stem cells, and other essential cells needed for bone healing, hair growth, and other reconstruction.
The platelet-rich fibrin matrix (PRFM) is, by definition, an enhanced version of PRP believed to have superior quality in helping wound healing. PRFM has been effectively used in skin grafts as it can be made into a sheet form. In one study, the process of making PRFM was a continuation of PRP preparation, with 25 mM CaCl2 added into the PRP solution, followed by 1800 g centrifugation for 60 min. This PRFM creation method was a modification of the Fibrinet method, which obtained a coin-shaped sheet PRFM with a diameter of 30 mm.8
PRFM, when used in skin grafts, does show superior wound healing properties via a higher number of polymorphonuclear neutrophils (PMNs), which are the most abundant innate immune cells in the body and act as the first defense against infections – as well as a higher number of macrophage and fibroblasts compared to PRP. PRP also exhibits certain drawbacks, including its liquid or gel consistency that causes PRP to dissolve in surgical sites.
PRFM instead forms a scaffold that can assist the platelet concentrate to cluster around the injection site, gradually releasing growth factors and promoting prolonged tissue regeneration, which increases the efficiency of the platelet-derived growth factors released. The platelets stay in the treatment area longer, providing more extensive healing results when the fibrin membrane of the autologous platelet-rich fibrin solution is used, taking advantage of the longer lasting effects and more efficient growth factors.
PRFM treatments are ideal choices for skin rejuvenation, “facelifts,” and hair regrowth therapies, as the slow-acting release of growth factors ensures that the cells will still be stimulated in between treatments. More importantly, this also guarantees that the cells in the treatment receive additional support after the treatment is over - as the fibrin membrane can help keep the platelet concentrate in place longer for a more stable outcome.
So, is there a real difference between PRF vs PRFM? While the platelet concentration of both products is the same, it is primarily their applications that differ. Most often used for dentistry and light aesthetic work, PRF is more suitable for certain applications, while PRFM is most often used for hair regrowth and deep skin rejuvenation, including the “facelift” procedure PRFM is most widely known for.
PRF and PRFM therapy share similarities in how they can help with the regeneration of the skin, soft tissue, and even bone in targeted treatment areas. In many cases, PRF and PRFM can be used interchangeably depending on the discreti on of the treating physician and the expected results.
PRF therapy is often used in reconstructive and regenerative dentistry, as it can speed up the healing process and avoid common problems. In addition to its use in dentistry, PRF treatments are utilized in skin rejuvenation therapies. PRF can be used as an enhancement for facial filler and also function as an alternative to laser or heat-based treatments. By increasing the collagen production of the filler area, it can provide support between filler treatments.
Dr. PRP’s kit can be used to make PRFM (platelet-rich fibrin matrix) by adding calcium chloride. The PRF membrane in PRFM treatments is uniquely suited to treatments related to hair loss and regrowth. PRFM preserves platelet efficacy and allows for a more sustained release of growth factors (especially when combined with the buffy coat method of platelet extraction). PRFM treatments can increase collagen production and improve blood circulation throughout the treatment area, which provides the nutrients required for hair regrowth. PRFM is also extensively used in skin rejuvenation, especially in instances where the production of vascular endothelial growth factor is crucial for restoring lost volume to the skin. PRFM helps in the formation and maintenance of blood vessels and provides the essential proteins needed for healthier skin.
Table 1 - PRP, PRF, and PRFM Applications
EDTA, or ethylenediaminetetraacetic acid, is an anticoagulant used in the processing of PRP. It was once thought that EDTA shouldn’t be used because it could cause platelet activation and could damage the platelet membrane by platelet swelling.9 Instead, some clinicians used anticoagulants with citrate and dextrose of sodium citrate.10
One study compared the effects of EDTA to those of two other anticoagulants, heparin and A-form of acid-citrate-dextrose (ACD-A). The authors reported that while EDTA indeed caused significant platelet swelling and activation, it was more efficient than the others for inhibiting platelet aggregation and platelet collection. They also noted that the preparation of a well-suspended and homogenous PRP was much easier using EDTA. EDTA also yielded the highest number of platelets.11
Some have also expressed concerns that EDTA suppresses the regenerative activity of certain cells.12 However, it’s important to note that these findings were from in vitro studies. When used in an animal model, EDTA-anticoagulated PRP preparations in combination with adipose-derived stem cells showed no apparent adverse effects.13
So, with careful use, EDTA can be used to simplify and optimize your PRP preparation.
Yes, the same centrifuge can be used for PRP, PRF and PRFM – with PRFM requiring the addition of calcium chloride. The protocol provided by the manufacturer should be followed in any case.
The Dr. PRP centrifuge includes complete instructions for the development of PRP, PRF and PRFM. If you’re a physician who would like to further discuss the benefits of any of these options for your patients, call us at (844) 377-7787 (DR-PRP-US). We look forward to serving you.