Platelet-Rich Plasma Procedure: From Consultation to Follow-Up

Platelet-rich plasma has moved from locker rooms and research labs into mainstream clinics over the past decade. I first used PRP in orthopedic practice to help athletes with stubborn tendon injuries that failed rest, physical therapy, and anti-inflammatories. Since then, I have seen it support hair restoration, soften fine lines, and calm arthritic knees that bark with every staircase. It is not a miracle shot, and it should not be sold as one. When it is matched properly to a patient, performed with the right technique, and paired with realistic expectations, PRP therapy can tilt the odds toward healing and better function.

This guide follows the PRP procedure from the first consult to the last follow-up. The specifics vary by clinic and indication, yet the working principles hold steady across hair, joints, skin, and tendons.
What PRP Is, and Why It Matters
PRP starts with your own blood. A small sample is processed to concentrate platelets and plasma proteins, which carry the signal molecules your body uses to organize repair. Growth factors like PDGF, TGF-β, VEGF, and IGF sit inside those platelets. When activated at an injury or target tissue, they cue a sequence: reduce inflammation, recruit cells that build and remodel tissue, and nudge microcirculation to improve.

That is the core of how a platelet rich plasma injection works. It is not adding a drug. It is redistributing and concentrating your body’s natural healing tools at the right place for a longer time. There are several flavors of PRP, which is one reason treatment reviews range from thrilled to underwhelmed. The cellular composition, platelet dose, and application method matter as much as the hands that deliver it.
Who Is a Good Candidate
I screen for two things at the consult: does PRP have a plausible mechanism for this person’s condition, and are the logistics aligned with their goals and timeline. A few examples help.

Hair: PRP for hair loss makes the most sense for androgenetic alopecia in men and women with miniaturizing follicles and intact hair density patterns. The earlier you start, the better the odds. In scarring alopecias, PRP may be adjunctive, not primary. For widespread thinning after severe illness or postpartum telogen effluvium, I wait until shedding stabilizes.

Joints and tendons: PRP for knee pain from mild to moderate osteoarthritis can improve pain and function beyond a steroid shot, with benefits that often last 6 to 12 months. Patellar tendinopathy, lateral epicondylitis, and partial rotator cuff tears respond best when imaging shows degenerative, not full-thickness, change. A PRP shoulder injection has less value if there is a large full-thickness rotator cuff tear that needs surgical repair.

Skin: PRP facial rejuvenation, including PRP microneedling and the so-called vampire facial, leverages collagen stimulation for fine lines, acne scars, and texture. Expect a subtle lift, smoother pores, and better tone rather than a filler-like volume change. PRP under eye treatment can soften crepey skin and mild hollows, especially in younger patients or as maintenance after tear trough fillers.

Back pain: PRP for back pain is nuanced. Facet-mediated pain and sacroiliac joint pain may respond. Discogenic pain requires highly specialized intradiscal techniques best done in centers that do them routinely. Be wary of broad claims.

Medical history shapes green lights and red flags. Uncontrolled diabetes, active infection, severe anemia, platelet disorders, anticoagulants that cannot be paused, and systemic inflammatory diseases may reduce effectiveness or pose risk. If someone lives far away and cannot commit to avoiding anti-inflammatories or heavy training for a few weeks, I will often time the PRP differently or choose another option.
The Consultation: Setting Strategy and Expectations
A methodical consult saves disappointment later. I review prior treatments, imaging, and medications. For hair, I examine the scalp under magnification, map patterns, and check ferritin, thyroid function, vitamin D, and sometimes androgens. For joints, I correlate exam findings with X-ray or MRI to confirm the pain generator. For skin, I photograph baseline from consistent angles with good lighting and no makeup.

We discuss what PRP can and cannot do. A knee with grade 2 to 3 cartilage thinning might be a candidate for PRP joint injection and a series of two to three sessions. A knee with bone-on-bone changes may still gain some pain relief, but the effect size is smaller and the duration shorter. For PRP hair restoration, I explain that visible thickening usually appears at 3 to 6 months, with continued improvement through month 12, then maintenance sessions every 6 to 12 months. For PRP facial rejuvenation, most patients notice glow within 2 weeks and collagen effects accumulating over 3 months. Small steps, not overnight transformation.

We also compare PRP against alternatives. For skin, PRP vs microneedling without PRP, PRP vs fillers, and PRP vs Botox address different goals. PRP stimulates collagen and texture, fillers replace volume, neuromodulators soften dynamic wrinkles. They are complementary. For joints, PRP vs hyaluronic acid can be a toss-up in mild osteoarthritis, but PRP tends to outperform for pain relief at 6 to 12 months. For tendons, PRP generally outpaces steroid in long-term outcomes, though steroid may give short-term relief.
Preparation: What You Do Before the Visit
Hydration helps. A well-hydrated patient gives a smoother blood draw and better plasma yield. I also ask patients to avoid NSAIDs for at least 3 to 7 days before and after PRP, since these drugs can blunt platelet function. Acetaminophen is fine for discomfort. Heavy alcohol the night before can dehydrate and is best avoided. If you are on aspirin for cardiac reasons, we coordinate with your cardiologist to decide whether it is safe to pause.

For hair procedures, wash the scalp the morning of treatment and skip styling products. For facial PRP, arrive with a clean face and bring a hat or scarf to avoid sun right after. For joint or tendon injections, wear loose clothing that allows access to the area.
What Happens on Procedure Day
The PRP procedure itself is usually under an hour. It includes the draw, processing, and placement. Patients often say the anticipation is worse than the reality.

Blood draw: We draw between 15 and 60 milliliters depending on the target and the system. For a single small tendon injection, 15 to 20 ml may suffice. For a larger joint or a combined face and under eye session, 30 to 60 ml helps generate enough platelet rich fraction.

Processing: The tube goes into a centrifuge to separate red cells, a buffy layer with white cells, and plasma. This step is where technique and kit choice impact final composition.

Leukocyte-poor PRP contains fewer white cells and is often chosen for intra-articular injections and facial applications to reduce post-procedure inflammation.

Leukocyte-rich PRP includes more white cells and is sometimes preferred for tendon and ligament injuries where a brief stronger inflammatory cascade might be helpful.

The goal is a platelet concentration 3 to 6 times baseline. Very high concentrations are not always better, and the sweet spot differs by tissue. The processing time runs 5 to 15 minutes. Some systems also allow extraction of platelet-poor plasma for microneedling prp injection https://share.google/DsGkiUFzd6WOxUOmA glide or tear dilution.

Activation: Some clinicians add calcium chloride or thrombin to partially activate platelets right before injection. Others rely on collagen and thrombin in the tissue to trigger activation in situ. For joints and tendons, I usually do not pre-activate. For skin resurfacing or topical application, mild activation can improve clotting and retention on the surface.

Placement: Guidance matters. Ultrasound guidance is standard for tendon, ligament, and many joint injections to ensure the PRP lands where biology needs it. I rarely inject a rotator cuff or elbow without the ultrasound screen. For knees, ultrasound or fluoroscopy can be used; in experienced hands, a landmark-guided knee injection can be accurate, though I prefer ultrasound to confirm intra-articular placement and avoid fat pad infiltration. For the scalp and face, placement is superficial and spread across multiple sites to cover the planned field.

Anesthesia: For joints and tendons, I use a small amount of local anesthetic in the skin and along the track but avoid mixing anesthetic with PRP because it can dampen platelet activity. For scalp injections, a ring block makes the series of tiny injections tolerable. For microneedling with PRP, topical anesthetic applied for 20 to 30 minutes reduces discomfort.
Variations by Indication
PRP is a tool kit. The needle size, depth, volume, and treatment cadence change with the target.

Hair and scalp: PRP scalp treatment uses small aliquots, often 0.1 to 0.2 ml per injection spaced 1 to 1.5 cm apart across the thinning zone. I typically perform three sessions, four to six weeks apart, then reassess at month 4. Maintenance is every 6 to 12 months. Combining with minoxidil and, when appropriate, finasteride or dutasteride for men and oral minoxidil or spironolactone for women often improves outcomes. I warn patients about a transient shed in the first few weeks as follicles reset. That is common and not a sign of harm.

Facial skin: PRP for face can be delivered two ways. First, via injections to areas like the tear troughs, nasolabial seams, and lateral cheeks to support collagen and tone. Second, as PRP microneedling, where we glide PRP over the skin as the device creates microchannels to pull it in. The so-called platelet plasma facial or vampire facial is essentially microneedling plus PRP, not a different technology. Expect 24 to 72 hours of redness and mild swelling. Makeup can usually resume after 24 hours. Improvements in pore size, fine lines, and acne scars build over 3 months. For deeper acne scars, I pair PRP with fractional laser or subcision.

Under eye and fine lines: PRP under eye treatment can be helpful for crepe texture and mild hollows. I use cannula placement just above the periosteum in small volumes to reduce bruising. Results are subtle and safe. For more pronounced hollows, a hyaluronic filler remains the workhorse, with PRP as a biologic booster.

Joints: PRP knee injection protocols vary. I most often use leukocyte-poor PRP, 4 to 6 ml intra-articular, one to three sessions spaced 2 to 4 weeks apart for osteoarthritis. For younger athletes with chondral defects, I sometimes add a post-injection offloading plan and targeted strength work. For PRP for shoulder pain from rotator cuff tendinopathy, a peritendinous injection under ultrasound targets the critical zone. For elbow tendinopathy, I fenestrate the degenerative portion and pepper in PRP along the tendon origin. Back pain requires careful selection, since facet, SI joint, or disc sources each require different approaches.

Tendons and ligaments: PRP for tendon injuries and ligament sprains works best after the acute inflammatory phase, when degeneration is present. The technique is not just a single bolus. I often combine dry needling of the degenerative tissue to stimulate bleeding and then inject PRP into and around the abnormal fibers to saturate the region.
Pain, Downtime, and Realistic Recovery
For most PRP procedures, soreness, stiffness, and mild swelling are normal for 24 to 72 hours. A knee may feel heavy and full. A tendon can be more tender than before. The face will look flushed after microneedling, with sandpapery texture for a couple of days. Scalp injections can make sleeping uncomfortable the first night.

The right aftercare is simple. Avoid NSAIDs for a week. Favor gentle movement to circulate synovial fluid in a joint. For tendons, I use a staged load progression that starts with isometrics and graduates over two to six weeks depending on the site. For hair and face, stay out of the sun for 48 hours and skip sauna and hot yoga for a day or two. Keep the skin clean and moisturized. Do not wash the scalp for 24 hours after hair PRP, then resume normal routine.

People often ask how long PRP lasts. For joints with osteoarthritis, pain relief commonly lasts 6 to 12 months, sometimes longer. Some patients repeat annually. For hair regrowth, once a series is complete, maintenance once or twice a year is typical. For facial PRP, I recommend a series of two or three, then maintenance every 6 to 12 months depending on goals and age.
Safety, Side Effects, and When to Avoid PRP
PRP uses your own blood, so allergic reactions are rare. The main risks are procedural. Bruising is common, especially on the face or with anticoagulants. Infection is uncommon when sterile technique is used, less than 1 percent in my experience. Nerve or vessel injury is rare but underscores why guidance and anatomy knowledge matter.

A short list of situations where I pause or avoid PRP:
Active infection or skin condition at the site. Platelet disorders, severe thrombocytopenia, or active cancer under treatment without oncologist input. Uncontrolled diabetes or significant immunosuppression. Pregnancy, not because PRP is proven harmful, but because we avoid elective injections. Inability to stop certain blood thinners, when bleeding risk outweighs benefit.
Most side effects are manageable: transient soreness, swelling, a flair of tendon pain for several days, scalp sensitivity, or temporary headache. For facial PRP, hyperpigmentation is rare if you avoid sun and follow gentle skincare. For hair, shock shedding resolves as follicles shift into a growth phase.
How Much PRP Costs and Why Prices Vary
PRP procedure cost has a wide range. Geography, physician training, equipment, and indication contribute. In the United States, small joint or tendon injections run roughly 500 to 1,200 dollars per session. Larger joints might be 700 to 1,500. Hair treatment sessions often land between 700 and 1,500. PRP facial or PRP microneedling ranges from 500 to 1,000 per session. Packages drop the per-session price.

A higher price does not guarantee better outcomes, but dirt-cheap offers tend to cut corners. Ask what system is used, how many platelets are in the final product, whether the clinic uses ultrasound guidance for musculoskeletal injections, and how many sessions are planned. A clear plan beats a one-off shot with no follow-up.
Technique Details That Influence Outcomes
Not all PRP is created equal. Three technical decisions matter.

Platelet dose and volume: Too dilute and you may not reach a therapeutic threshold. Too concentrated and you might overshoot and provoke a harsh inflammatory response, especially in joints. Most data cluster around 3 to 6 times baseline platelet concentration. For knees, 4 to 6 ml of leukocyte-poor PRP is a common sweet spot.

Leukocytes: Leukocyte-rich PRP can be useful for tendons, but it may irritate synovial tissue inside a joint. For osteoarthritis, I choose leukocyte-poor. For chronic tendinopathy, I often favor leukocyte-rich.

Guidance: Ultrasound or fluoroscopy improves accuracy. Despite arguments about “experienced hands,” even seasoned clinicians see better needle placement with real-time imaging. Accuracy translates to consistency.

The best PRP injection methods are also practical. Minimize local anesthetic in the target zone. Place PRP at the tissue interface where biology can respond. Respect tissue planes to avoid post-procedure flares that come from intrafascial or intrafad pad deposition.
Layering PRP with Other Treatments
PRP is rarely the entire plan. In joints, combine with targeted physical therapy to restore strength, alignment, and motor control. For knee osteoarthritis, address hip abductor strength and calf mobility to reduce joint load. For shoulder tendinopathy, scapular stability and rotator cuff endurance reduce recurrent strain.

For hair, pair PRP with minoxidil, low-level laser therapy, and nutrition optimization. Consider anti-androgens for women when appropriate. Platelet therapy for hair performs better when follicles are supported from multiple angles.

For skin rejuvenation, balance PRP with neuromodulators for dynamic lines and hyaluronic acids for volume. For acne scars, add subcision or fractional laser to break tethering and leverage PRP for healing. PRP for hyperpigmentation is a modest helper, not a primary therapy, but it can improve overall skin glow and tolerance of other procedures.
What a Typical Course Feels Like
A 42-year-old runner with patellar tendinopathy that has nagged for a year after a downhill marathon decides on PRP after months of therapy. Under ultrasound we find a hypoechoic zone at the proximal tendon. We dry needle the area and inject 3 ml leukocyte-rich PRP. The next week is sore. By week three, pain quiets with stairs. At six weeks, we load eccentrics and isometrics. At three months, he runs easy hills, pain 1 out of 10. He repeats a light PRP top-up at six months when ramping mileage.

A 34-year-old woman with early diffuse thinning and strong family history of hair loss schedules three PRP scalp treatments. We space them one month apart. She continues oral minoxidil 1.25 mg daily and iron supplementation to correct low ferritin. She sheds more at week two after the first session, then stabilizes. At month four, we see thicker caliber hairs in the part line and less scalp show. She bumps to maintenance every 8 months.

A 58-year-old with mild to moderate knee osteoarthritis dislikes steroid rebounds and wants a longer runway. We choose two PRP knee injections, three weeks apart, leukocyte-poor, 5 ml each. She has stiffness for two days after each. At month two, she reports better sleep and can walk 30 minutes without resting. The effect holds for a year, then we repeat ahead of a hiking trip.

A 46-year-old with fine periorbital lines and acne scars on the cheeks undergoes PRP microneedling at settings adjusted for each region. Three sessions, six weeks apart. She schedules Botox for crow’s feet two weeks after session two. Her skin looks brighter within two weeks of each procedure, and scar depth softens several months later.
What to Ask Your Provider
A brief checklist helps you separate marketing from medicine.
What type of PRP is used here, and what platelet concentration do you target for my condition? For my joint or tendon, will you use ultrasound guidance, and do you perform these injections routinely? How many sessions do you recommend, and how will you judge progress between them? What should I avoid after treatment, and what is the specific rehab plan for my case? What are the expected benefits, the best-case and typical timelines, and the plausible reasons it might not work for me? What the Evidence Says, Cautiously Read
The PRP literature is large and mixed. In osteoarthritis of the knee, multiple randomized trials and meta-analyses favor PRP over saline and often over hyaluronic acid for pain and function at 6 to 12 months. Tendinopathy trials show benefit in some sites, like lateral epicondylitis and patellar tendinopathy, when protocols standardize technique. For rotator cuff disease, results are better for partial tears and tendinopathy than for full-thickness tears.

In aesthetics, PRP for skin rejuvenation has small studies and consistent clinical experience suggesting improved texture, pore size, and fine lines, particularly when combined with microneedling. For hair, several controlled studies report increased hair count and shaft thickness in androgenetic alopecia with series-based treatment plans.

The gaps: heterogeneous protocols and variable platelet dosing make it hard to compare studies. Many trials are small. The take-home from the evidence and from clinical life is straightforward. Match the indication to the biology, choose the right PRP formulation, and commit to a reasonable course with structured follow-up.
Follow-Up: Measuring What Matters
No PRP plan is complete without follow-up. We document baseline, set targets, and revisit at defined intervals.

For joints and tendons, I track pain scales, function scores, and objective tasks, like single-leg sit-to-stand counts or timed walking. For knees, a 20 to 30 percent improvement at 6 to 8 weeks is a good sign that the trajectory will continue. For tendons, we look for increased load tolerance and fewer morning start-up pains.

For hair, standardized photos, hair part width, and sometimes trichoscopy metrics keep us honest. Patient perception matters but can be confounded by styling and lighting. I schedule photos in the same chair, lighting, and camera distance.

For skin, consistent lighting and angles show texture change. We also discuss skincare routines, sun habits, and any adjuncts since these influence maintenance.

If PRP underperforms, we reassess the diagnosis, tweak the protocol, or pivot. It is better to change course than to repeat the same session without effect.
Final Thoughts From the Clinic
PRP occupies a practical middle ground between pills and scalpels, a minimally invasive procedure that taps your own biology. It is not one-size-fits-all. The best outcomes I have seen follow a pattern. We choose the right patient and indication. We dose platelets appropriately and place them accurately. We time the series properly and support the tissue with the right stress, not zero stress. And we keep score at follow-ups, not just take a victory lap after one shot.

If you are weighing PRP for orthopedic pain, hair restoration, or facial rejuvenation, find a clinic that treats PRP as a clinical process, not a commodity. Ask pointed questions. Expect clear aftercare and a plan. Your blood can do a lot of healing work. Your plan should help it get there.