Platelet-rich plasma (PRP) therapy is a common treatment in aesthetic medicine for skin rejuvenation, hair regeneration and scar management. Its appeal lies in using the patient’s blood, reducing allergic risks while promoting natural tissue regeneration. However, similar to any medical intervention, PRP also has its side effects, which vary from mild to severe complications. Efficient management of unfavourable responses is important for patient safety, clinical credibility, and long-term trust.
This guide was developed with aesthetic practitioners in mind, which covers the management of PRP therapy complications from start to finish. Here, you will uncover actionable suggestions for how you can minimise PRP-related risks at every stage and maximise your patients’ results.
Understanding PRP Therapy and Potential Complications
With PRP therapy, we utilise the patient’s blood and separate the plasma through centrifugation, which is then injected back into areas that need treatment to improve collagen counts, increasing overall cellular repair. While PRP therapy is generally safe, some adverse reactions can arise due to biological and procedural factors.
Why do PRP complications occur? Occasionally, unfavourable reactions may result due to incorrect injection methods, contamination during preparation, or from a patient’s pre-existing health conditions. For instance, other products used with PRP treatment, especially topical anaesthetics may cause certain skin reactions. Additionally, in a more severe case, inexperienced practitioners may inject too deeply or in the wrong anatomical areas, causing nerve damage or vascular issues.
Thus, being certified with comprehensive and extensive PRP training is important. Proper PRP certification not only ensures that practitioners are well-versed in advanced techniques, but also equips them to manage complications efficiently, enhancing patient safety and trust.
Common Adverse Reactions in PRP Therapy
Mild and Common Reactions
- Pain or tenderness at injection sites: Pain should be minimal but is normal, especially in sensitive areas such as the scalp and under the eye. The swelling and pain generally subsides in a few hours or by the next day.
- Bruising and swelling: Bruising is caused by broken blood vessels during injection. Swelling is a normal response to injury, which can cause mild pressure pain and resolves within 3-7 days.
- Redness and inflammation: It is a normal immune response to any type of injury characterised by mild redness and inflammation near the injection site. Normally, inflamed areas would subside on their own within the day of treatment or by the next day.
Severe and Rare Complications
- Infection: Infections are rare but possible if the environment and apparatus used are not sterile. Symptoms include redness, swelling, and pus at the injection site. If not treated immediately, these infections may evolve into more serious complications like abscess formation or cellulitis.
- Allergic reactions: Although PRP injections do not cause allergies, topical anaesthetic creams and pre-procedural sterilising agents may provoke allergic responses. Symptoms can range from mild rashes to anaphylaxis.
- Vascular occlusion or nerve injury: Incorrect injections particularly in high-risk zones like the under-eye and nasolabial folds can block blood flow to these areas causing tissue damage (necrosis) or compromise nerve function.
- Granulomas: These are nodules or hard lumps that form as a result of prolonged inflammation, often requiring corticosteroid injections or surgical removal.
Immediate Management Strategies for PRP Complications
| Type of Complication | Management Strategy | Details |
| Mild Reactions (Initial pain, swelling, bruising, inflammation) | Analgesics | Use acetaminophen for pain relief; avoid NSAIDs (e.g., ibuprofen) as they inhibit platelet function, potentially reducing analgesic treatment efficacy. |
| Ice Application | Apply ice for 10-15 minutes to reduce swelling and discomfort immediately after the procedure. | |
| Elevation | Elevate treated areas, especially facial injections, to minimise swelling and improve fluid drainage when removing pus. | |
| Moderate Reactions (Prolonged mild reactions including skin discolouration) | Bruising | Use topical arnica or vitamin K creams to speed up healing. Inform patients that bruising typically resolves within a few days. |
| Prolonged Swelling | Apply cold compresses, prescribe short-term antihistamines, or recommend light lymphatic massage to reduce fluid retention. | |
| Prolonged Redness or Rash | Apply mild topical steroids or prescribe oral antihistamines if redness persists beyond normal post-treatment inflammation. | |
| Skin Discolouration | Advise patients to avoid sun exposure. Apply topical creams (e.g., hydroquinone) to address hyperpigmentation. | |
| Severe Complications | Infections | Initiate antibiotic therapy when infection is suspected. For abscesses, drainage may be required. Monitor for systemic signs such as fever or chills. |
| Vascular Occlusion | Look for signs like blanching, severe pain, or discolouration. Administer hyaluronidase (if fillers were involved), massage the area, and refer to a vascular specialist if needed. For more details on vascular occlusion management, please refer to the JCAD Aesthetic Complications Guidelines by The Aesthetic Complications Expert (ACE) Group.: King M, Walker L, Convery C, Davies E. Management of a Vascular Occlusion Associated with Cosmetic Injections. J Clin Aesthet Dermatol. 2020;13(1):E53-E58.Murray G, Convery C, Walker L, Davies E. Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion. J Clin Aesthet Dermatol. 2021;14(5):E61-E69. | |
| Nerve Damage | If patients report persistent numbness or tingling, refer them to a neurologist for further assessment and treatment. | |
| Anaphylaxis | Administer epinephrine immediately and call for emergency services. Ensure an EpiPen is available on-site for emergencies. | |
| Granuloma Formation | If granulomas (small nodules) form, treat with intralesional steroid injections or oral corticosteroids. Continue to monitor/follow up for resolution. | |
| Scarring | Advise patients to keep the area moisturised and protected from the sun. In severe cases, refer to a dermatologist for scar management therapies or consult for microneedling or laser treatment if the type of scar is feasible. |
Tip: Some patients may experience anxiety or dissatisfaction post-treatment. Provide reassurance, offer follow-ups, or recommend professional psychological support if needed.
Follow-Up Care and Monitoring
Active aftercare is an important part of managing side effects and offering the best results possible. Patients should return for a follow-up within 48–72 hours post-treatment for assessment of swelling, bruising and any other concerns.
Healthcare professionals should continue monitoring the patient on a bi-weekly basis to make sure that the recovery is on track, especially in cases of granulomas or nerve injury.
Reminder: Always encourage patients to communicate with you about their expectations regarding treatment outcomes, and also be open to patient reports of unexpected side effects e.g., delayed swelling that may develop days after the injection.
Educating Patients on PRP Complications
In the management of expectations and any subsequent complications, patient education is necessary. Practitioners need to inform patients about the risks, benefits and aftercare requirements before they go ahead with the procedure. Written instructions can help patients remember how to care for themselves at home.
Patient communication top tips:
- Educate your patients: Let them know that bruising, swelling or discomfort after treatment is normal and should resolve in about a week.
- Advising patients on what to expect and warning signs: Tell your patients the warning signs that may come with the treatment. For instance, if an infection occurs on their face and becomes too swollen, this can be a sign of something more concerning and they should get in touch with you as soon as possible.
- Post-procedure instructions: Avoid sweating, strenuous exercise, tanning, too much of sun exposure, and alcohol consumption for the first 24-48 hours to decrease swelling and bruising.
Best Practices to Prevent PRP Complications
The best way to deal with aesthetic complications is prevention.
Here are 3 key takeaways for good outcomes and safety of your PRP treatments:
- Eligibility criteria: Exclude patients with contraindications like autoimmune diseases, bleeding disorders or active infection.
- Keeping the environment sterile: Your equipment/apparatus and treatment area should always be sterile to minimise risks of infections.
- Training and certification: Ongoing education on PRP therapy helps to ensure that providers will be proficient in advanced injection techniques, which leads to fewer aesthetic complications.
To become a professional in PRP therapy, you can opt for a certified training programme by Acquisition Aesthetics UK, which provides a JCCP-approved certificate related to this at Birmingham, London, and Newcastle.
Here, we provide training specifically on Regen Lab PRP Systems, the only manufacturer of regulated medical devices for PRP selling directly to the UK market. With over 20 years of experience in the development of autologous preparations of PRP, this pioneering group is the market leader in terms of patented PRP technologies, practitioner and patient experience and ethical codes of conduct.
Legal and Ethical Considerations in PRP Complication Management
It is necessary to understand some legal-ethical points in the management of PRP complications.
This is important in defending both the patient and the practitioner. Before starting with PRP therapy, patients must be informed about the risks and complications of potential side effects.
For instance, recording the exact entries on all measures, such as assessments, diagnostic steps for patients, treatment methods employed in the clinic or other direct patient care settings, and complications as part of the documentation process in your clinic is important for legal protection.
It is the ethical responsibility of practitioners to inform patients about their complications and refer them as required. Be mindful that upholding high ethical standards strengthens trust and credibility in the long run for your clinic.
Conclusion
Managing complications from PRP therapy requires vigilance, proper manufacturer protocols, and effective patient-doctor communication. By understanding how to address adverse reactions, practitioners can enhance patient safety and ensure positive clinical outcomes and experience. Continuous education, patient transparency, and strict adherence to safety protocols are key to maintaining trust and minimising PRP risks.
Staying informed and up-to-date on the latest best practices will empower aesthetic practitioners to deliver safe, high-quality PRP treatments and handle complications with confidence. Get in touch with our friendly team today for more information on the Acquisition Aesthetics Platelet Rich Plasma (PRP) Training Course.
FAQs
- Is it normal to experience swelling after PRP therapy?
This is normal and the swelling should subside within a few days. However, you can apply ice to it, which will help to reduce the swelling.
- Can PRP cause infections?
The risk of an infection is extremely low, especially if one follows the given protocols. Giving antibiotics early can also help reduce infections.
- How long does it take to recover from PRP treatment?
Recovery usually takes 1 week, but depends on the individual.
- What should I do if my patient reports numbness after PRP injections?
If the loss of sensibility or numbness remains, this may mean that nerve damage may already occur. Please refer the patient to a neurologist for further evaluation.
