Biologics·Jul 24, 2026
PRP outcomes live and die in the preparation and the delivery. These are the working protocols we recommend, based on published evidence and the operational lessons from hundreds of clinics.
Universal preparation targets
- Draw volume: 30–60 mL for MSK, 15–30 mL for aesthetic, 20–40 mL for hair.
- Anticoagulant: sodium citrate (ACD-A) preferred over EDTA for regenerative use.
- Target concentration: 4–7× peripheral platelet baseline.
- Leukocyte content: L-PRP for tendinopathy and wound; P-PRP for joints, aesthetics, hair.
- Activation: in situ for intra-articular and tendon; exogenous for aesthetic and hair delivery.
Orthopedic protocols
Knee osteoarthritis
- P-PRP, 4–5× concentration, 5–7 mL intra-articular under ultrasound guidance.
- 3 injections at 2–4 week intervals; assess at 3, 6, 12 months.
Lateral epicondylitis
- L-PRP, 5–7× concentration, 2–3 mL peri-tendinous with fenestration.
- Single injection; loading program from week 2.
Patellar tendinopathy
- L-PRP, 5× concentration, 2 mL under ultrasound with tendon fenestration.
- Single injection combined with eccentric loading.
Rotator cuff partial-thickness tears
- L-PRP, 5× concentration, 3–5 mL peri-tendinous and intrabursal.
- 2 injections 4 weeks apart; combine with graded loading.
Aesthetic protocols
Facial rejuvenation with microneedling
- P-PRP, 5–6× concentration, 4–6 mL topical delivery.
- Series of 3–4 sessions at 4-week intervals.
Under-eye rejuvenation (tear trough)
- P-PRP or PRP-PRFM, 1–1.5 mL total, deep injection at periosteal plane.
- Series of 3 at 4-week intervals; reassess for filler need only after series.
Facial injection (Vampire Facelift style)
- PRP-PRFM combined with HA filler for structural + biologic effect.
- Single session with 3-month reassessment.
Hair restoration protocols
Androgenic alopecia
- P-PRP, 6× concentration, 4–6 mL over affected scalp.
- Papular technique at 0.5 cm intervals into subdermal plane.
- Monthly ×3–4, then every 3 months for 12 months.
- Pair with topical minoxidil and, when indicated, oral finasteride/dutasteride.
Urologic protocols
Erectile dysfunction (P-Shot-style)
- P-PRP, 5× concentration, 5–10 mL distributed along penile shaft and glans.
- 2–3 sessions 4–6 weeks apart; often sequenced with LiSWT.
Peyronie's disease
- PRP into plaque combined with traction therapy.
- 3–5 sessions monthly; consider intralesional collagenase per stage.
Wound care protocols
- L-PRP or PRF matrix applied topically to wound bed.
- Weekly application in conjunction with standard wound care.
- Strongest evidence in diabetic foot ulcers and post-Mohs wounds.
Head-to-head with alternatives
- vs corticosteroid: slower onset, more durable outcome; no tendon weakening; superior at 6–12 months in most tendinopathies.
- vs hyaluronic acid intra-articular: superior for knee OA at 12 months in most 2023–2025 meta-analyses.
- vs bone marrow aspirate concentrate: BMAC delivers cells + growth factors; PRP delivers growth factors only. Choose PRP for cost and simplicity, BMAC for advanced degeneration.
- vs exosome serum: PRP is autologous and lower cost; exosomes may have advantages in aesthetic delivery and hair loss where dose control matters.
Sequencing with devices
- Microneedling + PRP: same session, PRP topical after channel creation.
- Dermal infusion + PRP: same session, PRP as infusion serum.
- ECSWT + PRP: shockwave first, PRP 48–72 hours later.
- HPLT + PRP: HPLT 15–30 min before to warm and vasodilate the field.
Common protocol failures
- No baseline platelet count — cannot calculate concentration multiple.
- Using EDTA-anticoagulated blood — impairs platelet function.
- Skipping ultrasound guidance for intra-articular and tendon work.
- Aggressive activity too early — the biologic needs a controlled loading environment.