Comparing the Efficacy and Safety of PRP and PRF on Periorbital Skin Quality: A Randomized Split‐Face Clinical Trial

ABSTRACT Background Infraorbital area significantly affects perceived age and patient quality of life. Although regenerative treatments such as platelet‐rich plasma (PRP) are widely used for under‐eye, evidence comparing PRP with platelet‐rich fibrin (PRF) is limited. This study aims to compare PRP to PRF for periorbital area. Methods In this clinical trial, each participant randomly received PRP on one side and PRF on the contralateral side in three sessions. A tear‐trough‐based approach with sandwich technique was utilized. Outcomes were assessed at baseline, 3, 4, and 7 months using biometric indices (TEWL, melanin, erythema, elasticity parameters, colorimeter), standardized grading scales (hyperpigmentation, wrinkles, and hollowness, patient satisfaction scores), and ultrasonography. Statistical analysis was conducted with significance set at p < 0.05. Results Twenty‐four patients completed the study (mean age 40.71 ± 10.9 years; 95.8% female). TEWL and colorimeter decreased in both groups, without statistically significant differences between groups ( p > 0.05). Melanin and erythema demonstrated a consistent decreasing trend in the PRF group beginning at Month 3, whereas both indices paradoxically increased at Month 3 in the PRP group before declining thereafter. Sonographic parameters, POH grade, wrinkle grade at 3 and 4 months, and Allergan grade at 4 months improved significantly in both groups ( p < 0.05), with no significant differences between groups. Patient satisfaction increased in both groups and reached statistical significance between Months 3 and 4 ( p = 0.037). Both treatments were tolerated, with no major adverse effects. Conclusion Both PRP and PRF significantly improved periorbital hyperpigmentation, fine wrinkles, and mild hollowness. PRF demonstrated more stable reduction in melanin and erythema and showed earlier improvement in certain elasticity parameters. Neither treatment provided sufficient correction for severe hollowness. Repeated sessions every 3–4 months may be required to maintain results. Trial Registration Iranian Registry of Clinical Trials (IRCT): IRCT20200127046282N51