Platelet-Rich Plasma versus Platelet-Rich Fibrin in the Treatment of Periorbital Dark Circles: A Split Face Comparative Study

Background: Periorbital hyperpigmentation (POH) as a common cosmetic concern has multifactorial etiology and limited effective therapies. Platelet-rich plasma (PRP) widely been used for skin rejuvenation, whereas platelet-rich fibrin (PRF), that is a second-generation platelet concentrate, offers an option for sustained growth factor release and superior outcomes. The study aim was to compare the efficacy, safety, as well as patient satisfaction of PRP compared to PRF injections in the treatment of POH. Methods: A randomized controlled split-face study was performed on 37 patients with POH, the right infraorbital area received PRP and the left received PRF. Patients underwent three intradermal injection sessions at three-week intervals. Efficacy was evaluated at 10 weeks using clinical grading, therapeutic response, and patient satisfaction scales. Safety and tolerability were recorded, and patients were followed for 2 months. Results: Both treatments produced significant improvement compared to baseline (p=0.0001). PRF demonstrated superior outcomes, with higher regression of lesion grade (64.9% improved to grade 1 and 10.8% achieved complete clearance vs 8.2% grade 1 improvement with PRP; χ²=36.17, p=0.0001). Therapeutic response was significantly better with PRF (29.7% moderate, 16.2% good, 10.8% complete) compared to predominantly mild response with PRP (73.0%) (χ²=44.96, p=0.0001). Patient satisfaction was markedly higher with PRF, with 62.2% very satisfied versus none on the PRP side (χ²=38.4, p=0.0001). Conclusion: Both PRP as well as PRF are safe treatment modalities and effective for POH management. However, PRF demonstrated significantly superior clinical improvement and higher patient satisfaction, particularly in patients with moderate severity and lower eyelid involvement.