Recombinant Platelet-Derived Growth Factor-BB vs Platelet-Rich Plasma in Aesthetic and Regenerative Medicine: Mechanistic Standardization vs Biologic Heterogeneity

Abstract Platelet-rich plasma (PRP) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB) are both used in aesthetic medicine but have never been directly compared. They differ in origin, route of administration, and regulatory status, and neither is FDA approved for aesthetic use. This structured narrative review was reported in accordance with PRISMA 2020, PRISMA-S, and SWiM. PubMed was searched on May 5, 2026, using 4 strategies covering PRP/platelet-rich fibrin (PRF) in aesthetic, scar, and hair restoration applications; rhPDGF-BB/becaplermin in cutaneous wound healing; PRP preparation and reporting quality; and PDGF-related hair follicle biology. A total of 3667 records were identified, of which 36 met inclusion criteria. PRP had the broader aesthetic evidence base, with meta-analyses reporting hair density gains of ∼+25 to +40 hairs/cm2, but preparation and reporting were inconsistent, with only 12.1% of studies providing reproducible protocols and 26.6% reporting final product composition. Measured growth factor concentrations, including PDGF, did not consistently correlate with clinical outcomes. rhPDGF-BB provides defined dosing and benefit in diabetic wound closure (odds ratio, 1.53; 95% CI, 1.14-2.04), but aesthetic evidence is limited to controlled studies of 5 to 12 participants with follow-up of 6 months or less. No head-to-head aesthetic trials exist. PRP is supported by broader clinical experience, whereas rhPDGF-BB offers greater standardization whose aesthetic value remains unestablished. Because the agents are delivered by different routes to different populations, these findings describe parallel evidentiary paradigms rather than a comparison of interchangeable therapies. Standardization should not be interpreted as evidence of superior clinical efficacy. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.