Problems after PRP: Bruising, Infection, Risk of Vascular Occlusion and Safety Precautions

What problems can occur after PRP?

PRP involves injecting plasma that is prepared from your own blood and enriched with platelets into the scalp or the skin. For the procedure itself and what to expect, see our article “PRP (Platelet-Rich Plasma)”. This article focuses on problems that can appear after the procedure.

Because your own blood is used, the risk of allergy is considered low. However, the idea that it is your own blood and therefore without risk is not correct: hygiene and technical errors at each stage, from drawing the blood to preparing and injecting it, can cause problems.

How long do pain, swelling and bruising last?

You may feel stinging, aching and tenderness during and after the injection. In the first hours, redness, mild swelling and tightness in the treated area are usual. After treatment of the scalp, there may at first be a feeling of fullness and a mild headache.

• Redness: usually decreases the same day or the next day.
• Swelling: may be more noticeable in areas where the skin is thin, such as around the eyes; it usually goes down within a few days.
• Bruising: small bruises at the needle points that fade over time, turning yellow-green. It may be more noticeable in people taking blood thinners or certain supplements.
• Bruising at the blood-draw site: may appear on the arm where the blood was taken and goes away on its own.
• Dizziness or feeling faint: can occur especially while blood is being drawn, in people who have not eaten or who are afraid of needles.

For how swelling and bruising develop and how to reduce them, see our article “Bruising and Swelling”. If bruising and swelling do not decrease over the days but instead increase, let your physician know.

How can you recognise an infection after PRP?

Every injection opens a small pathway in the skin through which germs can enter. In addition, blood can become contaminated if it is left standing in the open outside laboratory conditions or processed with non-sterile equipment. Signs of infection usually start a few days after the procedure:

• Pain, redness and warmth that steadily increase
• Swelling that grows instead of going down
• Pimple-like, pus-filled bumps or discharge at the injection points
• Fever, chills, fatigue

Some types of infection can appear weeks later as persistent red-purple bumps and may not respond to ordinary treatments. For details, see our article “Infection after Aesthetic Treatments”. Do not start antibiotics on your own; the physician should decide on the diagnosis and treatment.

Can HIV or hepatitis be transmitted through PRP?

With a treatment carried out under the right conditions, using single-use sterile equipment and only your own blood, this risk is not expected. The risk arises in settings where equipment is reused, tubes are not labelled and hygiene rules are not followed.

In a report published in 2024, the U.S. Centers for Disease Control and Prevention (CDC) described a cluster of HIV infections linked to PRP treatments with microneedling, commonly known as vampire facials, at a beauty spa operating without a licence. The investigation found that some parts that should have been single-use were wiped with alcohol and reused, that unlabelled blood tubes were stored in the same fridge as food and that no client records were kept. The report stresses that HIV transmission through cosmetic injections had not been documented before.

This incident shows how decisive it is where and how the treatment is carried out, rather than PRP itself. Similar risks also apply to other blood-borne infections such as hepatitis B and hepatitis C.

Can PRP in the face cause vascular occlusion and loss of vision?

Yes, although very rarely. The medical literature has reported patients who developed irreversible loss of vision due to blockage of the eye’s artery immediately after PRP injections into the face, especially between the eyebrows (the glabella). In one case, blockage of blood vessels in the brain was also seen. Some of these reports state that the injection was performed by people who were not physicians.

A systematic review bringing these cases together stated that all reported cases of vision loss were linked to PRP injections into the face, and that there were no cases linked to PRP in the scalp or to superficial microneedling. The exact cause (the volume injected, the speed of the injection or other factors that trigger clotting) has not yet been clarified.

The warning signs are similar to those of vascular occlusion after filler: sudden problems with vision, eye pain, whitening of the skin or a purplish discolouration spreading like a net. For details of these signs, see our article “After Fillers: When Is It an Emergency?”. There is one important difference: the dissolving enzyme used for hyaluronic acid fillers does not work for PRP, which is why prevention and getting emergency help quickly are especially important.

Normal, see your physician, or an emergency?

Are the risks of PRP the same for the scalp and the face?

No, the risks vary depending on the area. With PRP in the scalp, the most common problems are pain, tightness, a temporary headache and minor bleeding; no cases of vision loss have been reported for this area. Injections into the face, however, especially in areas whose blood vessels are connected to the vessels of the eye, such as between the eyebrows, around the nose and around the eyes, carry a risk of vascular occlusion, even if rare.

In methods where PRP is applied to the skin together with microneedling, the needling is not as deep as an injection; no cases of vascular occlusion have been reported. However, because this method also creates many small punctures, the most important safety condition is that the device tip and all equipment are sterile and single-use. In areas where the skin is thin, such as around the eyes, swelling and bruising may be more noticeable.

What can your physician do?

The physician will first examine you and ask when the procedure was done, on which area and under what conditions. Depending on the situation, they may consider the following approaches:

• For expected side effects: monitoring and advice on care.
• If an infection is suspected: if needed, taking a sample for culture and medication chosen by the physician; draining an abscess if present.
• If it is suspected that the treatment was carried out in a non-sterile setting or with reused equipment: testing for blood-borne infections and, if needed, referral to the relevant specialty.
• If vascular occlusion is suspected: urgent assessment and rapid intervention together with specialties such as ophthalmology and neurology.

What can you do at home, and what should you avoid?

• Follow the aftercare instructions your physician gives you; on the first day, do not touch or rub the area or wear make-up.
• If you need a painkiller, ask your physician which one you can use; some painkillers can increase bruising.
• Record any changes with the date and a photo; keep the name of the place where the procedure was done and the date.

Do not do the following:

• Unless your physician recommends it, do not massage the area or apply heat or ice.
• Do not squeeze or burst pimple-like bumps.
• Do not use antibiotics or steroid creams on your own.
• Do not stop or change your blood thinner on your own.

To reduce the risk

• Have the treatment done by a physician in a licensed healthcare facility; do not accept blood being drawn and processed in settings such as homes, hotels or hairdressers.
• Ask whether a single-use, sterile, closed-system kit is opened in front of you.
• Check that your name is written on the blood tube; make sure that the plasma prepared is yours.
• Ask whether the needle tip of the microneedling device is single-use.
• Tell your physician about blood thinners, supplements, blood disorders, cold sores and any active infection.
• If you are considering injections into the face, ask the physician about the vascular risk in this area and what will be done in an emergency.

When choosing where to have the treatment, our article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics” may be useful.

Where is scientific knowledge limited?

Methods of preparing PRP differ from centre to centre, and there are few large studies that systematically record side effects. Vascular occlusion and loss of vision are known only from case reports; how often they occur is not certain. For this reason, the expression very rare does not describe a rate but reflects the fact that current knowledge is limited. As new data become available, the recommendations in this article may also be updated; the soundest approach is to discuss every question you have with your physician before the procedure.