Combined therapies with RF Combo Jector
ACE Conference 2025
AUTHOR:
Dr Jacek Nowak, PhD
dentist, aesthetic medicine doctor
Autologous fillers and platelet-rich fibrin can be an alternative to traditional volume restoration and volumetric treatments using hyaluronic acid. Discover their characteristics and the best indications for their use. Recommended by Jacek Nowak, MD, PhD, dentist, aesthetic medicine doctor, and masterclass trainer at Beautyeurope.eu.
The history of autologous treatments dates back to the 1950s, when a group of hematologists developed the concept of extracting the most valuable components from blood and using them for tissue regeneration. The term PRP (platelet-rich plasma) was first introduced in the mid-1950s to describe plasma with an increased platelet count, used clinically to treat thrombocytopenia. In the 1970s, plasma was used for transfusions in patients with platelet deficiencies, and in the 1980s–1990s it was introduced into dental, maxillofacial, and aesthetic surgery, as well as in grafting and wound healing therapies.
This method rapidly expanded into orthopedics and sports medicine (for muscle and joint injuries), and later, at the beginning of the 21st century, into dermatology, aesthetic medicine, and gynecology. Platelet-rich fibrin (PRF) appeared in 2001—Dr. Joseph Choukroun described it as a second-generation platelet concentrate, free of anticoagulants and containing a natural fibrin matrix.
The popularity of PRP in aesthetic medicine increased thanks to celebrities such as Kim Kardashian, who promoted the so-called “vampire facelift.” In subsequent years, fibrin and autologous fillers based on plasma and later fibrin were introduced into aesthetic practice.
Plasma vs. Fibrin
The concept of autologous treatments is based on obtaining, through centrifugation of the patient’s peripheral blood, a preparation rich in concentrated platelets. The most well-known and commonly used product is platelet-rich plasma (PRP). However, it is important to remember that PRP is an unstable product (which is why anticoagulants are used in “classic” PRP tubes). It is rapidly absorbed and provides an almost immediate “glow” effect and healthy, radiant skin. Therefore, in aesthetic medicine it is mainly used for anti-aging prevention and “event-ready” treatments.
Fibrin, on the other hand, thanks to its long-lasting three-dimensional structure, ensures prolonged release of growth factors and can be used for filling fine wrinkles or natural tissue augmentation. It does not require anticoagulants, and its effects are longer-lasting and intensify over time due to skin stimulation.
These products do not replace each other—each should be used according to patient indications, including in combination therapies.
It is also worth noting that, in addition to “standard” PRP, so-called second-generation plasma (PRP2) is available on the market—without a separating gel. By reducing centrifugation force, less plasma is obtained (3–4 ml vs. 5 ml in PRP1), but with a much higher concentration of growth factors (approx. 401 million platelets/ml vs. 13.8 million in PRP1). The absence of a separating gel reduces the risk of platelet damage. PRP2 can be injected deeper and is more suitable for skin with visible signs of aging.
Personally, my favorite products are autologous fillers such as Skin Up (plasma-based) and Skin Up Premium (fibrin-based), which additionally acts as an autologous stimulator with stem cells. I increasingly use autologous therapies—fibrin allows me to achieve very natural results while simultaneously regenerating the skin.
Autologous treatments are also an excellent way to prepare damaged, poor-quality skin for hyaluronic acid volumization, resulting in a more comprehensive and aesthetically pleasing outcome.
Autologous dressings (based on advanced fibrin, APRF) are also worth mentioning—they are used in wound treatment in dermatology and dentistry. My doctoral research in dentistry focused on the use of fibrin, including after surgical extraction of impacted third molars.
Growth Factor Network in Fibrin
The most valuable components of autologous preparations are growth factors contained in platelets. They are involved in all healing and tissue remodeling processes, affecting mesenchymal cell lines, inflammatory mediators, and processes such as angiogenesis, osteogenesis, and collagen production.
Fibrin is formed through fibrinogen polymerization, with cellular elements and growth factors trapped within its three-dimensional structure. This can be compared to a tightly woven fishing net holding fish—gradually unfolding the net releases them over time.
This highly active biochemical structure stimulates migration and proliferation of various cells, including fibroblasts, endothelial cells, and osteoblasts. Blood also contains mesenchymal stem cells (MSCs), which have significant regenerative potential.
Different centrifugation protocols allow for obtaining fibrin with varying consistency and growth factor content. However, the fundamental mechanism remains the same—gradual release of growth factors into the skin.
Key growth factors include:
- VEGF – strongly stimulates angiogenesis and nutrient supply
- PDGF – regulates cell migration and collagen production
- TGF-β1 – involved in immune modulation and wound healing
- IGF – promotes cell proliferation and faster healing
- bFGF – stimulates fibroblast activity
- EGF – supports angiogenesis and healing
Types of fibrin include:
- IPRF – liquid fibrin with the highest concentration of growth factors
- SPRF – structural fibrin with gradual release
- APRF – advanced fibrin used in wound care and dentistry
Autologous Fillers
Autologous fillers (biofillers, biogels) are gel-like preparations created through thermal processing of PRP or PRF. Platelet-rich fibrin is heated to 80°C and then cooled using specialized devices.
Using fibrin as a base (e.g., Skin Up Premium) provides better results than PRP due to higher platelet and growth factor content. The final product is a hybrid material consisting of:
- a fibrin-based gel providing volumizing and contouring effects while stimulating collagen and elastin production
- liquid fibrin rich in growth factors, promoting tissue regeneration
These components stimulate stem cells and fibroblasts, enhancing neovascularization and collagen synthesis. Importantly, since no anticoagulants are used, the procedure is virtually painless.
Autologous fillers do not last as long as hyaluronic acid fillers but are equally safe and provide natural results. They are particularly effective for tear trough correction, reducing dark circles, and improving skin thickness. They can also be used in the cheeks, jawline, marionette lines, and nasolabial folds.
Unlike hyaluronic acid, they do not bind water, so there is no risk of swelling—especially important in the under-eye area. No granulomas or chronic inflammation are observed.
These treatments are often chosen by patients seeking natural solutions, avoiding the “pillow face” effect or those intolerant to hyaluronic acid. They improve skin firmness, density, tone, and overall quality. They are also cost-effective.
Precautions
In addition to standard contraindications (pregnancy, breastfeeding, inflammation, cancer), limitations include conditions related to the patient’s blood, such as use of anticoagulants, autoimmune vascular diseases, or blood disorders. Proper hydration before the procedure is also essential.
The quality of tubes used is crucial. Certified medical-grade tubes ensure safety and optimal results, whereas diagnostic tubes may pose risks and reduce treatment quality.
Treatment Effects
Initial results include improved skin glow, tone, and texture. However, full remodeling and firming require time and repeated treatments. Effects typically last 3–6 months, with volumetric results at around 60–70% after 3 months.
For maintenance, treatments should be repeated 2–3 times per year.
Patients are highly satisfied with the natural rejuvenation achieved. When performed correctly with high-quality materials, complications are rare and usually limited to minor, temporary effects such as swelling or bruising.
Because the material is derived from the patient’s own blood, the procedure is immunologically safe.
