Platelet-Rich Plasma: An Endogenous Bioregulatory Modulator Coordinating Soft Tissue Remodeling.

BACKGROUND: Platelet-rich plasma (PRP) has emerged as a major focus in soft-tissue repair in recent years, with its diverse biological functions supported by extensive experimental and clinical evidence. The biological activity of PRP extends beyond simple growth-factor delivery and is shaped by preparation heterogeneity.
METHODS: This review synthesized English-language evidence from PubMed/MEDLINE, Web of Science, and Google Scholar on PRP, platelet-rich fibrin, platelet-derived extracellular vesicles, soft-tissue repair, scarring, fibrosis, angiogenesis, macrophage polarization, mitochondrial transfer, stem/progenitor cells, adipose grafting, facial rejuvenation, and aesthetic soft-tissue remodeling, with literature considered up to March 2026.
RESULTS: Current evidence indicates that PRP may influence several stages of soft-tissue remodeling, including inflammatory and immune regulation, angiogenesis and redox balance, extracellular matrix deposition and degradation, and endogenous tissue regeneration. Mechanistic findings link these effects to macrophage phenotypic modulation, TGF-β/Smad signaling, vascular reconstruction, matrix metalloproteinase activity, mitochondrial transfer, and regulation of tissue-resident stem or progenitor cells. However, PRP is not a single standardized biological product; platelet concentration, leukocyte content, activation method, fibrin architecture, release kinetics, delivery route, and distinctions among conventional PRP, PRF, and PRP-derived extracellular vesicles may substantially affect biological behavior and clinical interpretation.
CONCLUSIONS: PRP may be best understood as a context-dependent, platelet-derived bioregulatory system that modifies the local tissue microenvironment rather than as a simple volumizing or growth-factor supplement. Its potential relevance to scar revision, fat-graft retention, wound-related contour irregularity, post-inflammatory stiffness, and facial rejuvenation supports further standardized clinical studies with clearly reported formulations and outcomes.
LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .