Platelet rich plasma therapy has moved from professional sports training rooms and dermatology offices into mainstream clinics, and for good reason. Whether you are considering a platelet rich plasma injection for knee osteoarthritis, a PRP facial to boost skin texture, or scalp PRP therapy for hair regrowth, the treatment relies on your own blood. That autologous nature generally lowers risk compared with corticosteroid shots or filler, but it does not make PRP immune to side effects. Understanding what is expected, what is unusual, and what is an emergency will help you recover smoothly and spot problems early.
I have injected PRP for joint pain, tendon injury, acne scars, and hair restoration in a wide range of patients. The pattern is consistent across body areas, but the intensity of reactions varies with technique, concentration, and the target tissue. What follows blends published evidence with practical observations from clinic days and follow ups, including the questions patients text at 10 p.m. when their knee throbs more than they expected.
What PRP is doing under the surface
PRP is a concentrate of platelets suspended in a small volume of plasma. Platelets carry growth factors, cytokines, and bioactive proteins that signal healing. When injected into a knee, rotator cuff tendon, plantar fascia, or even the dermis of the face, those factors aim to nudge tissue toward repair, not mask symptoms. That difference matters for side effects. Steroids tend to quiet inflammation quickly, which is why a cortisone injection can feel like magic within 24 hours. PRP leans into early inflammation, which is why the first 48 to 96 hours often feel worse before they feel better.
The product itself varies. Single spin kits often produce 2 to 4 times baseline platelet concentration. Double spin systems can reach 5 to 7 times, and some leukocyte rich preparations bring more white blood cells along for the ride. Higher platelet doses may produce more pronounced early soreness. Leukocyte rich PRP can provoke more redness and swelling in superficial tissues like facial skin. None of that is inherently bad, but it sets expectations for short term reactions.
The most common side effects after PRP
Nearly every patient notices a combination of soreness, swelling, warmth, and stiffness around the injection site. The character depends on location.
Joint injections such as PRP injection for knees, hips, ankles, and shoulders often feel like a deep ache that peaks the evening of the procedure and the day after. In knees, many people describe a tight, full sensation, especially if a small volume of saline was added to deliver the platelet concentrate. Weight bearing can feel awkward for a day or two. An ice pack wrapped in a thin towel for 10 to 15 minutes at a time, a few times per day, usually takes the edge off.
Tendon and ligament injections, such as PRP for tennis elbow, plantar fasciitis, or a partial rotator cuff tear, can trigger a sharper, localized pain. This comes from both needle fenestration, when the doctor repeatedly passes a fine needle through the degenerative fibers, and the PRP itself. Expect “bruise-plus” discomfort for two to five days. Patients who sleep on the injected shoulder usually need a pillow change the first night.
Back pain injections into facet joints or around the sacroiliac joint tend to produce a dull, spreading soreness. Sitting for long periods may feel worse for 48 hours. Short, frequent walks help.
Scalp PRP therapy for hair restoration causes pinpoint bleeding that resolves quickly, followed by a tender scalp. A tight ponytail sensation is common for 24 to 72 hours, most noticeable when brushing or washing hair.
Facial PRP treatments come in a few flavors. Microneedling with PRP, sometimes called a PRP facial, yields sunburn-like redness that fades over two to three days, with mild swelling around the eyes and mouth. Direct PRP injection for face, including PRP under eyes, creates more localized puffiness and bruising that can last up to a week. Those tiny color shifts around the lower eyelids worry people, but they are usually mild and self limited.
Patients often ask about bruising. Because PRP is injected through the skin, bruises are a routine nuisance, especially around the eyes, lips, and hands. On joints and tendons, superficial bruises are less common but still occur. If you bruise easily or take blood thinners, expect more visible spotting.
A brief recovery guide for the first week
- Use cold packs in short intervals during the first 24 to 48 hours if swelling or throbbing bothers you. Skip anti inflammatory medications such as ibuprofen and naproxen for at least a week unless your doctor instructs otherwise. Acetaminophen typically is allowed for pain. Keep activity below symptom threshold. Short walks are better than long rests. Avoid heavy lifting or high impact exercise until your clinician clears you. Do not submerge the injection area for 24 hours. Showers are fine. Skip hot tubs for three days. For facial or microneedling with PRP, avoid makeup, retinoids, exfoliants, and unclean makeup brushes for 24 to 48 hours. Use bland moisturizer and mineral sunscreen.
The no anti inflammatory rule is one of the hardest for athletes and chronic pain patients. The rationale is straightforward. NSAIDs block prostaglandins that are part of the early healing cascade. We want that signaling to run its course. If you are on aspirin or blood thinners for a medical reason, coordinate with the prescribing doctor before scheduling PRP.
Side effects specific to common treatment areas
Not all tissues respond the same way, and expectations change with anatomy.
Knee osteoarthritis and cartilage wear respond with predictable stiffness. Swelling peaks by day two, then recedes. Patients with more advanced arthritis often need two to three sessions for best results, separated by two to six weeks. Some knees flare more after the second treatment than the first. People who have had a cortisone shot in the past sometimes expect the steroid pattern and worry when they do not get immediate relief. Setting the timing helps: PRP often begins to show clinical benefit between week two and week six.
Tendons and ligaments like the Achilles, patellar tendon, or lateral epicondyle are notoriously slow healers due to limited blood flow. A PRP induced flare can feel intense. Plan around it. If your job requires lifting or overhead motion, consider light duty for a week. For Achilles tendinopathy, the tendon may feel more stiff in the morning. Gentle range of motion before stepping out of bed tends to help.
Shoulder issues cover a spectrum. For partial rotator cuff tears and shoulder impingement, PRP may be injected into the tendon and/or the subacromial space. Expect night pain in the first 48 hours, especially if you are a side sleeper. A small pillow under the elbow to slightly open the shoulder joint can improve sleep. People with prior adhesive capsulitis are more prone to temporary stiffness, so your clinician may prioritize early guided mobility.
Spine and sacroiliac injections have a low but real chance of an inflammatory flare that radiates. Paresthesias, such as tingling down the leg, usually settle within a day as local irritation fades. If weakness or severe numbness appears, call immediately.
Scalp PRP for male pattern baldness and female hair loss has a unique minor effect pattern. A throbbing scalp after the anesthesia wears off is common. Some patients notice transient headache. Tiny crusts at needle sites flake off within a few days. Avoid hair dye for at least 72 hours to prevent irritation. If microneedling is combined with PRP, the redness can look more dramatic the first day, then calms quickly.
Facial PRP uses range from acne scar remodeling to under eye rejuvenation and PRP for fine lines. Under eye injections carry the most visible bruising risk because the tissue is thin and vessels are delicate. Swelling can be asymmetric, which makes mirrors less friendly for a couple of days. The puffiness almost always resolves. For PRP microneedling, people with darker skin tones should be screened for post inflammatory hyperpigmentation risk and prepped with a gentle plan. Most clinics moisturize and sun protect aggressively to limit pigment changes.
Uncommon but important risks
Because PRP is autologous, immune type reactions to the product itself are exceedingly rare. The risks that matter come from the act of injection, the local inflammatory response, and the context of your health.
Infection is possible whenever the skin is pierced. In high volume practices with sterile technique, the rate is low. I have seen two suspected infections in over a thousand musculoskeletal PRP sessions. They declare themselves with worsening pain after day three, not better pain; escalating redness that spreads; warmth that persists; and sometimes fever or chills. In a joint, infection presents with severe pain, inability to bear weight, and sometimes a feeling of pressure that does not release. If any of this happens, do not wait. Call the clinic and arrange evaluation. A joint infection requires urgent care.
Nerve irritation can follow close work around superficial sensory nerves. It feels like tingling, numbness, or sharp electric zings near the injection line. Most cases are transient neurapraxia from local irritation and settle within days to weeks. Rarely, a small cutaneous nerve can be nicked. In the elbow region, careful mapping helps avoid the lateral antebrachial cutaneous nerve. Around the knee, the infrapatellar branch can surprise even experienced hands. Time and gentle desensitization techniques typically help.
Vasovagal reactions are fairly common in people who do not love needles. Lightheadedness, sweating, and nausea may appear right after the draw or injection. Clinics handle these with positioning, snacks, and time. They do not change the long term outlook.
Post procedure flare reactions that last longer than expected can happen. I warn athletes that a two to three day flare is normal, but a five to seven day slow taper sometimes shows up with leukocyte rich preparations or deeper tendon work. Managing expectations here prevents panic. If pain spikes after a quiet period, especially accompanied by warmth and spreading redness, think infection and call.
Pigment changes after facial PRP are uncommon but not impossible. People with a history of melasma or post inflammatory hyperpigmentation should be counseled. Conservative settings during microneedling and diligent sun protection reduce risk. Under eye hyperpigmentation can look more prominent for a week simply because of swelling and bruising. True pigment change is rarer and managed with topical agents under supervision.
Scarring and keloid risk with microneedling plus PRP is low when depth and technique are correct. If you have a known keloid tendency, disclose it. We usually test a small area or choose alternative skin rejuvenation strategies.
Allergies do not apply to the plasma itself, but antiseptics, local anesthetics, and post care products can cause reactions. People with chlorhexidine or lidocaine sensitivity should alert the team in advance.
When to call your doctor
Two types of calls should happen. The first is routine check in for reassurance when symptoms feel stronger than expected. Your clinician would rather you ask than worry silently. The second is urgent contact when red flags appear.
- Redness that spreads, severe swelling that is not improving after day three, fever, chills, or pus at the injection site. Sudden, severe joint pain with inability to move the joint or bear weight, especially after an initial period of improvement. New or worsening numbness, weakness, or foot drop after spine or lower limb injections. Shortness of breath, chest pain, or signs of an allergic reaction after any injection visit.
If you cannot reach your clinic, go to urgent care or an emergency department for the last group. Thankfully, these scenarios are rare. Prompt evaluation protects joint health and overall safety.
How technique, preparation, and aftercare change your risk
You influence your PRP experience more than you might think, starting days before the injection. Hydration matters for the blood draw. Come in well hydrated so the phlebotomy is smooth and the yield is good. Alcohol the night before can dehydrate and is worth avoiding.
Medication review is not optional. Many clinics ask you to pause NSAIDs for a few days prior and after. If you take anticoagulants or antiplatelet therapy, coordination is critical. Some patients cannot stop those medications safely. In those cases, the plan shifts to minimize bleeding and bruising, and expectations are set accordingly.
Technique is the clinician’s responsibility, but you can ask informed questions. Ultrasound guidance improves accuracy for tendon and ligament targets and lowers the risk of injecting the wrong plane. In joints such as the knee or shoulder, landmark techniques are acceptable in experienced hands, but ultrasound adds confidence. Leukocyte poor versus leukocyte rich PRP choices depend on the condition. For intra articular injections like PRP for knee osteoarthritis, many clinicians prefer leukocyte poor to reduce irritant reactions while still delivering growth factors. For chronic tendinopathy, leukocyte rich preparations can be helpful. The trade off is more early soreness.
Aftercare deserves a measured approach. The body needs mechanical signals to remodel tissue, yet early overload can derail the process. This is where a physical therapist who understands regenerative injection therapy becomes a partner. With a rotator cuff PRP, we often rest for a few days, then start gentle range of motion, then add isometrics by week two, and progressive loading over weeks three to eight. For a PRP injection for joints like the knee, I often advise cycling or pool work before running. For facial and under eye treatments, simple measures like fragrance free moisturizers and broad spectrum sunscreen do more good than exotic serums in the first week.
Comparing PRP with other injections: why the side effects feel different
People often compare PRP to cortisone injections or hyaluronic acid gels. Cortisone reduces inflammation quickly, often providing a relief window of weeks to a few months. Repeated steroids can weaken tendon tissue and slow healing, which is why we limit frequency. Side effects from steroids include post injection flare, facial flushing, and in diabetics, a blood sugar bump. The relief pattern can lull you into early overuse.
Hyaluronic acid for knee osteoarthritis has a different profile. Swelling and warmth happen less often than with PRP, but they do occur, especially when a series is given. HA is a lubricant and shock absorber surrogate, not a healing stimulus, so expectations differ.
PRP vs stem cell therapy generates questions in consults. Most “stem cell” treatments in the clinic are actually bone marrow concentrate or adipose derived products, each with its own regulatory and safety considerations. Side effects from aspiration and injection can be more significant than PRP, including bone pain from marrow harvest. Evidence for superiority of stem cell products over PRP varies by condition, and costs are higher. When patients ask does PRP work for my problem, we discuss the evidence by diagnosis and match expectations to timelines.
Filler versus PRP for under eyes is another frequent debate. recommendations for PRP injection in Pensacola Filler provides volume and immediate contour change, but risks include Tyndall effect, nodules, and rare vascular compromise. PRP under eyes aims for tissue quality improvement and subtle thickening of the dermis, with a gentler risk profile and slower onset. Some patients choose a combination strategy in staged sessions.
How long do side effects last, and when do results show up
Acute side effects peak within two to three days and usually fade by day five. Residual stiffness or tenderness lingers a week or two, more for tendon cases in high load areas like the Achilles. Facial swelling after injections resolves in three to seven days, bruising up to ten days. Scalp tenderness is short lived, often 24 to 72 hours.
Results do not follow the same schedule. For PRP injection for knees with osteoarthritis, clinical improvement tends to emerge at two to six weeks and continue over three to six months. Some protocols repeat PRP at weeks two and six, or monthly for three sessions, to build momentum. For tendons, expect gradual gains in pain and capacity over six to twelve weeks. For PRP therapy for hair loss, early signs show as less shedding in six to eight weeks, followed by thicker caliber hairs over three to six months. For acne scars and skin rejuvenation, texture and tone changes emerge over weeks as collagen remodeling unfolds, with the best before and after photos taken at three months.
How long does PRP last depends on the condition and severity. In knees with mild to moderate osteoarthritis, benefit can persist six to twelve months. In chronic tendinopathy that finally responds, results can be durable if you maintain a smart loading program. Hair regrowth PRP generally requires maintenance every four to six months after an induction phase. Skin treatments are often done in a series, then annually to maintain collagen gains.
Cost and value, and how that intersects with side effects
Patients ask about PRP injection cost as part of Pensacola prp injection the decision. Prices vary by region, clinic, and the complexity of the procedure. A single knee injection may range from a few hundred to over a thousand dollars, more if ultrasound guidance and advanced PRP systems are used. Hair and facial series often bundle multiple sessions. These numbers matter because side effects cost time. Plan your calendar around the expected flare so you do not lose a competition week or a photo shoot window. The best PRP results often come from timing sessions with training cycles and recovery periods, not squeezing them between back to back events.
Situations where PRP may not be ideal
PRP is not a cure all. Severe joint deformity, mechanical locking from a large meniscus flap, or a full thickness tendon rupture needs a different strategy. If your arthritic knee has bone on bone changes and significant varus or valgus malalignment, PRP can ease pain but will not realign the leg. A meniscus tear that flips into the joint invites catching and pain that PRP will not fix. We still use PRP in surgical recovery to support wound healing or graft integration in some settings, but that plan is individualized.
People with active infections, uncontrolled diabetes, certain bleeding disorders, or platelet problems are not good candidates until those issues are optimized. Cancer history requires thoughtful timing and coordination with oncology. Pregnancy is often a pause zone for elective PRP, especially facial and cosmetic work.
Real world examples that help frame expectations
A 42 year old recreational runner with patellar tendinopathy had two years of sore stairs and cut back to twice weekly jogs. He chose leukocyte rich PRP with needle fenestration under ultrasound. Day two was the worst, with a deep ache and a sense that the knee was more inflamed. By day five he walked comfortably, started gentle isometrics week two, and built to eccentrics week three. At week eight he was running a mile pain free and returned to five mile runs at week twelve. His side effects were textbook and temporary.
A 56 year old office worker with knee osteoarthritis grade 2 had bilateral leukocyte poor PRP. Swelling peaked at 36 hours. She texted worried about warmth and stiffness, then noticed steady improvement by day four. At week four she reported less pain when rising from chairs and fewer nighttime awakenings. She scheduled a second session at week six to build on the gains.
A 34 year old woman pursued PRP under eyes for dark circles and fine lines. Bruising was more visible on the right side and lingered nine days. She sent daily photos the first week, then forgot about it until her eight week visit, when the dermis looked thicker and the tear trough shadow was softer. The visible early side effects were not a sign of harm, just the price of entry.
Making your session smoother
A handful of simple steps reduce hassle.
- Hydrate well, sleep decently, skip alcohol the night before, and eat a light meal within three hours of the appointment. Wear loose clothing that grants easy access to the injection site. Bring a cold pack in your car for the ride home if your clinic does not supply one. Plan your calendar. Avoid scheduling a major athletic event, flight, or photoshoot within three days for musculoskeletal PRP and within seven to ten days for under eye or facial injections.
Final perspective
PRP is a biologic nudge for healing, not a numbing or purely lubricating intervention. Its short term side effects reflect an early inflammatory phase that, in most cases, signals the process starting. The ordinary reactions are swelling, soreness, warmth, stiffness, bruising, and temporary functional dips that ease over days. The uncommon but serious risks, like infection or significant neurologic changes, deserve fast attention. Good technique, matched PRP preparation to the condition, and steady, progressive aftercare tip the balance toward success.
If you are weighing PRP vs cortisone injection or thinking about microneedling with PRP versus other resurfacing options, include recovery patterns in your decision. Results take time, but for the right indications, PRP offers a way to improve tissue quality rather than only quiet symptoms. Patients who understand the arc of side effects recover more comfortably and avoid missteps, which in the end is the quiet difference between a frustrating month and a satisfying one.
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