Vampire Facials

by Brian Dunning
May 28, 2024

Few industries are as thick with pseudoscience as skin care. Nearly everyone wishes they looked a bit better, so commerce is quick to respond; the inevitable result is that skin care and beauty products occupy disproportionately bloated sections of every supermarket and department store. But making people look like movie stars is not as simple a task as we all wish it could be, so the marketers and peddlers sometimes overpromise; and these promises are pregnant with zeal and positivity. But since the object of the game is selling not science, these promises are very often less than forthright about exactly what can be accomplished. Today we're looking at one such product promising to make your face look years younger, taking you from saggy and blotchy to teenaged and tight. It comes with fully-staged drama: needles, blood, pain, and high-tech equipment. It is the vampire facial, and we're going to find out if it's worth the money.

A vampire facial can pretty accurately be described as a full-face tattoo of your own blood. You go into the clinic or spa, they withdraw some of your blood and take the PRP, the platelet-rich plasma, then place it on your face much as a tattoo artist would place the ink. Then a microneedling system is used to go over the bloody skin. These systems typically have a head with anywhere from 12 to a few dozen needles that go in and out some 100-150 times per second, penetrating anywhere from half a millimeter to a few millimeters. The idea is that this injects your own PRP into your skin. The basic claimed benefit is that this will stimulate the regrowth of collagen, and make your aging skin look tighter and younger. Yes, it does hurt, and so most patients opt for at least a topical anesthetic. After a few days the injured tissue will be mostly cleared up, and patients are advised that results may take some months to appear. After all, we're waiting for collagen to grow.

PRP is a controversial treatment, such that it probably deserves its own Skeptoid episode. Quite a few medical specialties use it for various purposes, usually things like healing or rejuvenation, and particularly the repair of soft tissue injuries. As an unproven treatment, PRP is usually not covered by insurance, which means that any time you use it, you're looking at anywhere from about one to several thousand dollars out of pocket, per treatment (and most clinics recommend multiple treatments about a month apart). One reason for the extremely high cost is that the PRP is pretty involved to make. Your blood is drawn and then placed into a centrifuge to separate it into three layers. The bottom layer is red blood cells. The top layer is plasma, and the middle layer is platelet-rich plasma, which has about four times the concentration of platelets as regular plasma. This PRP is then what gets re-injected into your body.

Why would this be worth doing? The basic concept of PRP is plausible. Platelets are what promote blood clotting. When you get an injury and the platelets arrive at the damaged area in your bloodstream, they release growth factors that start the cells healing, and also chemicals to clot the blood and prevent more loss. So if a platelet can be thought of as a little cell-repair machine, then it would stand to reason that having more platelets in an injured area could only be beneficial. This is why you'll often get pitched PRP if you go to an orthopedic doctor or physical therapist for something like a sports injury. Inject PRP into that inflamed tendon. Inject PRP into that torn muscle, or that shredded knee ligament.

Research attempting to validate this, however, has been less than stellar. A lot less. Many clinical trials have been published, and positive effects tend to be seen in only small pilot studies and studies with poor controls; the largest and best controlled studies almost always find no benefit. The best example of this was a series of three clinical trials all published in the Journal of the American Medical Association during 2021, with an editorial explaining the results of all three. They tested the use of PRP for several types of osteoarthritis and tendonitis, among the conditions for which PRP is most often used. The bottom line is that these studies — which according to JAMA's editorial, are as good as studies get — found that PRP is no more effective than placebo for those conditions.

But what about using it for facial rejuvenation? Just because PRP is unproven to do anything for your sports injuries doesn't mean it's not going to make your skin look like you're 25 again. What's lacking are any large scale, well controlled clinical trials for vampire facials; and it turns out there's a good reason for this. Since PRP has not yet been found to be a treatment for any medical condition, it is not classified as a medication. So the FDA is a lot less strict about how it can be used. Currently there's no special approval needed to perform vampire facials, and so there's no pressure on the skin care industry to prove anything. With no need for clinical trials, there's little reason for anyone to step up to pay for them — especially since they might produce negative results (in fact, from what we know, they probably would).

What we'd like to see is a large controlled trial with proper blinding, where a sham treatment is given to control groups — a version of a vampire facial that either doesn't actually penetrate the skin, and/or that uses something indistinguishable from PRP but that lacks the platelets. Ask the trial participants if their skin seems improved after various periods of time. If the trial is large enough and produces good data, then we'd have an answer.

That's not to say that there has been no research at all. A 2019 review in the journal Aesthetic Plastic Surgery found some 108 articles touching on some aspect of vampire facials, but mostly just about PRP. Some were animal studies, some were general PRP studies, some were studies of how skin ages. It's kind of an odd paper and seems weirdly pointless; the publications reviewed were so diverse and most had little to do with one another. The authors concluded that "PRP may play a role in oxidative stress, anti-aging and other aspects which provides a new theoretical basis and therapeutic targets for facial rejuvenation." Pretty much as non-committal as you can get.

Poking bloody needles into your face seems both extreme, and with no other context, incredibly bizarre. Who would have first thought of doing such a thing, and why on Earth would it catch on? One reason is celebrity influence. In March 2013, Kim Kardashian famously posted a bloody-faced selfie on Instagram with the hashtag #VampireFacial. According to Google Trends, this triggered the greatest spike ever for that search term online. Prior to that, the term hardly existed, but it's been going steady ever since. Apparently the logic followed by many is that if a Kardashian does it, it must be a good thing to do. So let's take a look at exactly what some of the sales pitches are.

Keeping in mind that we have no meaningful data indicating a vampire facial has any benefits, combined with a vaguely plausible foundation that it might have some, combined with pretty good data that PRP has failed to produce any of its hoped-for benefits so far, let's read the pitches made by some of the dermatology spas that sell the procedure:

Skin texture, pore size, fine lines, acne scarring and more all can be improved with a vampire facial.

Makes skin look less wrinkled, firmer, and more elastic.

Improve skin tone, reduce fine lines & wrinkles, enhance and plump sagging skin, reduce acne scars, decrease signs of aging

Rejuvenates the skin, restores youth, and creates a healthy outlook

Pretty consistent claims. And they all say you need to wait the better part of a year to begin to really see those benefits; yet repeat treatments (usually three total) are recommended at intervals of about a month. To me, this one particular point really stands out as being especially important, and it does so in two ways:

1. First, when a lot of patients post pictures of themselves a few days, a few weeks after their vampire facial, there are always a few tiny little scabs that linger. They are probably only just totally healed when it's time for the next treatment. They have perhaps a few days to study their skin in the mirror after those weeks of lingering scabs. Does it look any better yet? Better than it did a week ago. Maybe it's already starting to work. Combined with the hope and the preconceived expectation of efficacy that drove the patient to go ahead and actually get this first treatment, we have a perfect scenario for a placebo effect.
   
   
2. The reliance on an ongoing series of treatments — even if it's only two or three — forces patients to justify the additional expenses due to the sunk cost fallacy. No matter how unexpectedly painful the treatment was, no matter how one really has to force oneself to see any improvement in the mirror; money has already been spent, and the sunk cost fallacy compels us to continue spending to see the process through. We spent money on it yesterday, so it's worth spending money on it today.

Once we've psychologically committed to the sunk cost, of course we're going to post our pictures to social media — not only to convince our friends, but also to reassure ourselves — that the procedure is going as planned and expected.

One last thing we haven't really talked about is the procedure's safety. Vampire facials are a case where the risks do not justify the benefits — but this is more because the benefits are probably zero. The risks are very low too, but they're definitely not zero. Anytime you're dealing with a business that sticks needles into people (especially in a non-regulated non-medical procedure), there is the potential to transmit bloodborne diseases. Such cases are rare; the risk is probably similar to those from getting a tattoo, but when they happen, they can be very serious. In April 2024, the CDC reported that three women were all infected with HIV from vampire facials at a spa in New Mexico in 2018. The spa had been re-using disposable equipment intended for single use. It also didn't even have an autoclave, which is necessary for sterilizing reusable equipment. There are other things that can go wrong too. Needles can be reused. Equipment may not be properly cleaned or sterilized. Vials can be mislabeled or switched, and the wrong patient's blood could be used for procedures. And of course, any time you puncture the skin you run the risk of infection, especially if you're getting a medical procedure in a non-medical setting. I've not been able to find any published data, but it's clear that a lot of people have tried this, and reported problems are in the statistical baseline noise level.

Here is my official concluding advice on this procedure. If you're considering getting one, see if you can do so in a clinical trial setting. Not only does this make your vampire facial free, it will contribute to our knowledge of whether PRP in the face is beneficial. Go to clinicaltrials.gov (that's a United States centric thing) and search for microneedling or facial rejuvenation or even vampire facials. You may find nothing, but you also might. Consider participating. But as far as just going out in the marketplace and paying full retail price for an unapproved medical procedure, I can't advocate for that. Instead, buy a tube of sunscreen — that's the best bang for the buck there is in keeping your skin looking young and healthy.

By Brian Dunning
Follow @BrianDunning