In this randomized controlled trial of 200 patients undergoing bilateral tonsillectomy, intraoperative topical autologous platelet-rich plasma (PRP) significantly reduced early postoperative pain (mean −0.8 VAS points over days 1–10) and improved wound healing, with higher rates of complete mucosal healing by day 14 (78% vs 59%) compared with placebo, without increasing complications or hemorrhage risk. These findings support PRP as a safe adjunct that modestly improves early recovery after tonsillectomy.