Evaluating the effectiveness of stromal-vascular fraction (SVF) cells along with subcision method in the treatment of acne scars: A double-blind randomized controlled clinical trial study

Evaluation and Comparison of the Efficacy and Safety of Erbium YAG Laser Along With Normal Saline vs. Its Combination With Stromal Vascular Fraction (SVF) and Platelet-Rich Plasma (PRP) in the Treatment of Striae Distensae: A Double-Blind Randomized Clinical Trial

BACKGROUND

There is no definitive solution for the treatment of striae distensae (SD), and effectiveness of each treatment method remains controversial. We aimed to investigate and compare the efficacy of the combination of Erbium YAG (Er:YAG) laser and stromal vascular fraction (SVF), the combination of Er:YAG laser and platelet-rich plasma (PRP) and Er:YAG laser plus saline in the treatment of SD.

MATERIALS AND METHODS

In 12 participating patients with at least three lesions (36 lesions in total), each lesion was treated with an Er:YAG laser. SVF was randomly injected intradermally for the first lesion, PRP for the second lesion, and normal saline as placebo for the third lesion. Treatment duration was one session, and the safety and efficacy of the treatment was assessed 3 months later using the following items: evaluation of biometric parameters including corneometery, erythema, melanin, tewametery, color, cutometery, complete thickness, epidermal thickness, dermal thickness, complete density, epidermal density, and dermal density; assessment of patient and physician satisfaction using Likert score; and recording of adverse effects of treatment.

RESULTS

The study involved 12 patients (evaluating 36 lesions in total), predominantly women (83%), with an average age of 39.16 years. The analysis revealed significant improvements in biometric indices, including complete thickness, epidermal thickness, dermal thickness, and R5 cutometer readings across all groups after the intervention. Notably, the SVF and PRP groups showed statistically significant enhancements in dermal and complete density compared to the placebo group. The SVF group demonstrated a significant increase in epidermal density (from 45.95 to 51.19, p = 0.001), unlike the PRP and placebo groups which showed nonsignificant changes. Comparing the average changes in biometric factors, the SVF group exhibited significantly greater increases in complete thickness, dermal thickness, complete density, epidermal density, and dermal density than the other groups. Both patient and physician satisfaction scores were highest in the SVF group (p = 0.001), with no significant posttreatment complications reported.

CONCLUSION

Our results showed that the combination of Er:YAG laser and SVF injection could be considered an effective and safe treatment method in the treatment of SD.

TRIAL REGISTRATION

IRCT20200127046282N14.

Therapeutic Potential of Stromal Vascular Fraction in Enhancing Wound Healing: A Preclinical Study

BACKGROUND

Adipose tissue provides an abundant source of stromal vascular fraction (SVF) cells for immediate administration. It can also give rise to many multipotent adipose-derived stromal cells. SVF is the population of cells obtained from mechanical or enzymatic digestion of lipoaspirate with no necessity for cell culture or expansion. Recently, the heterogeneous cell population found in the SVF gained wide-ranging translational significance in regenerative medicine.

METHODS

Forty-eight male rats were randomly divided into two main groups, including the control and SVF groups. Each group was further divided into four groups as follows: 0th-, 3rd-, 7th-, and 10th-day groups. A skin excision of 1 × 1 cm covering the epidermis and dermis was performed on the back skin. Just after the wound was created, a subepidermal injection of SVF was applied. SVF was obtained from human adipose tissue using Lipocube SVFTM. On the 0th (1 h after the injections), 3rd, 7th, and 10th days, rats were killed, and skin excisions from the wound areas tissues were performed. Histopathological, biochemical, and western blotting analyses were performed on tissues.

RESULTS

Our data showed that SVF obtained from a healthy woman improved wound healing in healthy rats. SVF has promoted wound healing mainly because of its antioxidant, antiapoptotic, and fibroblast/myofibroblast stimulating effects. SVF stimulated collagen production and contraction of the wound lips, supporting the closure.

CONCLUSIONS

Our study provides additional data about the efficacy and pathophysiological and molecular mechanisms of the action of SVF on wound healing in healthy subjects. Our study is an experimental animal study.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.

A Comparative Analysis of the Advances in Scar Reduction: Techniques, Technologies, and Efficacy in Plastic Surgery

The study provides a comprehensive analysis of the latest methodologies and treatments aimed at improving scar management. Scar formation results from the replacement of normal skin with fibroblasts, leading to a structured unidirectional collagen bundle, as opposed to the collagen sheet matrix found in healthy skin. This review categorizes scars into hypertrophic scars and keloids, each with distinct pathophysiological characteristics. It highlights the importance of consistent scar assessment using scales such as the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale, emphasizing the need for standardized evaluation methods. The study systematically reviews various scar management techniques, ranging from traditional surgical methods to innovative treatments. Conventional approaches such as pressure garments and silicone gel sheeting are explored, noting their roles in maintaining hydration and occlusion. The efficacy of intralesional corticosteroid injections and laser therapies is discussed, with particular attention given to their combined use for optimal outcomes. The review also covers advanced techniques such as microneedling, platelet-rich plasma therapy, and stem cell-based treatments, detailing their mechanisms and potential benefits in scar remodelling. Additionally, the study underscores the emerging role of botulinum toxin A in both preventive and corrective scar treatments, offering promising results in reducing movement-induced scar exaggeration. The systematic review includes a thorough examination of existing literature, clinical trials, and meta-analyses to evaluate the effectiveness of these interventions. It concludes by calling for further research to refine these techniques and enhance their application in clinical practice, aiming to achieve better aesthetic and functional outcomes for patients with scars.

Evaluation and comparison of the efficacy and safety of the combination of topical phenytoin and microneedling with microneedling alone in the treatment of atrophic acne scars: A controlled blinded randomized clinical trial

INTRODUCTION

Severe acne breakouts often lead to atrophic acne scars, which affect millions of people worldwide and can significantly affect a person's self-confidence and self-image. Given the difficulty in treating atrophic acne scars, this study aims to investigate the efficacy of topical phenytoin in the treatment of atrophic acne scars.

METHOD

This split face clinical trial on 25 patients between the ages of 18 and 40 involved the application of microneedling on one side of the face, with three sessions taking place over the course of a month. On the other side, a 1% phenytoin cream was administered three times daily for 1 week following the microneedling procedure. Baseline information was collected for all patients, and follow-up assessments were conducted during the treatment sessions and 2 months after the last session. The assessments included evaluating the number and area of pores and spots, determining scar severity, assessing patient satisfaction, and recording any potential complications.

RESULTS

Among patients, 20 individuals (80%) were females, and the average age of the participants was 35.96 ± 9.23. In terms of the fine pore area, despite the fine pore count, both groups showed improvement over time (p: 0.03 vs. 0.06). Also, regarding large pore count and area, and the count and area of spots, both groups showed improvement over time (p: 0.001). However, there were no significant differences between the two groups (p > 0.05). On the other hand, when it comes to acne scar grade and patients' satisfaction, the phenytoin group outperformed the control group in all follow-up sessions and this difference was found to be significant (p: 0.001). It is worth noting that no complications were observed among any of the patients.

CONCLUSION

It appears that combining phenytoin cream with microneedling has a more effective therapeutic outcome in enhancing atrophic acne scars, when compared to microneedling alone, and this method can be regarded as a viable alternative in treating these types of scars.

Investigating the impact of added Profhilo mesogel to subcision versus subcision monotherapy in treating acne scars; a single-blinded, split-face randomized trial

BACKGROUND

Acne scar is an inflammatory condition, which commonly occurs in patients with acne vulgaris, especially in adults. Mesogels have been reported effective in improving atrophic acne scars.

AIMS

We investigated the efficacy of adding Profhilo (a hyaluronic acid-based filler) to subcision as a new treatment method.

METHODS

Twelve patients aged 18-45 years with atrophic acne scars on both sides of the face participated in this single-blinded, split-face, randomized controlled trial. Each side of the face was randomly assigned to one of the treatment methods, including subcision alone and subcision + Profhilo. Patients in the Profhilo arm received mesogel (1 cc) in addition to the subcision procedure. Both methods were carried out two times at 1-month intervals. Assessments were done based on the sonographic depth of scars, and two blinded observers examined photographs at baseline and 3 months after the final session and the results were reported based on an exclusively made formula as the total score. The Global Improvement Scale and Visual Analogue Scale (VAS) (for patient satisfaction) were also used.

RESULTS

The VAS score of patient satisfaction was statistically significant in the Profhilo arm, with a mean improvement of 528.08 and 219.06 in the subcision arm (p = 0.02). No significant difference was seen in total acne scar reduction comparing the two methods (29.74 in the Profhilo arm and 22.27 in the subcision arm, p = 0.56). Sonographic depth reduction was also non-significant, with a mean of 29.21 in the Profhilo arm and 28.53 in the subcision arm (p = 0.4). The mean global improvement was reported as four in both arms, and no statistical significance was observed (p = 0.89). The best response to treatment belonged to the rolling subtype in both methods (p = 0.029 for the Profhilo arm and p = 0.001 for the subcision arm).

CONCLUSION

Despite no significant difference between the methods, Profhilo is more effective due to a higher satisfaction rate and better physiologic effects.

The investigation and comparison of the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated infraorbital dark circles and wrinkles: A controlled blinded randomized clinical trial

BACKGROUND

To evaluate the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated dark circles and wrinkles under the eyes.

METHOD

This study was a single-blinded randomized clinical trial conducted on patients with suborbital darkening under the eyes that randomly divided into control and case groups. In the control group, 15 patients were treated with one session of nanofat injection only, and five patients of each intervention groups received one session of nanofat+SVF injection, nanofat+PRP injection, and nanofat injection+Nd:YAG laser, respectively. Assessments methods were (1) evaluation of the degree of darkness and repair under the eyes by a blinded dermatologist based on clinical photographs, (2) investigating patient satisfaction, (3) using biometric variables for color, thickness, and density of the skin (only 3 months after the treatment), and (4) recording the possible adverse effects.

CONCLUSION

In terms of the extent of reduction in the intensity of darkness under the eyes, the combined treatment of nanofat injection together with SVF, PRP, and Nd:YAG laser had a much greater therapeutic effect than nanofat injection alone. In all three groups of combined treatments, patients were 100% satisfied. In terms of biometric variables, amount of changes in colorimeter, complete and dermal thickness, complete and dermal density, between the different groups was statistically significant. The use of combined treatments including nanofat with SVF injection, PRP, and 1064 Q-switched Nd:YAG laser may be more effective than nanofat alone, in reducing infraorbital dark circles and wrinkles.

Methods for skin image analysis and their applications in dermatology and cosmetic research: a comprehensive review

INTRODUCTION

In recent years, several non-invasive imaging methods have been introduced to facilitate studies in dermatology and cosmetic research, almost completely replacing invasive methods such as biopsy. Imaging devices have proven to be useful tools in skin analysis and therapy monitoring. This review aimed to investigate the most recent studies in cosmetic dermatology the imaging technology and methods that are being used to assess skin characteristics and summarize its fundamentals, possible applications, advantages, and limitations, and to give a future perspective to the clinical trials.

EVIDENCE ACQUISITION

For that, a literature review was carried out in the main scientific database platforms and the studies associating skin image analysis with dermatology and cosmetic research were selected and discussed.

EVIDENCE SYNTHESIS

It was possible to infer that skin image analyses are not only practical and effective, but have also become increasingly essential for the skin sciences. The in vivo and real-time image analyses allow a more complete evaluation and the follow-up of the same region for different periods. It was also possible to observe that macroscopic, microscopic, and mesoscopic imaging methods are complementary, allowing different approaches in the same study.

CONCLUSIONS

These technologies are expected to evolve more and more quickly in the near future.

Efficacy of fractional CO2 laser in combination with stromal vascular fraction (SVF) compared with fractional CO2 laser alone in the treatment of burn scars: a randomized controlled clinical trial

BACKGROUND

The appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue regeneration properties, plays an important role in the healing of skin lesions. Fractional CO2 lasers have occupied a special place in treating skin lesions, particularly skin scars, since their introduction. Our study aimed to compare the combination of SVF and fractional CO2 laser with fractional CO2 laser alone in the treatment of burn scars.

METHOD

This double-blind clinical trial study was conducted on ten patients with burn scars that were treated three times with a fractional CO2 laser at site of burn lesions, and one of the two areas studied was randomly injected with SVF. Two months after completion of the procedure, patients' scars were assessed using the Vancouver scar scale (VSS), biometric criteria, and physician and patient satisfaction ratings.

RESULTS

The results confirmed a significant improvement in VSS, cutometry, R7 criteria, complete density sonography, and skin density sonography in the fractional CO2 laser-treated group. The VSS criteria, epidermal thickness sonography, complete density sonography, and skin density sonography in the group treated with the combination of fractional CO2 laser and SVF also showed significant improvement. The VSS criteria and melanin index of Mexameter in the group treated with SVF in combination with fractional CO2 laser were significantly better than the group treated with fractional CO2 laser alone. Also, physician and patient satisfaction in the group treated with SVF injection in combination with fractional CO2 laser was significantly higher than the other group.

CONCLUSION

The results confirm the efficacy of SVF injection in combination with fractional CO2 laser in the treatment of burn scars and can be considered as a treatment option for better management of these lesions.

TRIAL REGISTRATION

The study protocol was retrospectively registered at Iranian Registry of Clinical Trials with code: IRCT20210515051307N1, Registration date: 2021-11-14, URL: https://www.irct.ir/trial/56337 .