Aesthetic Plast Surg. 2026 May 18. doi: 10.1007/s00266-026-05871-7. Online ahead of print.
ABSTRACT
BACKGROUND: Atrophic acne scarring presents a significant therapeutic challenge with a profound psychosocial impact, and conventional treatments often yield suboptimal results. Autologous biologics, specifically stromal vascular fraction (SVF) and platelet-rich plasma (PRP), have emerged as promising regenerative strategies to address this issue.
METHODS: This single-center, pilot, randomized, assessor-blinded controlled trial included 60 patients with severe atrophic acne scars. Patients were randomized into four groups: subcision plus SVF (Group 1), subcision plus combined SVF and PRP (Group 2), subcision plus PRP (Group 3), and subcision alone (Group 4, control). Primary endpoints included clinical improvement documented by digital imaging and changes in qualitative grading scales from baseline to 12 months post-procedure. Additionally, flow cytometry was performed to evaluate the cellular composition and mesenchymal stem cell (MSC) marker expression of the SVF preparations.
RESULTS: Group 2 (subcision + SVF + PRP) demonstrated superior clinical efficacy, with 53.3% of patients achieving “Grade 3” (marked) physician satisfaction compared to 0% in the control group (p ≤ 0.001). This group also showed significantly greater improvement in scar size and color (p ≤ 0.001). Mechanistically, flow cytometry confirmed that Group 2 contained significantly higher expression of mesenchymal stem cell markers (CD73+ and CD105+) compared to the SVF alone (p ≤ 0.001). While patient-reported FACE-Q scores consistently favored Group 2, differences in specific QoL sub-domains did not reach statistical significance (p > 0.05), likely due to the pilot sample size.
CONCLUSION: The combination of SVF and PRP, when used as an adjuvant to subcision, represents a promising regenerative strategy for atrophic acne scars, achieving clinical results superior to monotherapies or subcision alone. This enhanced therapeutic effect appears attributable to the enrichment of the mesenchymal stem cell population within the “biostimulated” SVF.
LEVEL OF EVIDENCE I: 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 .
PMID:42151612 | DOI:10.1007/s00266-026-05871-7
