Autologous Fat Grafting-A Panacea for Scar Tissue Therapy?

Abstract

Scars may represent more than a cosmetic concern for patients; they may impose functional limitations and are frequently associated with the sensation of itching or pain, thus impacting both psychological and physical well-being. From an aesthetic perspective, scars display variances in color, thickness, texture, contour, and their homogeneity, while the functional aspect encompasses considerations of functionality, pliability, and sensory perception. Scars located in critical anatomic areas have the potential to induce profound impairments, including contracture-related mobility restrictions, thereby significantly impacting daily functioning and the quality of life. Conventional approaches to scar management may suffice to a certain extent, yet there are cases where tailored interventions are warranted. Autologous fat grafting emerges as a promising therapeutic avenue in such instances. Fundamental mechanisms underlying scar formation include chronic inflammation, fibrogenesis and dysregulated wound healing, among other contributing factors. These mechanisms can potentially be alleviated through the application of adipose-derived stem cells, which represent the principal cellular component utilized in the process of lipofilling. Adipose-derived stem cells possess the capacity to secrete proangiogenic factors such as fibroblast growth factor, vascular endothelial growth factor and hepatocyte growth factor, as well as neurotrophic factors, such as brain-derived neurotrophic factors. Moreover, they exhibit multipotency, remodel the extracellular matrix, act in a paracrine manner, and exert immunomodulatory effects through cytokine secretion. These molecular processes contribute to neoangiogenesis, the alleviation of chronic inflammation, and the promotion of a conducive milieu for wound healing. Beyond the obvious benefit in restoring volume, the adipose-derived stem cells and their regenerative capacities facilitate a reduction in pain, pruritus, and fibrosis. This review elucidates the regenerative potential of autologous fat grafting and its beneficial and promising effects on both functional and aesthetic outcomes when applied to scar tissue.

Keywords: adipose-derived stem cells; autologous fat grafting; scar therapy; tissue regeneration.

Figure 1

Adipose-derived stem cells: properties and potential effects on scars. Angiogenesis: ADSCs secrete proangiogenic factors (VEGF, FGF, HGF) that promote new blood vessel formation, improving tissue oxygenation and perfusion. They also interact with the HIF-1α/VEGF axis and produce Sphingosine-1-phosphate (S1P) for vessel stabilization; immunomodulation: ADSCs release anti-inflammatory cytokines (IL-10, TGF-β) that reduce inflammation and scar formation. They also secrete other cytokines (IL-6, IL-4) and activate the JAK/STAT pathway to support healing; cell differentiation: ADSCs differentiate into various cell types, aiding tissue repair and regeneration through pathways such as Wnt/β-catenin and PPARγ. Extracellular matrix remodeling: ADSCs modulate collagen and matrix components, enhancing structural integrity and reducing fibrosis. They secrete MMPs for matrix breakdown and TIMPs to balance synthesis and degradation, influencing fibroblasts and secreting CTGF and Decorin for organized ECM formation.