Efficacy of modern therapeutic approaches In scar management: a systematic review

Abstract

Background: Current scar treatment modalities, including silicone gel, corticosteroids, laser therapy, and surgical interventions, demonstrate certain clinical benefits; however, their ability to fully restore normal skin architecture remains limited. In recent years, novel regenerative approaches aimed at enhancing scar tissue repair have been increasingly investigated. Among these, autologous fat grafting (AFG) has emerged as a promising modality. AFG contains adiposederived stem cells (ADSCs), stromal vascular fraction (SVF), and various growth factors, which may improve scar quality by promoting angiogenesis, reducing inflammation, and regulating collagen remodeling. Aim: In Mongolia, there are few studies on the effectiveness and safety of AFG, ADSC, and SVF-based treatments for scars, so it is necessary to summarize international evidence. Materials and Methods: This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive literature search was performed using PubMed, Scopus, and Web of Science databases. Of 902 identified studies, 27 met the inclusion criteria and were included for quality assessment and analysis to evaluate the therapeutic effects of AFG, ADSCs, and SVF in scar management. Results: Findings from the 27 included studies demonstrated that AFG, ADSC, and SVF-based therapies had overall beneficial effects on scar morphology, tissue structure, elasticity, pain, and functional outcomes. Various fat-processing techniques were utilized; however, in 15 studies, the Coleman technique was employed, with retrograde injection administered at the dermal-hypodermal junction. Of the included studies, 23 evaluated structural changes in scars and reported improvements in scar color, thickness, elasticity, and contour. Six studies assessing symptoms demonstrated reductions in pain and pruritus, while six studies reported improvements in functional impairment. Histological evaluation in 6 studies revealed improved collagen organization, increased angiogenesis, and reduced fibrosis. Additionally, 3 studies combining AFG with adjunctive therapies such as platelet-rich plasma (PRP), SVF, and fractional laser reported superior outcomes, although results varied depending on scar type, technique, and evaluation methods. Conclusion: AFG, ADSC, and SVF therapies promote scar tissue regeneration by enhancing angiogenesis, accelerating collagen remodeling, and reducing fibrosis. These effects contribute to improved elasticity, functional recovery, and overall quality of life in patients. Therefore, these approaches represent a promising novel strategy for scar management in Mongolia and warrant standardization and integration into clinical practice.