The Management of Facial Hypertrophic Scars By Using Fractional CO2 Laser, Adipose-Derived Stem Cells, Regenerative Epithelial Suspension and Lipoinjection Combination

PURPOSE: Facial burns often get an inextricable situation in terms of healing and long-term morbidity. Many different procedures were used to overcome these challenging topics. Although results were more promising in terms of surgeons, is inadequate for patients. We present the efficiency of fractional CO2 laser(FL), Adipose-Derived stem cells(ADSC), Regenerative Epithelial Suspension(Recell®) and lipoinjection combination treatment on facial hypertrophic scars due to burns(FS) in this paper.

METHODS: 18 patients(M: 10, F: 8) among the ages of 18-35 years(Mean:25) between 2012-2015 were divided into three groups. Skin thickness and perfusion were measured by ultrasonography, Vectra® computer simulation was performed for symmetric lipoinjection, biopsies were performed and hematoxylin-eosin and Movat pentachrome staining were carried out in all patients on preoperative and postoperative 12. months. ADSC-enriched lipoinjection was performed in all groups. The mechanical dermabrasion was applied in Group1, dermaroller was done in Group 2, and FL was performed in Group3, Recell® was administered following in all groups. All of the patients underwent a satisfaction questionnaire.

RESULTS: Mean follow-up was 18(14-24) months. A significant improvement in skin softness, thickness, elasticity, color and symmetry was obtained in all patients. An increase in Keratinocyte, type 1 collagen; a decrease in nodular type 3 collagen and elastin, epidermal rete ridges, proteoglycan, fibronectin, neurofilament, T cells, macrophages and mast cells was observed in the histopathological studies in Group 3 compared to other groups (Fig 1.). A significant reduction in skin thickness, scar microcirculation and an increase in fatty tissue rates were obtained from USG in Group 3. Group 3 had higher scores in satisfaction questionnaire.

CONCLUSIONS: FL has an active role on smoothing and regression of FS. ADSC-enriched lipoinjection is effective in the long term management of facial asymmetry. The Recell® application increases the amount of keratinocytes and provides significant skin quality.