Pilot Study Investigating the Efficacy of Fat Grafting As a Treatment for Male and Female Facial Acne Scarring
Acne vulgaris is a common, chronic inflammatory condition that can result in permanent scarring. Although there is no gold standard treatment for this condition, there are a number of options currently in use or under investigation. Microneedling, which has been assessed over the past two decades, has been shown to improve the appearance of atrophic acne scars based on blinded photo evaluations. Additionally, histologic analyses have demonstrated increases in collagen types I, III, VIII, as well as total elastin levels. Other modalities under investigation include laser resurfacing, particularly with carbon dioxide (CO2) and Erbium:YAG lasers, and chemical peels. Finally, dermal fillers can be used to increase volume and fill in depressed scars, leading to a smoother appearance in skin texture. Injectable solutions that have been evaluated include hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, human collagen derivatives, or autologous fat. Autologous fat offers the benefit that there is no risk of allergic reaction, as the filler is derived directly from the patient. Several studies have been conducted to assess the effects of this treatment, but have been limited to subjective measures of evaluation, such as blinded photo reviews and patient satisfaction surveys.
The purpose of this study was to assess the efficacy and tolerability of autologous fat grafting in men and woman with facial acne scars.
Methods/Technique
:This single-center, non-randomized, pilot study enrolled up to 15 subjects between the ages of 21 and 50. Each subject presented for a single autologous fat grafting treatment to their facial acne scars. Harvest sites included the abdomen, hips, or inner thighs, depending on the subjects’ body fat distribution, and were anesthetized with a local injection of 1/4% lidocaine with epinephrine 1:200,000 prior to harvest. After centrifuging the fat and anesthetizing the subject’s face with a local injection of 1% lidocaine with epinephrine 1:200,000, the aspirate, containing 90% fat and 10% oil, was injected into the regions of the face where acne scars were present. Subjects returned for follow-up visits three months and six months post-treatment.
At each visit, standard and close-up photographs were taken. Antera 3D imaging (Miravex Limited, Dublin, Ireland) was also performed to measure changes in skin texture and volume. The VISIA Complexion Analysis System (Canfield Scientific, Parsippany, NJ) obtained standard, cross-polarized, and UV photographs to analyze skin tone, texture, wrinkles, pore size, actinic sun damage, and porphyrins. Non-invasive measurements, including transepidermal water loss (TEWL), high-resolution ultrasonography, optical coherence tomography (OCT), and BTC-2000 were performed at the treatment and two follow-up visits. Microbiopsies, 0.33mm in diameter, were collected from a deep-pitting acne scar on the cheek, of which the exact location depended upon the subject’s clinical presentation. Finally, blinded photo evaluations were performed, and the Global Assessment Improvement Scale (GAIS) was completed by clinicians and subjects at the two follow-up visits.
Results/Complications
:All subjects experienced mild bleeding at the harvest and injection sites. The harvest sites were closed with absorbable sutures, and any bleeding at the injection sites ceased within minutes of completing the procedure. Mild edema, bruising, and erythema was also noted in all subjects post-treatment, but this is an anticipated reaction and resolved within 72 hours of treatment. Subjects reported that with local anesthesia, any discomfort associated with the procedure was minimal. No infections or any unanticipated adverse events were reported throughout the course of the study.
Antera 3D Imaging, VISIA Complexion Analysis, and OCT measurements showed a statistically significant improvement in skin roughness and texture. Additionally, microbiopsy analysis was used to correlate changes seen with the non-invasive skin measurements. At the follow-up visits, the relative intensities of several extracellular matrix genes were increased, and skin architecture was visualized using both Trichrome and hematoxylin and eosin (H&E) staining. The two clinician reviewers noted a clear improvement in subjects’ facial acne scars, both based on blinded photo evaluations and CGAIS scoring. Additionally, subjects reported that the appearance of their skin was much improved from the initial condition.
Conclusion
:The results of this study demonstrate the safety and tolerability of autologous fat grafting as a minimally invasive treatment of facial acne scars. The treatment was well-tolerated among subjects, with minimal discomfort reported after injection of local anesthesia. Subjects experienced bruising, edema, and erythema following treatment, all of which were mild and transient. Objectively, 3D imaging and non-invasive measurements showed a statistically significant improvement in measured skin roughness and texture. Additionally, microbiopsies were successfully extracted for histology and gene expression analyses. Subject satisfaction was high, and clinician photo evaluations demonstrated a perceived improvement in the appearance of the subjects’ acne scars. Further studies may recruit a larger sample size or evaluate the long-term efficacy of this treatment past six months.