Atrophic post-acne scars remain one of the most complex challenges in aesthetic medicine. Even after successful resolution of inflammatory acne, patients often struggle for years with skin texture irregularities, which frequently leads to social withdrawal and psychological distress [1, 2]. Traditional approaches are often limited: topical agents are ineffective against deep defects, while device-based methods that involve tissue injury require prolonged downtime and carry a risk of pigmentation. As a result, researchers are increasingly turning to cellular therapies that reconstruct tissue structure from within rather than simply masking the problem.

In a new study published in the Journal of Cosmetic Dermatology, the authors combined two powerful regenerative tools: autologous fibroblasts and platelet-rich plasma (PRP) [1]. This combination is strategic. Fibroblasts are the primary "builders" of the dermis, responsible for collagen and elastin synthesis, while PRP acts as a catalyst, providing essential growth factors that activate and promote their proliferation [3]. Unlike temporary fillers, this duo aims for long-term matrix reconstruction without the risk of allergic reactions that can sometimes be associated with foreign materials [1, 4].

Study Design

This pilot split-face study included eight patients with atrophic acne scars (six women and two men, with a mean age of approximately 42 years). Each participant received two different therapies simultaneously: a combination of fibroblasts and PRP on one side of the face and PRP alone on the other as the control. Side allocation was randomized, and both patients and the statistician were blinded to the treatment scheme applied to each side.

To obtain autologous fibroblasts, a 5 mm punch biopsy was performed in the retroauricular area of each patient. The skin sample was placed in high-glucose DMEM medium and transported at 4°C. Following sterilization in 70% alcohol and phosphate-buffered saline, fibroblasts were cultured using the explant method in DMEM supplemented with 10% human fetal serum. Cells were passaged upon reaching 80% confluence using 0.25% trypsin and cryopreserved at the fourth passage in liquid nitrogen. Before each injection, quality control was performed at the third passage, after which the fibroblasts were suspended in autologous PRP and administered immediately.

To prepare the PRP, 20 ml of venous blood was collected from each participant and divided into two sterile vacuum containers, each containing 1.5 ml of ACDA anticoagulant. Plasma was obtained via a two-step centrifugation process: the first at 1500 rpm for 10 minutes to separate red and white blood cells, and the second at 1200 rpm for 5 minutes to concentrate the platelets. This resulted in PRP with a platelet concentration 3–4 times higher than that of whole blood. The activated PRP was then drawn into 1 ml insulin syringes, with a total volume of 3 ml per patient.

The treatment protocol consisted of 3 sessions at 2-week intervals. Before each procedure, topical anesthesia (lidocaine/prilocaine 2.5%) was applied for 20 minutes. In the study group, 3 ml of the fibroblast-PRP suspension was injected intradermally; on the control side, 3 ml of pure PRP was injected. Injections were performed with a 30G needle directly into the scar depressions until characteristic tissue elevation and blanching occurred.

Efficacy was assessed at baseline and 6 months post-treatment using a comprehensive biometric suite. Parameters included stratum corneum hydration, transepidermal water loss (TEWL), melanin and erythema indices, skin elasticity (R2, R5, and R7 via Cutometer), skin thickness and density (ultrasound), pore and spot counts, and scar volume, area, and depth using the VisioFace system.

Results

Both methods demonstrated positive dynamics; however, PRP combined with autologous fibroblasts showed statistically significant superiority across most key parameters.

The most impressive changes were recorded in skin thickness and density. The median increase in total skin thickness with combination therapy was 32.57%, compared with only 5.33% with PRP control (p=0.018). Epidermal thickness increased by 13.64% with combination treatment versus 3.03% with PRP monotherapy (p=0.018), while dermal thickness grew by 27.60% and 5.60%, respectively (p=0.028). Ultrasound also revealed a significant boost in skin density: total density increased by 19.51% on the fibroblast side versus 6.93% on the control side (p=0.018).

Skin elasticity parameters also showed more pronounced improvement with combination therapy. The R2 value (gross elasticity) increased by 3.69% on the fibroblast side versus 2.35% on the control side (p=0.012). The R5 value (net elasticity) rose by 25.21% versus 17.94% (p=0.012), and R7 (biological elasticity) increased by 10.89% versus 8.49% (p=0.012). These data suggest that the combination therapy qualitatively improves the biomechanical properties of the dermis.

Skin barrier function was also significantly strengthened. TEWL decreased on both sides, but the reduction was 27.25% on the fibroblast side compared to 21.16% on the control side (p=0.018). Stratum corneum hydration increased by 9.00% with combination therapy, while the PRP side saw only a 3.42% increase (p=0.028).

The melanin index decreased by 4.39% on the combination side versus 2.58% on the control side (p=0.018), and the erythema index dropped by 4.78% versus 2.43%, respectively (p=0.018). These findings indicate a more pronounced anti-inflammatory effect and improved microcirculation when fibroblasts are used in conjunction with PRP.

The number of fine pores was reduced significantly more on the fibroblast side (median reduction of 52.49% vs. 16.67%, p=0.043). Acne scar volume decreased by 43.33% on the combination side versus 28.33% on the control side (p=0.043), and scar area was reduced by 46.66% versus 25.53% (p=0.043).

No serious adverse events were recorded throughout the study. Patients reported subjective satisfaction with the treatment results, although a formalized quality-of-life assessment was not conducted.

Conclusions and Practical Significance

The results of this pilot study indicate that combining autologous fibroblasts with PRP can be an effective method for treating atrophic post-acne scars. A course of 3 procedures performed at 2-week intervals resulted not only in reduced scar volume and area but also in a comprehensive improvement in skin quality, including increased dermal thickness, enhanced elasticity, and a strengthened barrier.

The practical value of this technique for aesthetic medicine lies in the ability to address tissue quality at a fundamental level. Unlike temporary fillers that require regular reinjection, autologous fibroblasts can provide long-term reconstruction of the dermal matrix [5]. Using the patient's own cells minimizes the risk of allergic and immune reactions [4]. Furthermore, this method may be particularly valuable for patients with higher phototypes, for whom the risk of hyperpigmentation limits the use of aggressive laser and ablative procedures.

Implementing this technology in clinical practice will require collaboration with certified cell laboratories and adherence to strict quality standards. The authors emphasize that this was a pilot study with a small sample size and a relatively short follow-up period. Larger randomized controlled trials are needed to confirm these results and compare them with other standard scar treatments. Nevertheless, the data open a promising path for developing personalized regenerative therapy protocols in aesthetic dermatology.

References

1. Zare S., Zeinali R., Nouri M. et al. Comparison of autologous fibroblast cells plus platelet-rich plasma (PRP) with PRP alone in the treatment of atrophic acne scars, a split-face pilot study with biometric assessment. J Cosmet Dermatol. 2025; 24: e70413. https://doi.org/10.1111/jocd.70413.
2. Chuah S.Y., Goh C.L. The impact of post-acne scars on the quality of life among young adults in Singapore. J Cutan Aesthet Surg 2015; 8(3): 153–158.
3. Kakudo N., Minakata T,. Mitsui T. et al. Proliferation-promoting effect of platelet rich plasma on human adipose derived stem cells and human dermal fibroblasts. Plast Reconstr Surg 2008;  122(5):1352–1360.
4. Colon J., Mirkin S., Hardigan P. et al. Adverse events reported from hyaluronic acid dermal filler injections to the facial region: a systematic review and meta-analysis. Cureus 2023; 15: e38286.
5. Gozali M.V., Zhou B. Effective treatments of atrophic acne scars. J Clin Aesthet Dermatol 2015; 8(5): 33–40.