Abstract

Objectives: This study aims to evaluate the safety and clinical efficacy of a novel combined approach—FILS (Fat Injection with Laser and Stem cells)—which integrates fractional ablative laser resurfacing with mechanically processed SVF-enriched autologous fat grafting. The primary goal is to assess improvements in scar severity, patient satisfaction, and tolerability over a 6-month follow-up period, using standardized clinical scales and non-invasive imaging techniques. Introduction: Atrophic acne scars are a frequent sequela of inflammatory acne, often resistant to single treatments. Fractional ablative lasers induce both dermal remodeling, while stromal vascular fraction (SVF)–enriched fat grafting provides regenerative and volumetric benefits. Here we propose FILS (Fat Injection with Laser and Stem cells), a novel combined protocol integrating fractional Er:YAG laser resurfacing with SVF-enriched microfat and nanofat. This study evaluates its safety and efficacy in the treatment of atrophic acne scars. Materials / method: Forty patients with atrophic acne scars received fractional ablative laser treatment followed by injection of SVF-enriched autologous microfat and nanofat. SVF fractions were prepared using a mechanical microfragmentation system that processes lipoaspirate into stem cell–rich micro- and nanofat without enzymatic digestion. Standardized photographs were taken at baseline, 1 and 6 months. Standardized clinical photographs were taken at baseline, 1 month, and 6 months using digital imaging and VISIA® complexion analysis system. Clinical improvement was assessed with GAIS (Global Aesthetic Improve Results: • GAIS (patient-reported): Median 2 (IQR: 2–3) at 1 month; 2 (IQR: 2–4) at 3 months (p=0.315 vs 1 month), indicating early improvement with sustained stability. • QGSGS: Median score decreased from 3 (IQR: 2–3) at baseline to 2 (IQR: 1–3) at 6 months (p<0.001).(Fig 1) • Satisfaction: Median 8/10 (IQR: 5–9). Negatively correlated with age (r=–0.385, p=0.023) and pain (r=–0.549, p=0.001). • Safety: Transient erythema (97.4%, median 3 days), edema (97.4%, median 7.5 days), and dryness (53.8%), all self-limiting. No serious adverse effects were observed. Conclusion: The FILS protocol, which combines fractional Er:YAG laser resurfacing with processed SVF-enriched fat grafting, resulted in significant scar score reduction and high patient satisfaction with minimal downtime. GAIS patient scores suggested an early improvement that may be preserved through 6 months. This reproducible, minimally invasive protocol appears safe and effective, providing both regenerative and volumetric improvement in acne scars.