摘要

Objectives: Evaluation of the efficacy, safety, and durability of cross-linked hyaluronic acid filler injections into and through facial atrophic scars. Introduction: Facial atrophic scars, commonly caused by acne vulgaris, may also result from varicella-zoster infection or trauma. These scars pose therapeutic challenges due to dermal volume loss and psychosocial burden. Multiple treatments exist—HA fillers, PRP, lasers, peels, microneedling—but efficacy is variable and evidence remains limited. A Cochrane review suggests dermal fillers may help, though data quality is low. Recent studies show cross-linked HA fillers may offer durable, safe, and well-tolerated outcomes for atrophic scar management. Materials / method: Twenty selected patients received cross-linked hyaluronic acid fillers into atrophic scars. Based on the depth and type of each scar, either high G-prime or low G-prime cross-linked HA fillers were injected from multiple or single entry points using the superficial repetitive scar fillers technique to form a mesh-like web of HA filler. 30G needles were used, and 0.001–0.005 ml of HA was injected during each entry. Injections were performed in multiple sessions at ≥14-day intervals. Outcomes were evaluated at 1, 3, 6, 9, 13 months, and were recorded and photographed under multi-angle lighting. Results: All rolling scars healed with scar fillers. At each appointment, facial scars showed significant improvement. Most of the rolling scars achieved complete healing with sufficient scar filler sessions. Boxcar scars showed a variable extent of improvement; some completely healed and exhibited a smooth surface transition with the surrounding skin, while others showed only mild improvement. The 6th, 9th, and 13th-month results were encouraging in terms of aesthetic appearance and patient satisfaction. Fillers showed no reduction or degradation, maintaining their longevity and effect. Conclusion: Rolling and boxcar scars can be completely smoothed and flattened with cross-linked hyaluronic acid fillers, and the results can be maintained for more than 1 year. No significant adverse effects were observed during the 13-month post-treatment period, while patients' satisfaction with the results was extremely high.