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Objectives: 1. Characterise the normal wound healing process versus abnormal scarring;
2. Discuss the theoretical rationale behind autologous fat use for scar treatment;
3. Describe the surgical technique used for difficult scar fat grafting;
4. Present the clinical results of difficult scar treatment with autologous fat injections in a plastic surgeons' practice.

Introduction: The use of autologous fat, which was once considered to be a purely aesthetic procedure (e.g. "lipofilling"), nowadays has gained multiple applications in many fields of medicine. For instance, fat and its components have shown to possess pronounced antifibrotic properties in the setting of both dermal and internal organ fibrosis. The underlying mechanisms of this action seem to be mediated by adipose-derived stem cells and their soluble products, which are an inherent component of fat tissue.

Materials / method: In this work, we provide an overview of the putative antifibrotic mechanisms of adipose-derived stem cells, based on the current literature. We point out the crucial steps of the pathological scarring process that can be affected by the biologic actions of fat tissue. Further, we describe the surgical technique that has been developed for fat grafting of difficult dermal scars (harvesting, processing and injection). Finally, we present clinical cases of pronounced dermal fibrosis that have benefited from this fat grafting technique.

Results: Multiple clinical studies and observations have demonstrated the beneficial effects of fat tissue and its components in the setting of dermal and non-dermal fibrosis. These effects are mediated by adipose-derived stem cells that reside within the fat tissue, as well as their secreted soluble factors. The abundance and ease of accessibility of autologous fat tissue, as well as its plasticity allows to develop different lipoaspirate products that are simple to obtain and use for surgical treatment of difficult scars with positive clinical results.

Conclusion: Autologous fat is a potent source of therapeutical products that have been shown to reduce dermal fibrosis due to the actions of adipose-derived stem cells and their soluble factors.

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Objectives: The main aim of the scar treatment is to have a good aesthetic result, restoration of functional activity in the scar zone and, of course, satisfied patient. In this report we tried to analyze our success and failures based on the pathophysiologic aspects and stages of wound healing process.

Introduction: In everyday practice dermatologists meet patients with scars. The main aim of the treatment is to minimize the scar or to replace the scar tissue by healthy one completely. To reach the best aesthetic results we should use the combination of different approaches according to the etiology, the stage of the wound healing process and histologic type of the scar. There is no scar treatment consensus or common protocols accepted. But according to knowledge in pathophysiology we understand what methods should be used in different stages of wound healing process to avoid pathological scars and to

Materials / method: In this report we introduce clinical cases of combined scar treatment using physiotherapy (microcurrent technology, LDM technology, lymphatic drainage methods) and laser methods (IPL, Er-Glass, CO2), injections (mesotherapy with hyaluronic acid, aminoacids, vitamins, antioxidants, collagen, botulinum toxin) and topical treatments. The methods are well-known, but what is the best way to combine them… This is our experience in combined treatment of different types of cicatritial changes according the type of scar, the time of its existence, the localization.

Results: In this report we’ll see different methods of treatment in terms of clinical cases. In all cases we used combined treatment: physiotherapy, laser treatment, injections in different combinations and local treatment with topical solutions.

Conclusion: Today we have a lot of combinations of treatment cicatrificial tissue, which help us minimize or totally displace almost every type of scar deformation. The key to successful scar treatment is the early beginning and right combination of methods based on the pathophysiology of wound healing process.

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