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The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis

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A Correction to this article was published on 26 February 2024

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Abstract

Background

Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation.

Methods

A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool.

Results

A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers’ ratings, with a SMD of − 1.09 [95% CI: − 1.32; − 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was − 0.99 [96% CI: − 1.31; − 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations.

Conclusions

Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Authors and Affiliations

  1. Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA

    Mario Alessandri Bonetti, Jose Antonio Arellano, Hilary Y. Liu, Asim Ejaz, J. Peter Rubin & Francesco M. Egro

  2. Department of Plastic Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy

    Anna Scarabosio

  3. Residency Program in Orthopedics and Traumatology, University of Milan, 20141, Milan, Italy

    Riccardo Giorgino

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Alessandri Bonetti, M., Arellano, J.A., Scarabosio, A. et al. The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis. Aesth Plast Surg 48, 989–998 (2024). https://doi.org/10.1007/s00266-023-03828-8

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