Clinical and Histopathological Evaluation of Combined Nanofat Grafting and Fractional CO₂ Laser (“Adipolaser”) for Post-Burn Scars: A Prospective Two-Arm Interventional Study.

ABSTRACT Background: Post-burn scars commonly result in functional limitation and cosmetic disfigurement due to abnormal collagen remodeling, persistent inflammation, and altered dermal architecture. Recent regenerative approaches aim to improve scar quality rather than simple resurfacing. Nanofat grafting provides a rich source of stromal vascular fraction with regenerative and anti-fibrotic effects, while fractional CO₂ laser induces controlled dermal injury, collagen remodeling, and enhanced tissue regeneration. The combined use of both modalities, known as “Adipolaser,” may potentiate clinical and histopathological improvement in post-burn scars (1–3). Aim: To evaluate the clinical and histopathological outcomes of two Adipolaser application protocols—same-session and staged sessions—in patients with mature post-burn scars. Methods: This prospective two-arm interventional study included 40 patients with mature post-burn scars. Patients were allocated into two protocols: Protocol A involved fractional CO₂ laser followed by nanofat grafting in the same session, while Protocol B involved staged sessions. Clinical assessment was performed using surgeon-based Vancouver Scar Scale (VSS), patient- reported VSS, patient satisfaction scoring, and standardized clinical photography. Histopathological evaluation using hematoxylin and eosin staining was conducted before and after treatment to assess collagen organization and dermal changes. Results: Both protocols demonstrated noticeable improvement in pigmentation, pliability, height, and overall scar appearance. Histopathological analysis revealed reduced collagen density, improved collagen bundle organization, and increased neovascularization, indicating active dermal remodeling (8,12). Conclusion: Adipolaser represents a safe and effective regenerative approach for the management of mature post-burn scars, with both application protocols achieving meaningful clinical and histopathological improvement.