Reply: Effectiveness of Autologous Fat Grafting in Adherent Scars

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We would like to thank the authors for their valuable comments on our article, “Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol.”1 We would also like to thank the authors for pointing at their promising data on the treatment of retractile and painful scars using autologous fat grafting.2 Their findings strengthen our results, as they also found improvement in scar quality and elasticity. Their efforts are highly appreciated also because they used subjective and objective measurement tools such as the Patient and Observer Scar Assessment Scale and the durometer. The authors reported on the use of that scale and on modifications of the current version (Version 2.0; www.posas.org).3 Although we do appreciate their enthusiasm for improving the Patient and Observer Scar Assessment Scale, we think that any additions or changes to this validated, internationally accepted, and now widely used scale should be conducted in a coordinated fashion. It would certainly have a negative impact on the relevance and generalizability of the Patient and Observer Scar Assessment Scale if different groups start using different variants of the scale. Therefore, we are pleased to present the Patient and Observer Scar Assessment Scale 3.0 project, which started recently. The authors are kindly invited to join the international expert panel that is currently set up. Those who are interested in participating in the expert panel can contact us at ppmvanzuijlen@me.com.
To evaluate whether the positive outcomes of both cited studies are a reflection of the presence of new adipocytes or the remodeling of scar tissue induced by adipose-derived stem cells, future studies are necessary. Imaging techniques such as high-frequency ultrasound and third-harmonic-generation microscopy (advanced optical three-dimensional imaging) could help us to expand our knowledge on the biological effects of autologous fat grafting and to evaluate the presence and/or viability of fat grafts over time. Furthermore, as also reported by the authors, the applicability of autologous fat grafting reaches much further than the treatment of problematic scars. Many benefits are attributed to the technique, which promotes use in a wide range of indications. Accordingly, it is important to continuously expand scientific data so that the use of autologous fat grafting in clinical practice is increasingly supported.
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