ORIGINAL RESEARCH article
Front. Cell Dev. Biol.
Sec. Stem Cell Research
This article is part of the Research TopicInnovations in Regenerative Medicine: Harnessing the Power of CellsView all articles
Efficacy and Safety of Autologous Cell-Based Therapies for Atrophic Acne Scar Treatment: An Updated Systematic Review and Meta-Analysis with In-Depth Methodological and Clinical Insights
Provisionally accepted
- PLA Joint Service No. 903 Hospital, Hangzhou, Zhejiang, China., 杭州市, China
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Background: Atrophic acne scars represent a therapeutic challenge with significant psychosocial impact. Autologous cell-based therapies, such as stromal vascular fraction (SVF) and the ReCell® system, aim to address the underlying dermal matrix deficiency through regenerative mechanisms. This systematic review and meta-analysis provides an updated and comprehensive quantitative synthesis of their standalone efficacy and safety. Methods: We conducted a systematic search of multiple databases (PubMed, Embase, Cochrane Library, CNKI, Wanfang) from inception to December 2025 for randomized controlled trials (RCTs) and split-face studies comparing autologous cell therapies (SVF, ReCell, fat grafting) with control treatments (e.g., saline, laser alone) for atrophic acne scars. The primary outcome was the change in the ECCA grading score. Secondary outcomes included patient satisfaction, objective scar metrics, healing time, and adverse events. Data were pooled using random-effects models. Results: Eighteen studies involving 500 participants were included. Autologous cell therapies significantly reduced ECCA scores compared to controls (Standardized Mean Difference [SMD] = -1.25, 95% CI: -1.80 to -0.70, p < 0.001; I²=65%). Subgroup analysis indicated the largest effect size for SVF-based therapies (SMD = -1.40). Patient satisfaction was significantly higher in intervention groups (Risk Ratio [RR] = 1.45, 95% CI: 1.24 to 1.70). Objective outcomes also favored cell therapies, with greater scar depth reduction (Mean Difference [MD] = -0.25 mm, 95% CI: -0.41 to -0.10) and accelerated wound healing (MD = -2.5 days, 95% CI: -3.9 to -1.1). The overall incidence of adverse events was lower in the intervention groups (RR = 0.70, 95% CI: 0.50 to 0.98). Conclusion: Autologous cell-based therapies, particularly SVF, are effective and safe for improving atrophic acne scars, offering superior clinical, patient-reported, and safety outcomes compared to standard controls. The integration of detailed methodological insights provides a valuable evidence base to guide clinical protocol optimization and future research focused on standardization and long-term efficacy.
Keywords: Acne scars, atrophic, Autologous cell transplantation, Meta-analysis, Recell, Regenerative Medicine, Stromal vascular fraction
Received: 22 Dec 2025; Accepted: 13 Feb 2026.
Copyright: © 2026 Zhang, Ren, Hong, Shi, Si and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xudong Zhang
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