# 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

## TL;DR

This study reviews and analyzes the effectiveness and safety of autologous cell therapies for treating atrophic acne scars, showing they significantly improve outcomes compared to standard treatments.

## Contribution

The paper provides an updated meta-analysis and methodological insights on autologous cell therapies for atrophic acne scars.

## Key findings

- Autologous cell therapies significantly reduced ECCA scores compared to controls.
- SVF-based therapies showed the largest effect size in improving acne scars.
- Cell therapies resulted in higher patient satisfaction and fewer adverse events.

## Abstract

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.

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.

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: 1.24–1.70). 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: 0.50–0.98).

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.