The Effectiveness of Nanofat in the Management of Skin Scars: A Systematic Review

Nanofat is an adipose tissue product obtained through mechanical emulsification, preserving stromal vascular fraction and extracellular matrix. Nanofat has been primarily investigated in the contexts of skin scar repair. This systematic review assesses existing evidence on the effectiveness of nanofat for various skin scar types. In this systematic review, we aim to evaluate the effectiveness of nanofat injections in improving skin scars compared with controls, considering clinical, radiographical, histological, and histomorphometrical outcomes. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases including MEDLINE, Embase, and the Cochrane Library were searched from January 2013 through March 2025. Studies involving human patients receiving nanofat for scar treatment were included. Risk-of-bias assessments were performed by the Cochrane RoB 2 tool for randomized controlled trials (RCTs) and the NIH Quality Assessment Tool for Pre-Post Studies lacking control groups. Of 415 identified publications, 12 studies were included, comprising 5 RCTs and 7 pre-post intervention studies. Participant numbers ranged from 12 to 48. Most studies reported substantial short-term improvements in scar appearance, texture, and patient satisfaction. Histologically, findings indicated increased skin thickness, improved neovascularization, and collagen deposition. However, 2 high-quality RCTs showed no sustained significant benefits beyond 12 months. Few minor complications were documented; no serious adverse events occurred. Overall, nanofat injections appear to be an effective, minimally invasive treatment for skin scars, particularly in the short term. Nonetheless, the long-term benefits are less certain, underscoring the importance of conducting further research by standardized protocols and extended follow-up periods to confirm these findings. Level of Evidence: 4 (Therapeutic).