Mechanobiological Stimulation With Nanoencapsulated Recombinant Growth Factors Combined With Subcision for the Treatment of Complex Post-traumatic Atrophic Facial Scars: A Case Report.

Post-traumatic atrophic scars represent a complex therapeutic challenge whose pathophysiology involves three concurrent structural deficits: reticular dermis degradation, formation of vertical fibrous tracts that anchor the skin to deep planes, and subcutaneous lipoatrophy. We present a three-session multimodal protocol at two-week intervals, applied to a 53-year-old female patient with atrophic scars of the right hemiface secondary to a motor vehicle accident, refractory to prior reconstructive surgery, autologous fat transfer, and 10 sessions of fractional CO₂ laser. The protocol integrated tumescent hydrodissection, subcision with a 22G blunt cannula, controlled adipose tunneling to activate the stromal vascular fraction (SVF) in situ, and immediate transepidermal and retrograde delivery of nanoencapsulated recombinant human growth factors (rh-GF). Objective assessment using the Vancouver Scar Scale (VSS) demonstrated a 50% reduction in total score (from 6 to 3 points out of 14), with the greatest gains in pliability (4 → 2) and height (1 → 0), maintained at six months of follow-up. The patient spontaneously reported reduced sensation of pressure and facial stiffness, as well as improvement in her self-esteem and perceived quality of life. This single-case report - with the limitations inherent to this study design - provides preliminary evidence that justifies the development of prospective controlled studies to evaluate the integration of mechanotransduction, adipose regeneration, and molecular signaling in complex scar defects.