Recombinant Platelet-Derived Growth Factor BB vs Autologous Nanofat to Enhance Recovery After CO2 Laser and Microneedling: A Split-Face, Randomized Controlled Trial.

Nanofat has been used as a "rescue" modality to support healing after CO2 laser resurfacing with microneedling. Because demand grows for less invasive facial rejuvenation options, recombinant platelet-derived growth factor (rhPDGF-BB) has emerged as a popular adjunct to enhance postresurfacing recovery. The aim of this study was to compare autologous Nanofat to rhPDGF-BB as rescue treatments for pain and skin recovery following combined thermal and mechanical injury for improvement of facial rhytids. Five patients underwent full-face CO2 laser treatment followed by microneedling. Each patient received split-face randomization: one side was treated with Nanofat and the contralateral side with rhPDGF-BB (300 µg/mL). Patients were blinded to allocation. Standardized 3 mm biopsies were obtained at baseline and at postprocedure Day 4, 1 month, 3 months, and 6 months and evaluated by a blinded board-certified histopathologist. Outcomes included practitioner- and patient-reported Perioral Rhytid Severity Rating Scale (PR-SRS), Global Aesthetic Improvement Scale (GAIS), and patient satisfaction. Both treatments improved patient/practitioner PR-SRS and GAIS beginning on Day 4 and continuing through 6 months. There were no significant differences between treatment groups (P > .05). Patients reported high satisfaction with both treatment groups. Overall, histopathology assessments demonstrated that both Nanofat and rhPDGF-BB supported normal wound healing and produced comparable tissue remodeling over time. Differences between treatments were subtle and confined to the early inflammatory interval, with Nanofat showing a consistently milder inflammatory response. This is the first human histologic split-face study of rhPDGF-BB in facial rejuvenation. This preliminary study found that either Nanofat or rhPDGF-BB treatment following full-face CO2 laser treatment and microneedling resulted in improved clinical and histologic outcomes. Nanofat showed milder early inflammatory changes, but both treatments produced normal wound healing and robust extracellular matrix formation and comparable tissue remodeling by 1, 3, and 6 months. Level of Evidence: 2 (Therapeutic).