Combination of concentrated growth factor and collagen filler for recalcitrant atrophic scars: Two case reports

Introduction

Foreign body granulomas following mesotherapy can result in severe and often underrecognized atrophic scarring that remains challenging to treat. Although anti-inflammatory therapies, including systemic agents and laser-based interventions, may facilitate granuloma resolution, associated dermal and subcutaneous destruction with fibrosis frequently leads to persistent atrophy or depressed scars. These lesions exhibit limited intrinsic capacity for repair and can significantly affect cosmetic appearance and quality of life.1, 2, 3 Clinically, these scars are characterized by dermal thinning and fibrosis, with limited response to conventional therapies, including energy-based modalities such as fractional laser and radiofrequency microneedling, as well as hyaluronic acid injections, highlighting the need for approaches that restore volume while promoting dermal regeneration.

Here, we report 2 cases of treatment-resistant post-granuloma atrophic scars managed with a regenerative approach combining autologous concentrated growth factor (CGF) and a collagen filler.

Cases

Case 1

A 34-year-old woman presented with facial swelling, diffuse nodules, and a persistent foreign body sensation 1 month after receiving a 10-mL facial injection of a composite solution containing “Cytocare 532,” polynucleotides, and additional unspecified components obtained outside our institution. According to the patient's recollection, the total volume administered was approximately 10 mL during a single treatment session; detailed information regarding injection technique could not be retrospectively obtained. Physical examination revealed bilateral subcutaneous induration of the cheeks. After 3 months of medical and laser-based therapy, the nodules resolved; however, extensive erythema, hyperpigmentation, and atrophic scarring developed. Prior treatments, including intense pulsed light and radiofrequency microneedling, were ineffective. One month after hyaluronic acid filler injection, a Tyndall effect appeared, accompanied by worsened hyperpigmentation, prompting a change in management.

A combination therapy with autologous CGF and a collagen filler was initiated. CGF was prepared from venous blood using a standardized centrifugation protocol and mixed 1:1 with a sterile medical-grade collagen filler. The mixture was injected using a microdroplet multipoint technique targeting the deep dermis to subcutaneous plane to release fibrotic adhesions and restore tissue volume. Two treatment sessions were performed at 2-month intervals.

At 12-month follow-up, the patient demonstrated marked improvement. The atrophic scars were substantially reduced, and the Tyndall effect had resolved (Fig 1). Objective assessments also showed improvement, with Vancouver Scar Scale (VSS) and Physician Global Assessment (PGA) scores decreasing from 6 to 1 and from 5 to 1, respectively. The patient reported high satisfaction, and no treatment-related adverse events were observed during follow-up.

Fig 1.

Patient 1: (A) Pretreatment views showing atrophic scars. B, Twelve-month post-treatment clinical photographs demonstrating significant improvement.

Case 2

A 42-year-old woman presented with a 2-year history of facial depressed scars following mesotherapy (5 mL composite solution with incompletely known composition). She had previously developed foreign body granulomas that resolved with medical therapy but resulted in diffuse atrophic scarring. Prior radiofrequency microneedling and fractional laser treatments were unsuccessful.

The same CGF–collagen combination therapy was performed using an identical preparation and injection protocol. Three treatment sessions were administered at 2-month intervals.

At 9-m follow-up, there was notable improvement in scar volume, surface texture, and erythema (Fig 2). Objective assessments showed that VSS and PGA scores improved from 8 to 0 and from 5 to 1, respectively. The patient was satisfied with the outcome, and no treatment-related adverse events were observed during follow-up.

Fig 2.

Patient 2: (A) Pretreatment views showing diffuse atrophic scars. B, Nine-month post-treatment views demonstrating marked improvement in volume and erythema.

Discussion

Post-granuloma atrophic scarring is a clinically challenging sequela of mesotherapy with limited effective treatment options. In this report, a combined regenerative strategy using CGF and a collagen filler was associated with sustained clinical improvement in 2 refractory cases.

Unlike acne scars, postgranuloma atrophic scars arise from deeper and more destructive processes. Contributing mechanisms are thought to include collagen degradation and necrosis during granuloma formation, inflammation-mediated suppression of collagen synthesis, persistent foreign material, and localized fat loss. Consequently, these lesions often respond poorly to energy-based treatments alone, which do not adequately address volume depletion.⁴

Conventional fillers provide temporary volumization but do not restore the damaged dermal matrix. The combined approach described here addresses both structural and biological deficits. The collagen filler provides immediate support and volume restoration, while its intrinsic color may help visually reduce postinflammatory hyperpigmentation,⁵ as reflected by the resolution of the Tyndall effect in case 1. Meanwhile, CGF is believed to provide a sustained release of growth factors—including vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor–β—which promote neovascularization, stimulate fibroblast activity, and enhance neocollagenesis.⁶ Compared with platelet-rich plasma, CGF may provide a denser fibrin matrix and a more sustained release of growth factors, which may enhance tissue regeneration. This synergistic “scaffold-plus-signal” strategy may contribute to the durable clinical improvements observed.⁷ Objective VSS and PGA assessments further supported the observed improvements across scar volume, texture, and erythema. Both patients maintained sustained clinical improvement without adverse events during follow-up.

The incompletely known composition of injected materials reflects a common real-world challenge in mesotherapy-related complications. Reports on the use of combined CGF and collagen filler for postgranuloma atrophic scars remain scarce. Compared with alternative approaches such as nanofat grafting or repeated hyaluronic acid injections, this method is relatively simple and well tolerated, with positive clinical responses observed in both patients.

Limitations include the small sample size and lack of standardized CGF protocols; however, the consistent and durable improvement observed in these refractory cases supports the potential reproducibility of this approach. These findings should be interpreted with caution but highlight a promising therapeutic direction. This approach may offer a practical, minimally invasive option for clinicians managing treatment-resistant postgranuloma atrophy and may help inform future regenerative strategies.

Conflicts of interest

None disclosed.