LAUSR

To the Editor: W e read with great interest the article entitled “Unfiltered Nanofat Injections Rejuvenate Postburn Scars of Face” by Jan et al. The authors compared the quality of postburn facial scars before and after injection of unfiltered nanofat by the changes of scores on the Patient Observer Scar Assessment Scale and pigmentation change of ImageJ scanning, showing significant improvement in scar quality. Several parameters were observed including pigmentation, thickness, relief, and pliability within the Patient Observer Scar Assessment Scale, and these data were definitely key to appearance of scars preoperatively and postoperatively. However, we believe that there could be further assessment on the improvement of facial mobility and symmetry, which is very important in facial esthetics particularly when the area of scar is relatively large. It would be more intuitionistic to see both static and dynamic figures in the anterior view in the further study. Fat grafting is a popular technique developing with rapid advancements in practice, within which there has occurred several versions of nanofat grafting. It is reported to be rich in mesenchymal stem cells, which are also called adipose-derived stem or stromal cells (ADSCs). There is ample evidence that ADSCs increase angiogenesis, induce mitosis in resident tissue cells, and are able to remodel extracellular matrix. Despite of several animal models and in vitro investigations of underlying molecular pathways, the effectiveness of ADSCs is still not clearly elucidated. In this study, there was neither nontreated nor placebo controls. It also lacked histological changes of the patients, which may better present the structure of the scars returned near to that of normal. Bruno et al found a better organization and alignment of collagen fibrils, better vascularization of the dermal papillae, less melanocytic activity in the epidermis, and increase of the amount of elastin fibers. On