Aesthetic Plastic Surgery

, Volume 43, Issue 2, pp 480–489 | Cite as

Managing Pathologic Scars by Injecting Auto-Cross-linked Hyaluronic Acid: A Preliminary Prospective Clinical Study

  • Michele Riccio
  • Andrea Marchesini
  • Letizia Senesi
  • Edlira Skrami
  • Rosaria Gesuita
  • Francesco De FrancescoEmail author
Original Article Non-Surgical Aesthetic



Pathological scars are unattractive and may significantly impair the patient’s quality of life. Current treatments provide inconsistent results, and none may be regarded as definitive. Recently, an auto-cross-linked hyaluronic acid (HA) formulation, IAL-SYSTEM ACP, featuring a long residence time and an enhanced safety profile, has been successfully used to prevent surgical adhesions, treat tendon lesions and rejuvenate the face and the décolletage. This study aims to preliminarily investigate whether IAL-SYSTEM ACP may also be effective in treating pathological scars resulting from burns, trauma or iatrogenic causes.


Patients presenting one pathological scar were prospectively recruited and treated with two IAL-SYSTEM ACP injections carried out two weeks apart. Scar improvement was measured comparing the patient and observer scar assessment scale (POSAS) scores collected before treatment (T0) and 90 days after the second injection (T90) using nonparametric tests. The effect of age and scar type over score variation was investigated through quantile regression analysis.


Forty-one patients, 10 women and 31 men (median age, 34 years) were recruited. No patient dropped out, and no significant adverse event was observed. At T90, the median observer total score decreased by 11 units (− 77.5%) and the median patient total score decreased by 15 units (− 73.7%). The difference was significant (p < 0.001) in both cases. Traumatic injuries and young patient’s age were the most significant predictors of a positive treatment outcome.


Treatment of pathological scars by two IAL-SYSTEM ACP injections, carried out two weeks apart, may provide significant clinical benefits. These findings should be the subject of further investigations.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Hypertrophic scar IAL-SYSTEM ACP Auto-cross-linked hyaluronic acid Dermal pliability Dermal thickness 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All subjects provide their informed consent.


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© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.SOD Chirurgia Ricostruttiva e Chirurgia della Mano (Department of Reconstructive Surgery and Hand Surgery)AOU “Ospedali Riuniti”AnconaItaly
  2. 2.Centre of Epidemiology, Biostatistics and Medical Information Technology“Politecnica delle Marche” UniversityAnconaItaly

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