Comparison of microneedling and CO2 laser with adipose-derived stem cells for facial rejuvenation: a randomized split-face study.

Background: Facial aging, characterized by structural decline and loss of collagen and elastin, has led to increased demand for rejuvenation treatments. Adipose-derived stem cells (ADSCs) have emerged as a promising option, but comparative studies on their application methods are limited.

Objective: Our aim was to compare the efficacy of ADSC combined with microneedling or CO₂ laser for facial rejuvenation.

Methods: Twenty-seven participants were randomized into two groups: Microneedling (MN, n = 14) or CO₂ laser (n = 13). Each group underwent three treatment sessions at 4-week intervals. The ADSC solution was applied to one side and the placebo to the other using a split-face design. We performed objective evaluations (UV spots, brown spots, wrinkles, texture, pores, red areas, and porphyrins) and subjective assessments, including clinical photographs, patient satisfaction scales, and histological analysis of skin biopsies.

Results: The CO₂ laser with the ADSC group showed significantly more significant improvements in UV spots (P = 0.002) and wrinkles (P = 0.002) compared to the MN with the ADSC group. Histological analysis revealed superior elastin fibers and epidermal thickness improvements with CO₂ laser treatment. Patient satisfaction was higher in the CO₂ laser group, with 84.6% reporting complete satisfaction compared to 50% in the MN group.

Conclusions: The combination of CO₂ laser with ADSCs demonstrated superior efficacy for facial rejuvenation compared to MN with ADSCs. This approach improved UV spots, wrinkles, skin structure, and overall patient satisfaction. Further studies with larger cohorts and extended follow-up are needed to confirm long-term efficacy.