Co esponding au ho : Emmanouil Dandoulakis
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Nano echnology-based app oaches o sca minimiza ion in plas ic su ge y:
Sys ema ic o e iew and u u e pe spec i es
Emmanouil Dandoulakis *
Independen Medical Resea che , A hens, G eece.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1191-1200
Publica ion his o y: Recei ed on 06 July 2025; e ised on 14 Augus 2025; accep ed on 16 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2950
Abs ac
Sca ing is a signi ican p oblem in plas ic su ge y, which a ec s bo h aes he ic and unc ional esul s and leads o
psychological discom o . Classical me hods o sca ea men (su ge y, lase ea men , silicone shee ing) usually ha e
e y a iable ou comes wi h high ecu ence a es. They a e no good op ions o ea pa hological sca ing
(hype ophic and keloid sca s). Nano echnology has p o ided a - e ched solu ions o p oblems using unique
cha ac e is ics o he nanoma e ial, like imp o ed d ug deli e y, biocompa ibili y, and issue egene a i e p ope ies.
This sys ema ic e iew p o ides an o e iew o nano echnology applica ions o sca minimiza ion, wi h pa icula
emphasis on app oaches such as nanopa icle-media ed d ug deli e y, nanomic oneedles, nanosca olds, and
biomime ic nanoma e ials. Based on a e iew o li e a u e om 2015 o 2025, hese s udies demons a e po en ial
use ulness in egula ing wound healing phases, educing in lamma ion, and p omo ing sca less issue egene a ion.
Clinical applica ions o he e iew include he use o deli e able an i- ib o ic agen s and combina ion wi h s em cell
he apy o gi e supe io ou comes compa ed o s anda d managemen , as e ealed by highe mean Vancou e Sca
Scale sco es and low a es o ecu ence. I espec i e o he ad an ages, challenges like egula ions, cos o p oduc ion,
and sa e y issues in he long un do exis . This a icle aims o close he loop in nano echnology de elopmen be o e i s
applica ion in clinical p ac ice, o ecas ing he u u e, and assessing he po en ial o 3D-p in ed nanod essings using AI
o pe sonalized sca ea men . Di e en ly, nano echnology has he po en ial o change and ha e a signi ican posi i e
e ec on pa ien cases in plas ic su ge y h ough he en i onmen - iendly alliance be ween nanoscien is s and plas ic
su geons.
Keywo ds: Nano echnology; Sca Minimiza ion; Plas ic Su ge y; Wound Healing; Nanoma e ials
1. In oduc ion
Sca ing is a emendous pi all o plas ic su ge y and has signi ican impac s on aes he ics and unc ions. Sca s ha e
been ca ego ized in o h ee ypes: hype ophic, keloid, and a ophic, each wi h dis inc cha ac e is ics. The
hype ophic kind is aised ypes hough bound wi hin hose o wound, and hey may eg ess o disappea o e ime as
compa ed o keloid, which g ows e y as and ecu s a a es o 50-80 pe cen (Mus oe e al., 2002). A ophic sca s a e
hose ha emain dep essed, e.g., acne sca s, because o a lack o collagen. Pa hology sca ing huge sca s o hype ophic
and keloid sca s on he body has bo h physical and psychological e ec s in gene al, leading o physical symp oms o
pain and i ching among o he s, and also psychological e ec s o eeling unwo hy o a pe son and a g ea wish o a oid
social in e ac ions wi h o he s (B own e al., 2008). Con en ional me hods o managing he sca , e.g., su ge y, lase
ea men , and silicone shee ing, ha e se e al d awbacks. The excision su ge y o en leads o elapse o he sca , and
lase ea men , such as ac ional CO2 lase s, is also pe o med on a se ies o occasions, and has he isk o
complica ions, including hype pigmen a ion. Silicone shee ing is non-in asi e, bu i has he d awback o low
ep oducibili y and low pa ien adhe ence since i in ol es p olonged use. These weaknesses necessi a e he
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de elopmen o e ec i e new me hods o achie ing sca less healing, pa icula ly in he ield o plas ic su ge y, whe e
aes he ics play a c ucial ole. Recen wound healing s udies a e leading o new ad ancemen s and he de elopmen o
no el in e en ions o add ess hese issues, le e aging nano echnology.
Nano echnology, o manipula ion o ma e a he nanoscale (1-100 nm), has e olu ionized medical use h ough
nanomedicine, p o iding supe io app oaches o diagnosis, ea men , and p e en ion. Nanoma e ials, nanopa icles,
nanogels, and nanosca olds ha e special ea u es o high su ace a ea- o- olume a ios, high biocompa ibili y, and d ug
elease con ol. These p ope ies pe mi a ge ing o cellula and molecula pa hways o an excellen deg ee, and
he e o e, nano echnology is e y applicable o sca minimiza ion in plas ic su ge y. An i- ib o ic d ugs could also be
deli e ed using nanopa icles wi h a con olled elease o elimina e excessi e deposi ion o collagen, which is a
con ibu ing ac o o pa hological sca ing. Cons uc ed nanosca olds a e enabling sca less healing, some imes
mimicking he ex acellula ma ix o encou age he eg ow h o issues and in lamma o y-based healing. Chi osan
nanogels, in pa icula , acili a e wound healing wi h minimum du a ion o side e ec s (Moeini e al., 2020).
Nano echnology add esses he limi a ions o con en ional me hods, which a e cha ac e ized by a lack o signi ican
expandabili y and educed in asi eness. In he p eclinical ial, esea che s demons a ed ha he nano echnology-
based in e en ion can signi ican ly educe sca o ma ion, suppo ing he iew ha his echnology could become a
b eak h ough s a egy o ea ing sca s in clinical p ac ice.
This a icle in ends o p o ide a sys ema ic e iew o he nano echnology- ela ed me hods o applying sca
minimiza ion and analyze hei p ac ical e ec i eness, weaknesses, and possible success o ailu e in plas ic su ge y.
The e iew will combine he indings o ecen s udies in an a emp o e alua e he wound healing modula ion capaci y
o nanoma e ials, including nanopa icles, nanomic oneedles, and nanosca olds, in p e en ing o ea ing pa hological
sca ing. The goals will be o compa e he app oaches wi h he exis ing me hods, p esen obs acles o hei clinical
implemen a ion, and discuss he possible ways o wa d, including indi idualized nano he apies and compa ibili y wi h
egene a i e medicine. Risks and complexi ies o egula ions, as well as long- e m sa e y aspec s, will also be co e ed
o gi e a comple e o e iew o he ole o nano echnology in sca managemen in he e iew. This a icle can lead plas ic
su geons and esea che s o ways o c ea i e s eps in healing wi hou lea ing sca s, making pa ien s aes he ically and
unc ionally be e . The a icle ills he gap be ween he de elopmen o nano echnology and p ac ice in he clinic.
The p e e ed epo ing i ems o sys ema ic e iews and me a-analyses (PRISMA) guide he sys ema ic e iew o
p o ide me hodological igo . The da abases ha we e used in he s udy we e PubMed, Scopus, and Web o Science,
whe e a sea ch o ele an li e a u e agains sca minimiza ion using nano echnology was conduc ed o enable inclusion
o he la es de elopmen s in nano echnology. Pee - e iewed s udies wi h a ocus on he nano echnology applica ion in
sca p e en ion o ea men we e included in he scope o a icles published in English and included p eclinical and
clinical s udies. Non-English s udies and non-pee - e iewed a icles and s udies un ela ed o sca managemen we e
deemed exclusion c i e ia. The Boolean ope a o s we e used oge he wi h he keywo ds: nano echnology, sca
minimiza ion, plas ic su ge y, wound healing, and nanoma e ials. Da a ex ac ed in ol ed s udy o ma , ype o
nanoma e ial, and clinical esul (e.g., sco e on Vancou e Sca Scale), and limi a ions as epo ed. The quali y was
measu ed using ools such as Coch ane Risk o Bias in clinical ials and he SYRCLE isk o bias ool in p eclinical s udies.
This s ingen app oach p o ides sound e idence o examining he po en ial o nano echnology in sca managemen
in plas ic su ge y.
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Figu e 1 P isma Diag am
2. Backg ound: Sca Fo ma ion and Cu en Managemen S a egies
The p ocess o wound healing in ol es ou key s ages: hemos asis, in lamma ion, p oli e a ion, and emodeling.
Howe e , when hese p ocesses a e dys egula ed, hype ophic sca s, keloid sca s, o a ophic sca s may occu .
Hype ophic ones emain wi hin he con ines o a wound, Keloids sp ead beyond wound bo de s wi h high ecu ences
(50-80 pe cen ), and a ophic sca s gi e he pic u e o sunken spo s. Sca s a e physically and psychologically oubling.
The ea men o sca ing, which in ol es silicone shee ing, p essu e he apy, su ge y, and lase s, has al e na ing
e ec i eness, a high ecu ence a e, and side e ec s; he e o e, new nano echnological me hods a e equi ed in plas ic
su ge y o ea sca less healing.
2.1. Pa hophysiology o Sca Fo ma ion
Wound healing is a p ocess cha ac e ized by ou phases ha o e lap wi h one ano he : hemos asis, in lamma ion,
p oli e a ion, and emodeling, which a e essen ial in he p ocess o issue epai bu may be dys egula ed, esul ing in
pa hological sca s. To p e en bleeding, he i s e ec o hemos asis is he agg ega ion o pla ele s and he consequen
o ma ion o a clo , and he second is conside ed o be in lamma ion du ing which neu ophils and mac ophages
elimina e pa hogens and deb is (Gu ne e al., 2008). The p oli e a ion s age is i mly cha ac e ized by e-
epi helializa ion, angiogenesis, and p oduc ion o collagen by ib oblas s, which is acili a ed by cy okines such as
ans o ming g ow h ac o -be a (TGF-be a). Remodeling occu s a e mon hs o e en yea s o emodeling, ea anges
collagen in o o ms ha gi e an alizing s eng h. Dys egula ion o he ope a ion o hese p ocesses, mos commonly an
excessi e o ma ion o collagen and abno mali ies in he elease o cy okines, esul s in pa hological sca ing. An
example is an o e ac i e TGF-signaling ha inc eases ib oblas p oli e a ion and collagen o e p oduc ion, which
esul s in ele a ed sca s (Gaugli z e al., 2011). O he causes, like ch onic in lamma ion o gene ic inclina ions, wo sen
his imbalance. Excess collagen leads o hype ophic sca s, which a e obse ed along wound edges and can be e e sed
as hey go wi h ime. Keloids, on he con a y, g ow agg essi ely and ecu in 50 80% o cases because ib oblas s
con inue hei ac i i y and TGFB is no egula ed (Mus oe e al., 2002). Sca s such as acne also occu when he e is no
enough collagen p oduc ion, which esul s in ecessed skin known as a ophic sca s.
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Figu e 2 Sequen ial s ages o no mal wound healing: Hemos asis, In lamma ion, P oli e a ion, and Remodeling. Each
phase is essen ial o e ec i e issue epai , and dys egula ion may lead o pa hological sca ing. Adap ed om Tö en
& Buzgo (2023)
Dispa i ies be ween hype ophic sca s, keloids, and a ophic sca s a e ounded on hei cellula and molecula ac ions.
Hype ophic sca s ha e a s uc u ed appea ance o bundles o collagen, mode a e ascula i y, and commonly esol e
spon aneously o pa ially. The esis ance o he apeu ics s ems om keloids being diso ganized in collagen, con aining
excessi e ascula i y, and being in a pe manen in lamma o y s a e (Gaugli z e al., 2011). A ophic sca s, in u n, exhibi
diminished collagen and de mal ma ix, esul ing in he loss o issue. The di e en ailmen s poin o he esponsibili y
o a speci ic se o in e en ions, such as con en ional he apies, including su ge y o lase s, which, howe e , neglec
causa i e condi ions since keloids a e e y ecu en . These di e ences a e also essen ial o he design o he nex le el
o he apy, he nano echnology-based echniques, o egula e he wound healing esponse and a ain sca less esul s.
Figu e 3 Visual ep esen a ion o common sca ypes including a ophic, keloid, con ac u e, s e ch ma ks, and
hype ophic sca s. These dis inc pa e ns a ise om a iable collagen dynamics and in lamma o y esponses.
Adap ed om Tö en & Buzgo (2023)
2.2. T adi ional Sca Managemen Techniques
The me hods used in dealing wi h sca s ha e adi ionally been non-in asi e as well as in asi e, bu hey a e ine ec i e
mos o he ime. Silicone gel shee ing is also used as a non-in asi e solu ion ha hyd a es he sca and con ols he
le els o collagen p oduc ion, minimizing he hickness o hype ophic sca s by up o 50 pe cen in some pa ien s
(Ogawa, 2022). The mos widely applied p essu e he apy o hype ophic sca s caused by bu ns is mechanical
p essu e, which hal s collagen o e p oduc ion. Howe e , his me hod equi es cons an applica ion o e 6 mon hs o 1
yea , leading o poo pa ien compliance. Topical co icos e oids like iamcinolone elie e bo h in lamma o y and he
ac i i y o ib oblas s bu a e plagued by he isk o skin a ophy and unp edic able ou comes, especially keloids (Roques
& Téo , 2008). These non-in asi e p ocedu es a e a o dable and sa e, bu hey usually ail o p oduce a ge -speci ic
changes o he unde lying pa hophysiological p ocesses. This leads o inconsis en esul s and long- e m ea men
egimens ha pa ien s o en ind di icul o ollow, especially in cosme ically sensi i e a eas such as he ace.
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They include in asi e ea men s, such as su gical o lase ope a ions, c yo he apy, e c., o cu e se e e sca s, bu hey
a e e y oublesome. Su gical excision is no only associa ed wi h he emo al o sca issue, bu has high a es o keloid
ecu ence; 50-80 pe cen (Mus oe e al., 2002). Pulsed dye lase s, including ac ional CO2 lase s, imp o e he ex u e
and ascula i y o sca s, wi h up o 60 pe cen imp o emen wi h hype ophic sca s. Again, his in ol es a se ies o
expensi e isi s ha un he isk o causing hype pigmen a ion o discom o (Als e & Hand ick, 2000). Small keloids
espond well o c yo he apy, which, albei leading o hypopigmen a ion o he sca , canno be used on la ge sca s. The
weaknesses o hese in asi e me hods, such as high ecu ence a es, side e ec s, and a iabili y in e ec i eness, make
i e iden ha mo e al e na i e solu ions a e equi ed ha will be less in asi e and he e o e ha e ewe side e ec s
bu ha e g ea e e ec i eness. Nano echnology, wi h i s p omise o applica ion o a ge ed and minimally in asi e
me hods and he p omise o ensu ing sca less healing, p esen s i sel as a solu ion o his p oblem.
2.3. Need o Inno a i e App oaches
Sca managemen Demand is ueled by he lack o consis ency in esul s obse ed wi h con en ional me hods in plas ic
su ge y. Al hough hese me hods a e minimally in asi e, ha e low ecu ence a es, and a e pa ien - iendly, hey a e
p ima ily used o achie e bo h aes he ic and unc ional successes. The adi ional me hods, such as su gical emo al,
lase ea men , o silicone d essing, ha e high ecu ence a es (5060% in keloids), a long cou se o ea men , and
ad e se ou comes o hype pigmen a ion o skin a ophy (Mus oe e al., 2002; Ogawa, 2022). Such sho comings, as well
as he dissa is ac ion and discom o pa ien s expe ience, highligh he necessi y o inno a i e solu ions. Sca less cu ing
is o u mos alue o pa ien s (especially clien s o cosme ic ea men p ocedu es) so ha , wi hou any in asi e
p ocedu es o p olonged ea men imescale, he pa ien s could ge he bes aes he ic ou comes. New he apies,
he e o e, ha e o comba hese pi alls by a acking he molecula and cellula p ocesses o pa hological sca s, and a
he same ime be sa e and e ec i e.
Nano echnology has p o ided a adical way o b idging hese sho comings, u ilizing ema kable p ope ies o
nanoma e ials like p ecisely di ec ed medica ion anspo a ion o he a lic ed zone and imp o ed issue egene a ion.
Nanopa icles and nanosca olds may manipula e wound epai by he con olled deli e y o an i- ib o ic agen s o
g ow h ac o s and minimize o e p oduced collagen and in lamma ion (Moeini e al., 2020). In con as o he
con en ional ools, nano echnology allows he use o minimally in asi e ools (e.g., nanomic oneedles), which maximize
pa ien compliance and com o . Nano echnology can be used o ans o m sca managemen and could e en manage
o ha e sca less ea men in plas ic su gical p ocedu es by o e coming he cu en cons ain s o such he apies.
3. Nano echnology-Based App oaches o Sca Minimiza ion
Nano echnology is ans o ming he minimiza ion o sca s in plas ic su ge y, as nanoma e ials possess desi able
p ope ies such as a ge ed d ug deli e y and enhanced issue egene a ion. Nanoma e ials, nanopa icles, nanogels,
nanosca olds, and nanomic oneedles sol e he weaknesses o adi ional sca ea men , which has minimal
compliance and eoccu ence a e (Mus oe e al., 2002). Liposomal and polyme ic nanopa icles acili a e he local
adminis a ion o an i- ib o ic agen s, he eby p e en ing excessi e collagen deposi ion, a p ima y con ibu o o
hype ophic and keloid sca s (Gaugli z e al., 2011). Nano gels, such as hyalu onic acid-based gels, keep he wound
mois , he eby allowing i o heal wi hou a sca . Meanwhile, nano sca olds mimic he ex acellula ma ix, enhancing
issue epai . Nanomic oneedles do no cause pain when he apeu ics a e deli e ed o he epide mis o de mis; his is
in addi ion o inc eased abso babili y and he ac ha in asi eness is minimal (P ausni z, 2004). Nano echnology wi h
hese p ope ies can a ge such molecula pa hways as TGF-b signaling o p o ide he co ec , pa ien - iendly pa h
om sca ea men wi h plas ic su ge y, whe e he aes he ic ou come is an essen ial ac o .
In d ug deli e y, sca olds and nano echnology-based d ug deli e y sys ems a e he co e o e ec i e sca managemen .
Polyme ic nanopa icle deli e s an i-in lamma o y semi agen s o es ic ib osis, and gold nanopa icles educe
oxida i e s ess o imp o e wound sealing. In he ea men o keloids, nanomic oneedles a e used o p o ide TGF-
inhibi o and ha e p o en o pene a e deepe in o he de mis, demons a ing negligible sys emic impac (P ausni z,
2004). Chi osan-algina e p oduced h ough elec ospinning also p esen ed high po osi y and an imic obial
cha ac e is ics, along wi h eleasing g ow h ac o s such as VEGF o igge bo h angiogenesis and e-epi helializa ion
in skin egene a ion (Moeini e al., 2020). Nanosca olds loaded wi h s em cells enhance he a e o e-epi helialisa ion
in issue enginee ing. In con as , lipid nanopa icles a ge ing ke a inocy es induce neocollagenesis, which in u n
educes he possibili y o ib osis. These modali ies a e mo e e ec i e han s anda d me hods because hey add ess he
unde lying cause o pa hology (pa hology mechanisms) and o e a ious minimally in asi e al e na i es in e ms o
e icacy and pa ien compliance o sca p e en ion and ea men .
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Sca minimiza ion is also u he boos ed by he use o nanobiomime ic me hods and diagnos ics. An imic obial-loaded
elec ospun nano ibe s esemble skin s uc u e, inhibi in ec ion, and con ibu e owa ds sca less wound healing
(Balusamy e al., 2017). The quan um-posi ioned nano-scale senso , like nano senso s, can do eal- ime imaging o
in lamma ion and ascula iza ion. The e o e, i is easy o moni o he e ec i eness o ea men by de ec ion o he
bioma ke s (Michale e al., 2005). In medical e ms, such echnologies a e used o a oid su gical wound sca s. They a e
used o co ec hype ophic, keloid, and pos -acne sca s, being combined in o a ea men p og am wi h Bo ox o
hyalu onic acid compounds. The e a e s ill obs acles, including egula o y bo lenecks and long- e m sa e y isks, and
mo e esea ch is necessa y be o e hei mass use can happen. The capabili y o nano echnology o p o ide a ge ed and
low- ecu ence solu ions makes i he ool ha can ans o m he p ocess o plas ic su ge y o yield sca less esul s.
4. Recen Ad ancemen s and High-Impac S udies (2015–2025)
4.1. Key S udies on Nano echnology in Sca Minimiza ion
Nano echnology has expe ienced signi ican ad ancemen s in sca minimiza ion in he ecen pas (20152025),
speci ically on nanopa icles and an imic obial wound d essing. AgNPs a e powe ul obs acles o bac e ia and lowe
in ec ion in ch onic wounds, which is one o he signi ican ac o s o pa hological sca ing. As an example, he AgNP-
con aining poly(lac ic acid)/poly(e hylene glycol) nano ilm displayed concen a ion- and species-speci ic an imic obial
p ope ies agains S aphylococcus au eus and Pseudomonas ae uginosa o ensu e sca less wound healing by p o iding
a s e ile wound condi ion (Ba dania e al., 2020). These nano ilms also alle ia e oxida i e s ess, acili a ing issue
epai . The li e a u e has indica ed ha AgNPs p o ide p ospec s in he p e en ion o hype ophic and keloid sca s
h ough coun e ac ing he mic obial and in lamma o y causa i e ac o s, which a e mo e e ec i e han con en ional
d essings wi h minimal in ec ions.
Nanomic oneedles and nanosca olds also ha e an inc eased e ec on sca managemen . Jus like ex acellula ma ix,
sel -assembling pep ide nano ibe s acili a e he p oli e a ion o sca less healing by conse ing endogenous hemos asis
and cell mig a ion and ec ui ing cells in a s uc u e wi hou in lamma o y cells (Yang e al., 2022). Pho odynamic
he apy (PDT) wi h nanomic oneedles p o ides he pho osensi ize s, such as 5-aminole ulinic acid, o he keloid,
enhancing ansde mal deli e y and supp essing hype plasia o sca s by gene a ing eac i e oxygen species (Yu e al.,
2022). These a e high-impac pape s ha e eal how nano echnology can o e low- ecu ence and ye non-in asi e
solu ions ha blow he limi a ions o con en ional me hodologies ou o he wa e and clea he way owa ds
e o ma i e sca managemen in plas ic su ge y.
4.2. Compa a i e E icacy o Nano echnology-Based s. T adi ional Me hods
Me hods o sca educ ion based on nano echnology show be e clinical esul s han adi ional ones, which can be
p o en by be e Vancou e Sca Scale (VSS) sco es and cus ome sa is ac ion. Resea ch indica es ha he imp o emen
in he VSS sco es can each up o 60% compa ed o 30-40% o con en ional silicone shee ing when using nanopa icles
o enhance he apies like he use o sil e nanopa icle-loaded d essings, which also posi i ely a ec sca hickness and
e y hema mo e han he s anda d me hods (Ba dania e al., 2020). Nano echnology leads o an inc ease in pa ien
sa is ac ion since i educes he ime spen in ea men , along wi h he ime aken o heal, which is a conce n in e ms
o compliance wi h long- e m op ions, such as p essu e ga men s (Ogawa, 2022).
Nano echnology signi ican ly educes ecu ence a es and side e ec s, As an example, he use o silicone gel wi h
nanopa icles, including chi osan-based p epa a ions, esul s in he educ ion o he ecu ence o keloids o 20 30 once
i is used ins ead o 50 80 when s anda d silicone shee ing is applied (Mus oe e al., 2002; Moeini e al., 2020). These
p epa a ions educe side e ec s such as skin i i a ion o a ophy, which a e associa ed wi h co icos e oids o lase
he apy. Nano echnology can be used o adminis e he speci ic d ug and educe in lamma ion, ac ing as a low-
ecu ence in e en ion ha is also iendly o he pa ien , unlike any adi ional in e en ion o sca managemen in
plas ic su ge y.
4.3. P eclinical and Clinical T ials
The p eclinical and clinical expe imen s on nano echnology used o minimize sca s ha e shown posi i e e ec s,
especially in imp o ing wound healing and diminishing he o ma ion o ib o ic issue. Resea ch s udies in animal
models e eal po en ial an imic obial and an i-in lamma o y p ope ies due o sil e and gold nanopa icle o ma ions,
whe eas chi osan-based nanosca olds posi i ely a ec he e-epi helializa ion and ascula iza ion p ocesses (Moeini
e al., 2020; Ba dania e al., 2020). Phase I/II ials a e also cu en ly unde way on lipid nanopa icles and mic oneedle-
based a ge ed an i ib o ic deli e y sys ems ha demons a e s a is ically signi ican esul s in sca appea ance and
pa ien sa is ac ion a es (Yu e al., 2022).
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The e is, howe e , a p oblem in implemen ing hese inno a ions in o clinical p ac ice. Among hem a e egula o y
unce ain y, he absence o s anda diza ion in nanopa icle syn hesis, and low scalabili y (Tö en & Buzgo, 2023). Nano
medicine is also es ic ed by a lack o in o ma ion in nanomedicine, as well as he expensi e de elopmen al cos s o
clinicians. Va ious gaps ha e o be add essed ia in e disciplina y coope a ion and changes in egula ions (Solidum e
al., 2023).
4.4. High-Impac Publica ions
Sca minimiza ion has ecei ed ounda ional esea ch in nano echnology jou nal a icles in he Jou nal o
Nanobio echnology, Nanomedicine, and Plas ic and Recons uc i e Su ge y. These a e nanosca olds enginee ing,
nanopa icle-based d ug deli e y, and mic oneedle-based ansde mal he apies wi h signi ican wound healing
pa ame e s (Solidum e al., 2023; Yu e al., 2022).
Acco ding o sys ema ic e iews and me a-analyses, he e is a dec eased ecu ence o hype ophic and keloid sca s,
e-epi helializa ion, and nanoma e ials a e also sa e (Tö en & Buzgo, 2023). The e iews a i m ha in e en ions based
on nano echnology a e mo e success ul and sa is ac o y in pa ien s compa ed o adi ional he apies, which has
s eng hened hei inc eased applica ions in plas ic su ge y. These e iews highligh he supe io i y o nano echnology
in e en ions o e con en ional he apies, unde sco ing he g owing adop ion o nano echnology in plas ic su ge ies,
which is associa ed wi h imp o ed e icacy and pa ien sa is ac ion.
Figu e 4 O e iew o clinical applica ions o nanomedicine in plas ic and econs uc i e su ge y, including
chemo he apy, wound healing, bone egene a ion, and immune modula ion. Adap ed om Solidum e al. (2023)
5. Mechanisms o Ac ion
S a egies o sca minimiza ion empowe ed by nano echnology egula e he wound healing p ocess h ough he
de ini ion o impo an cellula and molecula mechanisms. Nanopa icles and nanosca olds egula e he in lamma o y
s age by he elease o an i-in lamma o y ac o s, dec easing ele a ed le els o cy okines, such as TGF-b, which is he
leading cause o inc easing collagen exp ession obse ed in hype ophic and keloid sca s (Gaugli z e al., 2011). An
example o nanopa icle nano echnology is he liposomal nanopa icles ha can guide he elease o an i- ib o ic
medicines ha p e en he g ow h o ib oblas s and induce he equi able p oduc ion o collagen. The nanosca olds, as
desc ibed by Bhima a hi e al. (2020), mimic he ex acellula ma ix and can p omo e cell mig a ion and ascula
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g ow h in pa ien s who succumb o i s sec e s, including e-epi helializa ion and angiogenesis (Moeini e al., 2020).
These p ocesses lessen sca o ma ion by maximizing issue epai and lowe ing ib osis.
The o he cha ac e is ic o nanoma e ials is ha hey con ain an i-in lamma o y and an imic obial cha ac e is ics,
which a e i al in he p ocess o sca less healing o wounds. Sil e nanopa icles-con aining wound d essing kill such
pa hogens as S aphylococcus au eus, p e en ing he occu ence o he in lamma ion caused by he in ec ion p esence
and he de e io a ion o he sca ing condi ion (Ba dania e al., 2020). TGF-β inhibi o s a e ansduced in o keloids
using nanomic oneedles, whose ela i e non-in asi eness has dis up ed he ib o ic pa hways (P ausni z, 2004). Also,
he nano opog aphy o he sca old imp o es cellula a achmen , minimizing in lamma ion and leading o an o de ly
deposi ion o collagen. Nano echnology has he po en ial o add ess he pa hological sca ing p oblem a i s sou ce by
a ge ing he in ol ed pa hways and p o iding p ac ical, p ecise in e en ions. This app oach su passes adi ional
in e en ions, which a ely a ge unde lying mechanisms.
6. Ad an ages and Limi a ions o Nano echnology-Based App oaches
6.1. Ad an ages
Enhanced D ug Deli e y: Nano echnology imp o es solubili y and bioa ailabili y o an i- ib o ic and an i-in lamma o y
d ugs, enabling p ecise a ge ing o sca - o ming pa hways. Liposomal and polyme ic nanopa icles p o ide con olled
elease, sus aining he apeu ic e ec s and educing dosing equency, which enhances pa ien compliance compa ed o
adi ional opical ea men s (Moeini e al., 2020; P ausni z, 2004).
Minimally In asi e Techniques: Nanomic oneedles deli e he apeu ics painlessly o he epide mis/de mis, minimizing
issue auma and in ec ion isk compa ed o su gical excision. Nanosca olds, ab ica ed ia elec ospinning, suppo
issue egene a ion wi hou in asi e implan a ion, p omo ing sca less healing by mimicking he ex acellula ma ix
(Balusamy e al., 2017; P ausni z, 2004).
Reduced Recu ence Ra es and Side E ec s: Nanopa icle-enhanced he apies, such as chi osan-based silicone gels,
lowe keloid ecu ence a es o 20–30% e sus 50–80% o s anda d me hods. Ta ge ed deli e y minimizes side
e ec s like skin a ophy o hype pigmen a ion, common wi h co icos e oids and lase s (Mus oe e al., 2002; Moeini e
al., 2020; Ogawa, 2022).
Po en ial o Pe sonalized Medicine: Nanoma e ials can be cus omized o pa ien -speci ic sca ypes, wi h ailo ed d ug
payloads o sca old designs op imizing ou comes. Nanosenso s, like quan um do s, enable eal- ime moni o ing o
in lamma ion and ea men e icacy, acili a ing indi idualized adjus men s o hype ophic o keloid sca s (Gaugli z
e al., 2011; Michale e al., 2005).
6.2. Limi a ions
High Cos o De elopmen and P oduc ion: The syn hesis o nanoma e ials, such as nanopa icles and nanosca olds,
in ol es complex p ocesses like elec ospinning o chemical conjuga ion, leading o ele a ed de elopmen and
manu ac u ing cos s. These expenses limi widesp ead adop ion, pa icula ly in esou ce-cons ained heal hca e
se ings, compa ed o cos -e ec i e adi ional ea men s like silicone shee ing (Moeini e al., 2020; Ogawa, 2022).
Regula o y Challenges: Nano echnology-based he apies ace s ingen egula o y hu dles, such as he FDA’s igo ous
app o al p ocess o nanomedicines, due o hei no el p ope ies and po en ial oxici y. The lack o s anda dized
guidelines o e alua ing nanoma e ials delays clinical ansla ion, unlike con en ional he apies wi h es ablished
p o ocols (Ven ola, 2012).
Limi ed Long-Te m Sa e y Da a: While nanoma e ials show p omise, long- e m sa e y da a a e sca ce, aising conce ns
abou po en ial oxici y, such as nanopa icle accumula ion in issues o un o eseen immune esponses. This
unce ain y hinde s clinical accep ance compa ed o well-s udied adi ional me hods (Gaugli z e al., 2011;
Obe dö s e e al., 2005).
Scalabili y and Accessibili y in Clinical Se ings: Scaling up nanoma e ial p oduc ion o consis en quali y and la ge-
scale use emains challenging. Addi ionally, he need o specialized equipmen and ained pe sonnel limi s
accessibili y in ou ine clinical p ac ice, pa icula ly in non-specialized plas ic su ge y se ings, unlike widely a ailable
con en ional ea men s (Ven ola, 2012).
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7. Compa ison wi h Con en ional T ea men s
Table 1 Compa ison wi h Con en ional T ea men s
Aspec
Nano echnology-Based T ea men s
Con en ional T ea men s
E icacy
Supe io ou comes, wi h up o 60% imp o emen in
Vancou e Sca Scale sco es due o a ge ed d ug
deli e y and issue egene a ion (Ba dania e al.,
2020).
Va iable e icacy, wi h 30–40% imp o emen
in sca appea ance; limi ed by inconsis en
esul s (Ogawa, 2022).
Recu ence
Ra es
Lowe ecu ence (20–30% o keloids) ia p ecise
deli e y o an i- ib o ic agen s, e.g., nanopa icle-
enhanced silicone gels (Moeini e al., 2020).
High ecu ence a es (50–80% o keloids)
wi h me hods like su gical excision (Mus oe e
al., 2002).
Side E ec s
Reduced side e ec s (e.g., minimal skin a ophy)
due o a ge ed deli e y, unlike co icos e oids o
lase s (Moeini e al., 2020; Ogawa, 2022).
Highe isk o side e ec s, including
hype pigmen a ion, pain, o a ophy om
lase s and co icos e oids (Als e & Hand ick,
2000).
Pa ien
Compliance
Enhanced compliance due o minimally in asi e
me hods (e.g., nanomic oneedles) and sho e
ea men du a ions (P ausni z, 2004).
Poo compliance due o p olonged ea men
(e.g., silicone shee ing, p essu e he apy) and
discom o (Ogawa, 2022).
8. Fu u e Pe spec i es
Newe echnologies in he ield o nano echnology hold he p omise o e olu ionizing he p ocess o sca minimiza ion.
3D-nano echnology-p in ed d essings ha change shape and posi ion acco ding o he opog aphy o he wound can
deli e speci ic d ugs as well as egene a e issue (Zhu e al., 2016). Quan um do s a e inno a i e nanosenso s due o
hei eal- ime wound moni o ing capabili y ha eads in lamma ion o in ec ion signals, p o iding he oppo uni y o
u ilize highe deg ees o p ecision in ea men (Michale e al., 2005). By in eg a ing AI o p edic i e analy ics, sca
managemen can be enhanced h ough he abili y o p edic healing ou comes, enabling p epa a o y changes o he apy
and su passing he eac i eness o adi ional me hods.
Indi idual sca he apy is ano he cen al a ea o ec ui men in he u u e, whe e nanoma e ials will be designed
a ound he sca ype in many pa ien s, e.g., cus omized nanopa icles (Gaugli z e al., 2011). Nano echnology and s em
cells o gene he apy used in combina ion he apy p omo e e-epi helializa ion and dec ease ib osis. Ne e heless,
such issues as he possible nano oxici y, he o e all p oblems o high p oduc ion p ices, and he necessi y o equi ed
su geon aining emain (Obe dö s e e al., 2005). The s anda diza ion o he FDA app o al p ocesses and he
enac men o in e na ional sa e y s anda ds a e essen ial. Regene a i e medicine, coupled wi h nano echnology-
induced sca less healing, has he po en ial o c ea e he bes unc ional and cosme ic esul s o plas ic su ge y.
9. Conclusion
The p ospec o nano echnology is e olu iona y in minimizing sca s when applied in plas ic su ge y. Nanoma e ials,
such as nanopa icles and nanosca olds, can be used o achie e simila esul s wi h signi ican ly be e ou comes,
ma ked by subs an ial changes in sca appea ance and ecu ence. Mo e s udies and human expe imen s a e needed o
o e come such issues as nano oxici y and egula o y ba ie s. To ease adop ion, nanoscien is s, plas ic su geons, and
egula o y au ho i ies mus collabo a e. Nano echnology ep esen s a pa adigm shi , holding he u u e p omise o
elimina ing sca ing in wound healing and enhancing he ou comes o aes he ic and unc ional wound es o a ion.
Re e ences
[1] Als e , T. S., & Hand ick, C. (2000). Lase ea men o hype ophic sca s, keloids, and s iae. Semina s in
Cu aneous Medicine and Su ge y, 19(4), 287–292.
[2] Balusamy, B., Sen hamizhan, A., & Uya , T. (2017). Elec ospun nano ib ous ma e ials o wound healing
applica ions. In Elec ospun ma e ials o issue enginee ing and biomedical applica ions: Resea ch, design and
comme cializa ion (pp. 147–177). Woodhead Publishing.
