الفهرس 
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Abstract
Stem cells are undifferentiated cells, which have the properties of self-renewal and differentiation for repair of the body. Stem cell may be adult, embryonic and fetal cells.
Amniotic fluid contains multiple fetal stem cells and also various types of cytokines and growth factors that are known to be important in normal wound healing. The use of growth factors in wound healing is well established, however, its use in skin rejuvenation and atrophic post-acne scars is considered an emerging novel treatment modality since few human studies discussed their clinical efficacy, using histological evaluation or any objective mean.
Most growth factors are large hydrophilic molecules that unlikely topically penetrate the epidermis in measurable quantities to produce pharmacologic effects. So, the cutaneous application of these growth factors should be accompanied with any mean that increase its penetration like creation of pinhole wounds using microneedling.
Several minimally invasive procedures are new modalities used for skin rejuvenation and scar remodeling. It includes; microdermabrasion, microneedling, chemical peeling, stem cell therapy and non-ablative lasers and light-based therapies.
Microneedling is a simple office technique that has many advantages when compared with other procedures. The most important is that the epidermis remains intact eliminating most of risks and side effects caused by chemical peeling or laser resurfacing.
The present study aims to evaluate clinically and histologically the use, efficacy and safety of AF-MSC-CM after microneedling for management of atrophic acne scars and facial aging.
In the present study, both sides of the face were treated with 5 sessions of skin microneedling using DR with 2 weeks interval. Meanwhile, AF-MSC-CM was added to the right side of the face after skin microneedling in both acne scarring and facial aging groups.
Atrophic post acne scars is one of the most dramatic consequences of inflammatory acne that can be debilitating to patients. It is characterized by enzymatic degradation of collagen fibers and subcutaneous fat.
In conclusion, AF-MSC-CM combined with microneedling proved to be more effective both clinically and histologically in management of atrophic post acne scars and facial aging than microneedling alone. Microneedling is considered an easy, safe, simple and effective method for dermal remodeling and increased epidermal thickness. Meanwhile, AF-MSC-CM combined with microneedling could augment its efficacy by decreasing abnormal elastic fibers and elastotic material and increasing collagen synthesis (collagen induction therapy), mainly through the effect of growth factors. Larger-scale in-vivo studies with a longer follow-up are mandatory to confirm such findings and to standardize the used protocols.