Topical Peptide Technology and the Scarring Spectrum: Linking Mechanistic Pathways to Internal Scarring (Fibrous Banding) and External Scarring (Incisional) and Outcomes in Postsurgical Healing

Surgery results in external scars and internal scars (subcutaneous fibrous banding). Although external scarring is well understood, internal fibrous banding is less studied, despite its impact on comfort, mobility, and recovery in surgical patients. Alastin ReFORM & RePAIR COMPLEX with TriHex Technology (R&R) is a peptide-based formula that remodels the extracellular matrix (ECM). It has been tested in multiple clinical trials, showing it stimulates autophagy and macrophage repolarization. The aim was to outline the mechanistic and clinical evidence related to both internal and external scarring. They conducted a secondary analysis of 3 split-body clinical trials, with proposed mechanistic explanations extrapolated. Endpoints assessed included patient-reported outcome measures, blinded investigator ratings, ultrasound, histology, and photographic scar evaluations. Cellular secretome, interleukin-6 (IL-6) modulation, and autophagic clearance of lipid droplets and ECM remodeling provide a mechanistic explanation for the observed effects. In body contouring procedures, R&R significantly accelerated the resolution fibrous banding compared with comparators in split-body studies. Ultrasound confirmation and histology showed reconstituted ECM on the R&R-treated side. External scar assessment revealed improved subjective scar quality over time. These outcomes are mechanistically linked to the autophagic clearance of lipid droplets, ECM remodeling, and macrophage polarization, which are influenced by IL-6 and modulate the transition from inflammation to regeneration. R&R influences the spectrum of surgical scarring, affecting both internal and external scars. The scar spectrum broadens traditional views of postoperative healing, emphasizing internal fibrous banding as a measurable outcome and positioning a topical formulation as a credible additional tool in perisurgical care. <b>Level of Evidence</b>: 2 (Therapeutic).