Extracorporeal Shock Wave Stimulates Angiogenesis and Collagen Production in Facial Soft Tissue

J Surg Res. 2020 Jan;245:483-491. doi: 10.1016/j.jss.2019.06.077. Epub 2019 Aug 22.


Background: This study investigated the efficacy of extracorporeal shock wave (ESW) application in stimulating dermal thickness, vascularity, and collagen synthesis of facial skin in a large animal model.

Materials and methods: The facial skin of the maxillary and mandibular areas of goats (n = 6 per group) was treated with ESWs of different intensities (0.15 and 0.45 mJ/mm2; 1000 pulses). After 4 d, histology and immunohistochemistry were used to evaluate the following: dermal thickness, total number and abundance of microvessels, amount of type 1 collagen, and α-smooth muscle actin expression.

Results: Dermal thickness, number and abundance of microvessels, and collagen synthesis increased after ESW application at both intensities (each P < 0.05). When comparing ESW groups, the highest collagen abundance was seen after 0.15 mJ/mm2 (P = 0.034), whereas the highest number of microvessels was detected after treatment with 0.45 mJ/mm2 (P = 0.002).

Conclusions: A single-session application of focused low-energy ESWs to facial skin can increase dermal thickness by stimulating collagen production and local microcirculation. These findings commend the technique for future investigation for pretreatment of local or microvascular skin flaps to enhance tissue healing.

Keywords: Angiogenesis; Dermal thickness; Extracorporeal shock wave; Flap surgery; Skin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Collagen / metabolism*
  • Disease Models, Animal
  • Face / surgery*
  • Goats
  • High-Energy Shock Waves / therapeutic use*
  • Humans
  • Male
  • Models, Animal
  • Neovascularization, Physiologic / radiation effects*
  • Skin / blood supply
  • Skin / metabolism
  • Skin / radiation effects*
  • Surgical Flaps / blood supply
  • Surgical Wound / radiotherapy
  • Wound Healing / radiation effects


  • Collagen