Clinical Evaluation of the Efficacy of Botulinum Toxin a for Improving Facial Scars (Randomized Clinical Trial)

Abstract

INTRODUCTION:Scars widen when the underlying musculature (frontalis muscles, procerus, and corrugator supercilii muscles) pulls apart suture lines, and scars oriented against relaxed skin tension lines (RSTL) are especially susceptible to these distraction forces. Because botulinum toxin A (BTA) induces complete muscle paralysis, the purpose of the current study was to evaluate the effects of BTA using both observer dependent qualitative assessments and quantitative measurements to verify its beneficial effects on facial scarring. OBJECTIVE: To evaluate the efficacy and safety of Botulinum Toxin type A injection on improving vertical or oblique facial scars when injected in early postoperative days. MATERIALS AND METHODS: Twelve individuals with vertical or oblique recent forehead lacerations were randomly selected. The sample was chosen based on a set of inclusion and exclusion criteria and was then randomized to one of two groups:The BTA injection was given to one group (n = 6) within five days of primary closure, while the other group (n = 6) received no further treatment. Assessment included measurement of wound width and Vancouver scar scale, along with clinical photographs. RESULTS: In comparison to the control group, patients treated with BTA injections had a significant improvement in VSS and a less gain in wound width. At the 3-and 6-month examinations, all significant changes were found, but not at the 1-month appointment. All cases showed uneventful healing. CONCLUSION: This study showed that when BTA injections are administrated during the early postoperative days it shows great improvement in the scar quality.

Effect of Botulinum Toxin on Surgical Wound Healing and Scar Formation (An Experimental Study)

“…Our attempt at early injection of botulinum toxin was consistent with a number of studies, as suggested by Sheta et al (9) who suggested that injection of botulinum toxin in the first 5 days after wound closure could improve forehead scar appearance. Additionally, Kim et al (23) reported successful results for thyroidectomy scars after 6 days of injection of botulinum toxin type A.…”

“…Wide hypertrophic scars have been an issue, but various solutions have been proposed; however, none of them prevent the pathologic process that causes wide hypertrophic scars, which is the distracting force of muscular pull. Since BTA toxin, which is generated by Clostridium botulinum, is a powerful neurotoxin that causes muscle paralysis by blocking acetylcholine release at the neuromuscular junction, it can be applied to reduce all tensile stresses coming from a surgical wound's underlying muscles (8,9).…”