Early Postoperative Application of Botulinum Toxin Type A Prevents Hypertrophic Scarring after Epicanthoplasty: A Split-Face, Double-Blind, Randomized Trial

Abstract

Background: Postoperative hypertrophic scarring of the medial canthal area is a common phenomenon and deterrent for patients considering epicanthoplasty. Botulinum toxin type A has been reported for hypertrophic scar and keloid treatment. However, there is a lack of high-level evidence regarding the effects of botulinum toxin type A in the medial canthal area. Methods: In this split-face, double-blind, randomized trial, 43 consecutive consenting patients undergoing Park Z-epicanthoplasty were randomized to receive 5 U of botulinum toxin type A or the same volume of saline injections at days 6 to 7 postoperatively. Scars were assessed independently using the Vancouver Scar Scale, the visual analogue scale, and patient satisfaction rating at the 1-, 3-, and 6-month follow-ups. Results: Overall, 30 patients completed this trial. The botulinum toxin type A–treated side achieved significantly improved Vancouver Scar Scale scores. The most obvious improvements were observed at the 3-month follow-up visit. Among the four subscores of the Vancouver Scar Scale, the most significantly improved subscores were the height and pliability. The visual analogue scale scores also decreased significantly on the botulinum toxin type A–treated side at all three follow-up visits. Approximately 86.7 percent of the patients were satisfied with the scar and epicanthoplasty outcomes. No severe complications were reported. Conclusions: Early postoperative botulinum toxin type A injection in the medial canthal region efficiently reduces hypertrophic scarring and improves the outcome of epicanthoplasty. Therefore, botulinum toxin type A injection can be used as a routine method to prevent hypertrophic scarring and improve the outcome of epicanthoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Efficacy and Safety of Botulinum Toxin Type A in Preventing Postoperative Scars and Improving the Cosmetic Appearance of Scars: A Systematic Review and Meta-Analysis

“…Among these removed studies, 5 were conducted on animals; 3 were letters; 4 were reviews; 4 lacked a control group; 2 were case reports; and 3 had incomplete data. Finally, 12 studies [12][13][14][15][16][17][18][19][20][21][22][23] involving 497 cases (372 patients) were identified and included in the meta-analysis ( Figure 1).…”

“…These studies were conducted in patients from several different countries, as shown in Table 1. Ten studies compared a BTXA group with a saline group, [12][13][14][15][17][18][19][20][21]23 and 2 studies compared a BTXA group with a blank control group. 16,22 Several different types of BTXA products were reported, as shown in Table 2.…”

“…16,22 Several different types of BTXA products were reported, as shown in Table 2. All studies evaluated surgical scars, of which 9 evaluated facial scars [13][14][15][16][18][19][20]22,23 ; 2 neck scars 12,21 ; and 1 thoracic wall scars. 17 Nine studies had a follow-up duration of 6 months [13][14][15][16][17][19][20][21]23 ; 2 studies had a follow-up duration of 12 months 12,22 ; and 1 study had a follow-up duration of 27 months.…”

“…All studies evaluated surgical scars, of which 9 evaluated facial scars [13][14][15][16][18][19][20]22,23 ; 2 neck scars 12,21 ; and 1 thoracic wall scars. 17 Nine studies had a follow-up duration of 6 months [13][14][15][16][17][19][20][21]23 ; 2 studies had a follow-up duration of 12 months 12,22 ; and 1 study had a follow-up duration of 27 months. 18 A total of 8 studies reported the VAS score [13][14][15][18][19][20]22,23 ; 8 studies reported the VSS score 12,13,[15][16][17]19,20,22 ; 5 studies reported the scar width [15][16][17]19,20 ; and 4 studies reported patient satisfaction.…”

“…18 A total of 8 studies reported the VAS score [13][14][15][18][19][20]22,23 ; 8 studies reported the VSS score 12,13,[15][16][17]19,20,22 ; 5 studies reported the scar width [15][16][17]19,20 ; and 4 studies reported patient satisfaction. 13,17,21,22 Quality Assessment…”