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

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Scars with poor cosmesis that develop after wound healing may affect normal life. </jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p> To assess the efficacy and safety of botulinum toxin type A (BTXA) in preventing postoperative hypertrophic scars or keloids. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A systematic review was performed by searching the PubMed, Cochrane Library, and EMBASE databases from their inception date up to February 2020 for randomized controlled trials (RCTs) evaluating the efficacy of BTXA in preventing hypertrophic scars or keloids. The primary outcome measures included the Vancouver Scar Scale (VSS) score, Visual Analog Scale (VAS) score, scar width, patient satisfaction, and adverse events. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Twelve RCTs involving 497 cases (372 patients) were included. The meta-analysis showed significant differences in the VAS score (weighted mean difference [WMD] = 1.31, 95% CI = 1.06 to 1.55, P &lt; .00001), VSS score (WMD = −1.02, 95% CI = −1.72 to −0.32, P = .004), scar width (WMD = −0.18, 95% CI = −0.29 to −0.08, P = .0008), and patient satisfaction (relative risk = 1.25, 95% CI = 1.06-1.49, P = .01). Four studies reported trivial adverse events. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> This meta-analysis showed that BTXA was more effective than the control treatment in preventing postoperative scars and improving the cosmetic appearance of facial scars for East Asians, and no serious adverse events were found during the follow-up period. However, there was insufficient evidence to support the use of BTXA for the prevention of scars in patients from other ethnic groups and regions or scars in non-facial areas. </jats:p></jats:sec>

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

“…It has also been proven to be safe and reliable, with reversible side effects. Several trials have suggested that Botulinum Toxin type A can be injected into adjacent musculature around traumatic or incisional wounds (2,(12)(13)(14)(15)(16)(17). The purpose of this clinical trial was to evaluate the effectiveness of BTA using qualitative assessment and quantitative measurements to verify its positive effect on facial scarring.…”

Efficacy of Botulinum Toxin A for Scar Prevention After Breast Augmentation: A Randomized Double-Blind Intraindividual Controlled Trial

“…[15][16][17][18] In the past 2 decades, experimental studies and systematic reviews demonstrated that BTX was effective in minimizing scars. [6][7][8] The wound sites in those previous reports were mainly on the face and neck, and few studies reported on the scar minimizing the effects of botulinum toxin on the trunk, which has a greater tension load than the face.…”

“…In the past 2 decades, there have been many experimental studies and meta-analysis of randomized controlled trials demonstrating the ability of botulinum toxin Type A (BTX) to improve the scars' appearance. [6][7][8] Interestingly, previous studies revealed that BTX inhibits fibroblast growth and decreases the expression of a profibrotic cytokine, transforming growth factor-b1. 9 However, most of the scars in previous trials were located on the face and neck area.…”

Inyección local de toxina botulínica para la prevención de cicatrices hipertróficas y queloides: un protocolo para una revisión panorámica

“…Todo trauma en la piel trae como consecuencia la generación de una cicatriz, sin embargo, algunos individuos desarrollan tejidos hipertróficos y/o queloides en el proceso de reparación tisular (exceso de fibrosis que no remite, deposición de colágeno excesiva, angiogénesis acelerada) (Austin et al, 2018 ;Bi et al, 2019 ;Yang & Li, 2019 ;Zhang W et al, 2020 ;Fu et al, 2022).…”

“…Este proceso resulta en una parálisis de la musculatura mediante una quimio-inmovilización (Rizo & Südhof, 2002 ;Austin et al, 2018), disminuyendo la tensión en los bordes de la herida en reparación, el cual es un factor crítico en el proceso de cicatrización (Austin et al, 2018 ;Lee & Jang, 2018 ;Bartkowska et al, 2020 ;Chen et al, 2020 ;Guo et al, 2020 ;Song et al, 2020 ;Zhang W et al, 2020 ;Qiao et al, 2021 ;Xu et al, 2021 ;Fu et al, 2022 ;Yue et al, 2022). Adicionalmente, el uso de TB podría tener un efecto profiláctico.…”