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An Algorithm Using Botox Injections for Facial Scar Improvement in Fitzpatrick Type IV–VI Skin

Shome, Debraj, MD, FRCS (Glasgow), FACS, MBA*; Khare, Stuti, MD; Kapoor, Rinky, MD

Plastic and Reconstructive Surgery – Global Open: August 8, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001888
Latest Articles: PDF Only

Background: Wounds of the face are known to heal poorly with conspicuous scarring. Hence, it is crucial to address the distracting effect of muscle pull on immature collagen, which often leads to worsening of scars.

Study Design: Prospective clinical study.

Methods: One hundred patients with a minimum of 6 months follow-up were recruited. All patients with depressed scars underwent surgery for scar revision. Two weeks before surgical intervention, intramuscular Botulinum toxin was injected around the scar, to prevent movement of the facial muscles. From the second week postsurgery, Cicatrix (Formulation containing activated Centella Asiatica & Pinus Sylvestris, Catalysis, Spain) was routinely used, 3 times a day, for 6 months post the scar revision surgery. Six weeks postsurgery, Fractional C02 laser treatment was started and performed every 4 weeks.

Results: Using the Objective Assessment Score and the Subjective Assessment Score, the mean of the scores were taken. All patients had satisfactory results, as measured by a patient satisfaction survey and objectively by the physician assessment.

Discussion: Botulinum toxin injected before scar revision surgery resulted in the wound being stabilized, better wound healing, and prevention of wound widening during healing.

Conclusion: In view of the results of this study, it is considered worthwhile to offer patients with facial scars, Botulinum toxin injections before scar revision surgery, followed by Fractional C02 laser, along with the routine use of Cicatrix Cream.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Department of Facial Plastic Surgery & Director, The Esthetic Clinics, Mumbai, India

Department of Clinical Dermatology, Cosmetic Dermatology & Dermato-Surgery,The Esthetic Clinics, Mumbai, India

Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery & Director, The Esthetic Clinics, Mumbai, India.

Published online 8 August 2018.

Received for publication May 14, 2018; accepted June 13, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Debraj Shome, MD, FRCS, FACS, MBA, The Esthetic Clinics, Mumbai, India., E-mail:

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.