Botulinum toxin A (BTA) temporarily paralyzes nearby muscles to reduce tension in wound sites, inhibiting scar hyperplasia.
Objective:
To evaluate the effectiveness of BTA injection on scar formation and quality in various face, head, and neck sites.
Methods:
A comprehensive search was conducted across four electronic databases and registries to identify relevant studies. We assessed the following outcomes: visual analog scale (VAS), Vancouver scar scale (VSS), scar width, patient self-assessment scale, Stony Brook scar evaluation scales, Observer scar assessment scale, Manchester scar scale, and patient scar-assessment scale.
Results:
This systematic review included 20 studies encompassing 894 patients, of which, 18 studies were eligible for meta-analysis. The VAS and VSS significantly improved with BTA compared to controls which significantly reduced scar width at the first and second measurement points compared to controls. Subgroup analyses revealed that BTA had better upper lip and forehead outcomes.
Conclusion:
This systematic review and meta-analysis found that scars of the face, head, and neck were improved with BTA treatment compared to controls. This highlights the need for further study, especially concentrating on the upper lip and forehead regions, where improved outcomes were identified on subgroup analysis.
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References
1.
AtkinsonJ-AM, McKennaKT, BarnettAG, McGrathDJ, RuddM. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse langers skin tension lines. Plast Reconstr Surg. 2005; 116:1648–1656.
2.
JeongHS, LeeBH, SungHM, et al.Effect of botulinum toxin type A on differentiation of fibroblasts derived from scar tissue. Plast Reconstr Surg. 2015; 136:171e–178e.
3.
GassnerHG, SherrisDA, OtleyCC. Treatment of Facial Wounds with Botulinum Toxin A Improves Cosmetic Outcome in Primates. Plast Reconstr Surg. 2000; 105:1948–1953.
4.
GauglitzGG, BureikD, DombrowskiY, PavicicT, RuzickaT, SchauberJ. Botulinum toxin A for the treatment of keloids. Skin Pharmacol Physiol. 2012; 25:313–318.
5.
XiaoZ, ZhangF, CuiZ. Treatment of hypertrophic scars with intralesional botulinum toxin type A injections: A preliminary report. Aesthetic Plast Surg. 2009; 33:409–412.
6.
XiaoZ, ZhangF, LinW, ZhangM, LiuY. Effect of botulinum toxin type A on transforming growth factor β1 in fibroblasts derived from hypertrophic scar: A preliminary report. Aesthetic Plast Surg. 2010; 34:424–427.
7.
IbrahimO, KellerE, ArndtK. Update on botulinum neurotoxin use in aesthetic dermatology. Semin Cutan Med Surg. 2014; 33:152–156.
8.
CoccoA, AlbaneseA. Recent developments in clinical trials of botulinum neurotoxins. Toxicon. 2018; 147:77–83.
LuL, SaulisAS, LiuWR, et al.The temporal effects of anti-TGF-β1, 2, and 3 monoclonal antibody on wound healing and hypertrophic scar formation. J Am Coll Surg. 2005; 201:391–397.
11.
LiY-H, YangJ, LiuJ-Q, et al.A randomized, placebo-controlled, double-blind, prospective clinical trial of botulinum toxin type A in prevention of hypertrophic scar development in median sternotomy wound. Aesthetic Plast Surg. 2018; 42:1364–1369.
12.
AbediniR, Mehdizade RayeniN, Haddad AbianehS, RahmatiJ, TeymourpourA, NasimiM. Botulinum toxin type A injection for mammoplasty and abdominoplasty scar management: A split-scar double-blinded randomized controlled study. Aesthetic Plast Surg. 2020; 44:2270–2276.
13.
ElshahedAR, ElmanzalawyKS, ShehataH, ElSaieML. Effect of botulinum toxin type A for treating hypertrophic scars: A split-scar, double-blind, randomized controlled trial. J Cosmet Dermatol. 2020; 19:2252–2258.
14.
YueS, JuM, SuZ. A systematic review and meta-analysis: Botulinum toxin A effect on postoperative facial scar prevention. Aesthetic Plast Surg. 2022; 46:395–405.
15.
HigginsJPT, ThomasJ, ChandlerJ, et al.Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. John Wiley & Sons: Chichester (UK); 2019.
16.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021; 10(1):89.
SterneJAC, SavovićJ, PageMJ, et al.RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366: l4898.
19.
ZiadeM, DomergueS, BatifolD, et al.Use of botulinum toxin type A to improve treatment of facial wounds: A prospective randomized study. J Plast Reconstr Aesthetic Surg. 2013; 66:209–214.
20.
ZelkenJ, YangSY, ChangCS, et al.Donor site aesthetic enhancement with preoperative botulinum toxin in forehead flap nasal reconstruction. Ann Plast Surg. 2016; 77:535–538.
21.
HuangRL, HoCK, TrempM, XieY, LiQ, ZanT. Early postoperative application of botulinum toxin type A prevents hypertrophic scarring after epicanthoplasty: A split-face, double-blind, randomized trial. Plast Reconstr Surg. 2019; 144:835–844.
22.
HuL, ZouY, ChangSJ, et al.Effects of botulinum toxin on improving facial surgical scars: A prospective, split-scar, double-blind, randomized controlled trial. Plast Reconstr Surg. 2018; 141:646–650.
23.
GassnerHG, BrissettAE, OtleyCC, et al.Botulinum toxin to improve facial wound healing: A prospective, blinded, placebo-controlled study. Mayo Clin Proc. 2006; 81:1023–1028.
24.
EbrahimH, ElardiA, KhaterS, MorsiH. Successful topical application of botulinum toxin after microneedling versus microneedling alone for the treatment of atrophic post acne scars: A prospective, split-face, controlled study. J Clin Aesthet Dermatol. 2022; 15:26–31.
25.
ChenH, PanW, ZhangJ, ChengH, TanQ. The application of W-plasty combined Botox-A injection in treating sunk scar on the face. Medicine (Baltimore). 2018; 97:0–4.
26.
ChangCS, WallaceCG, HsiaoYC, ChangCJ, ChenPKT. Botulinum toxin to improve results in cleft lip repair: A double-blinded, randomized, vehicle-controlled clinical trial. PLoS One. 2014; 9:1–12.
27.
ChangCS, WallaceCG, HsiaoYC, ChangCJ, ChenPKT. Botulinum toxin to improve results in cleft lip repair. Plast Reconstr Surg. 2014; 134:511–516.
28.
BaeDS, KooDH, KimJE, ChoJM, ParkJO. Effect of botulinum toxin an on scar healing after thyroidectomy: A prospective, double-blind, randomized controlled trial. J Clin Med. 2020; 9(3):868.
29.
SamarthA, BudamakuntlaL, ShilpaK. The use of botulinum toxin-A as an adjunctive treatment for facial atrophic and hypertrophic scars after surgical correction. J Cutan Aesthet Surg. 2022; 15:131.
30.
PatilMS, NileshK, MatePP. Efficacy of botulinum toxin in healing of posttraumatic facial lacerations: A prospective, randomized, comparative study. J Cutan Aesthet Surg. 2022; 15:295–302.
31.
Navarro-BarquínDF, Lozada-HernándezEE, Tejeda-HernándezM, et al.Use of the type A botulinum toxin in patients submitted to cheiloplasty to improve results in scarring in patients with nonsyndromic cleft lip and palate. Eur J Plast Surg. 2019; 42:291–294.
32.
BernstienD. Botulinum toxin is a potential prophylactic therapy for minimizing post-excisional scarring (allergan botox scar study) 2020. Clinical Trials. 2019; NCT02623829.
33.
LeeSH, MinHJ, KimYW, CheonYW. The efficacy and safety of early postoperative botulinum toxin A injection for facial scars. Aesthetic Plast Surg. 2018; 42:530–537.
34.
KimYS, LeeHJ, ChoSH, LeeJD, KimHS. Early postoperative treatment of thyroidectomy scars using botulinum toxin: A split-scar, double-blind randomized controlled trial. Wound Repair Regen. 2014; 22:605–612.
35.
KimSH, LeeSJ, LeeJW, JeongHS, SuhIS, AiempanakitK. Clinical trial to evaluate the efficacy of botulinum toxin type A injection for reducing scars in patients with forehead laceration: A double-blinded, randomized controlled study. Med (United States). 2019; 98(34):e16952.
36.
HuangYL, WallaceCG, HsiaoYC, et al.Botulinum toxin to improve lower blepharoplasty scar: A double-blinded, randomized, vehicle-controlled clinical trial. Aesthetic Surg J. 2021; 41:1003–1010.
37.
SungY-T, WuJ-S. The Visual Analogue Scale for Rating, Ranking and Paired-Comparison (VAS-RRP): A new technique for psychological measurement. Behav Res Methods. 2018; 50:1694–1715.
38.
ThompsonCM, SoodRF, HonariS, CarragherGJ, GibranNS. What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers. Burns. 2015; 41:1442–1448.
39.
XiaoZ, QuG. Effects of botulinum toxin type A on collagen deposition in hypertrophic scars. Molecules. 2012; 17:2169–2177.
SuarezE, SyedF, Alonso-RasgadoT, MandalP, BayatA. Up-regulation of tension-related proteins in keloids. Plast Reconstr Surg. 2013; 131:158e–173e.
42.
QiaoZ, YangH, JinL, LiS, WangX. The efficacy and safety of botulinum toxin injections in preventing postoperative scars and improving scar quality: A systematic review and meta-analysis. Aesthetic Plast Surg. 2021; 45:2350–2362.
43.
LeeB-J, JeongJ-H, WangS-G, LeeJ-C, GohE-K, KimH-W. Effect of botulinum toxin type A on a rat surgical wound model. Clin Exp Otorhinolaryngol. 2009; 2:20.
44.
OrtonneJ-P, BissettDL. Latest insights into skin hyperpigmentation. J Investig Dermatology Symp Proc. 2008; 13:10–14.
45.
Carrillo-CórdovaJR, Martínez-WagnerR, Trolle-SilvaA, et al.Botulinum toxin type A is associated with an increase in angiogenesis of wounds in an experimental murine model. [In Spanish]. Cirugía Plástica. 2017; 27:107–112.
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