More Than Anti-Aging Treatment

A clinical trial performed by the Shanghai Jiao Tong University School of Medicine shows success in using botulinum toxin A, or Botox, for improving the appearance of surgical scars.

The study was published in the March issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons. It illustrates that using Botox injections soon after surgery can mean narrower and flatter facial surgery scars.

The results of the Shanghai trial are promising and prove to be another potential use for the popular endotoxin beyond wrinkle prevention.

Botox was the top minimally invasive cosmetic procedure in the United States with 7.23 million injections performed last year, according to statistics from the ASPS.

Study authors tested Botox on 16 patients who were undergoing facial plastic and reconstructive surgery at the School of Medicine over a four-month period.

Patients participating in the study were 12 years old on average, and most were undergoing plastic surgery to correct facial birthmarks.

“For many people, facial birthmarks, such as port wine stains, can make them feel self-conscious. These feelings often motivate individuals to have their birthmarks surgically removed,” said Dr. Gregory W. Chernoff, a triple-board-certified plastic surgeon with practices in Indianapolis.

After their surgeries, each participant received a random assignment to a test group or a control group. Patients in the test group received Botox injections, while patients in the control group received a placebo of inactive saline.

Injections were delivered to one side of each surgical scar.

Six months after surgery, plastic surgeons not affiliated with the study measured the scars and rated them for their appearance.

The scars ranged from 3 to 16 centimeters, with the average length being 6.74 centimeters.

The independent plastic surgeons then rated the scars on a 10-point scale, with zero being the worst and 10 being the best.

The scars of the Botox group were rated consistently better than the placebo group, with the overall appearance averaging 5.76 compared to 4.97.

The sides of the scars treated with Botox were narrower and less raised than the other side compared to those treated with the placebo.

Characteristics of scars such as color, vascularity and pliability were not noticeably different.

“Scars form after a wound or break to the skin from surgery, a cut or even acne. How they form varies from person to person – some individuals may form a raised scar while others have sunken scars. Using Botox for scar treatment may help take out some of the variables,” Chernoff said.

The authors of the Shanghai study say the benefits of Botox for scar revision come from the temporary muscular paralysis it produces.

“Botox temporarily paralyzes the muscles in treatment. In most cases, it is injected into the forehead and around the eyes to prevent wrinkles from forming because of facial expressions,” Chernoff said.

The paralysis caused by Botox lasts three to four months, on average.

The researchers on the Shanghai study think this temporary paralysis relaxes the area around the incision, which helps relieve tension on the scar and prevent it from stretching.

Previous research has suggested that Botox may also block certain cells called fibroblasts and other factors involved in the development of scars.

Botox is commonly used for anti-aging treatments but has been found to be useful for other problems such as extreme sweating, chronic migraines, twitching eyelids and crossed eyes.

“I think research is just scratching the surface of the capabilities of Botox,” Chernoff said.

ASPS. “Effects of Botulinum Toxin on Improving Facial Surgical Scars: A Prospective, Split-Scar, Double-Blind, Randomized Controlled Trial. 27 February 2018.
ASPS. Plastic Surgery Statistics 2017.