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

Abstract

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.

Figures

Fig. 1.

Showing before image of patient 1, with the facial scar caused due to burns.

Fig. 2.

Showing after image of patient 1, on whom scar revision surgery was performed for the facial scar caused due to burns. Results after 8 sessions of FCO2 laser. Photographs pre and post, taken 12 months apart.

Fig. 3.

Showing before image of patient 2.

Fig. 4.

Showing after image of patient 2, on whom scar revision surgery was performed. Results after 6 sessions of FC02 laser. Photographs pre and post, taken 9 months apart.

Fig. 5.

Showing before image of patient 3.

Fig. 6.

Showing after image of patient 3, on whom scar revision surgery was performed. Results after 7 sessions of FC02 laser. Photographs pre and post, taken 12 months apart.

Fig. 7.

Showing before image of patient 4.

Fig. 8.

Showing after image of patient 4, on whom scar revision surgery was performed. Results after 8 sessions of FC02 laser. Photographs pre and post, taken 15 months apart.

Fig. 9.

Showing before image of patient 5.

Fig. 10.

Showing after image of patient 5, on whom scar revision surgery was performed. Results after 8 session of FCO2 laser. Photographs pre and post, taken 18 months apart.

Fig. 11.

Showing before image of the patient 6, who suffered facial trauma due to road traffic accident.

Fig. 12.

Showing after image of patient 6, after 8 sessions of FCO2 laser. Photograph taken 18 months later.