Toxins, fillers and lasers can improve appearance of postsurgical scarring

Key Points

Using botulinum toxin prior to certain closures (whether before Mohs or reconstruction surgery or even facelifts) can help to immobilize the targeted musculature and lead to less tension across wounds in specific regions.

"By limiting the mobility of the area, you are able to decrease tension vectors across the wound," says Joel L. Cohen, M.D., director of AboutSkin Dermatology and DermSurgery P.C., Denver.

In one study performed at the Mayo Clinic, patients with facial lacerations (traumatic forehead lacerations or elective excisions of forehead masses) were randomized to receive either botulinum toxin or placebo injections into the musculature adjacent to the wound within 24 hours after wound closure.

Investigators found that botulinum toxin-induced immobilization of forehead wounds enhanced the healing of the wounds and that in selected patients, this approach could be useful in improving the eventual appearance of the scar (Gassner HG, Brissett AE, Otley CC, et al. Mayo Clin Proc. 2006;81(8):1023-1028).

In another study, the utility of intraoperative botulinum toxin for scar cosmesis was assessed in patients undergoing surgical reconstruction after Mohs surgery for treatment of skin cancer. Results showed that the use of botulinum toxin could help the healing of wounds (Flynn TC. Dermatol Surg. 2009;35(2):182-188).

"I have been using this technique for several years in my patients where I think immobilization of the musculature could assist wound healing. Such an approach is very important to consider in those areas where there is both a lot of expected facial animation movement as well as consistent aesthetic efficacy of botulinum toxin itself - such as the forehead, glabella, lateral canthal and perioral regions," Dr. Cohen says. "Presurgical botulinum toxin can be very useful in those patients who are particularly cosmetically minded and articulate great concern regarding the degree regarding the degree of expected scarring."

Cosmetic patients will typically receive botulinum toxin rejuvenation treatments in the forehead, the glabella and lateral canthus areas. These are also regions of increased muscle movement, and, according to Dr. Cohen, patients undergoing excisional surgery in these areas may not only benefit from adjunct botulinum toxin treatment to improve scar quality, but also appreciate the rejuvenation effect on the region as a whole.

"The critical time for a scar in terms of avoiding significant mobility in the area is the first couple of months after the surgery, which is also as long as botulinum toxin will last. Often, patients like the technique and the rejuvenation effect of botulinum toxin and request further treatments long after the surgery. The use of this technique originally for the purpose of improving scar outcome sometimes morphs into regular botulinum toxin treatments in terms of rejuvenation therapies and not just scar treatment," Dr. Cohen says.