Botulinum Toxin to Improve Facial Wound Healing: A Prospective, Blinded, Placebo-Controlled Study

Department of Otorhinolaryngology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clinic Proceedings (Impact Factor: 6.26). 09/2006; 81(8):1023-8. DOI: 10.4065/81.8.1023
Source: PubMed


To test whether botulinum toxin-induced immobillzation of facial lacerations enhances wound healing and results in less noticeable scars.
In this blinded, prospective, randomized clinical trial, patients were randomized from February 1, 2002, until January 1, 2004, to botullnum toxin vs placebo injection into the musculature adjacent to the wound within 24 hours after wound closure. Blinded assessment of standardized photographs by experienced facial plastic surgeons using a 10-cm visual analog scale served as the main outcome measure.
Thirty-one patients presenting with traumatic forehead lacerations or undergoing elective excisions of forehead masses were included in the study. The overall median visual analog scale score for the botulinum toxin-treated group was 8.9 compared with 7.2 for the placebo group (P=.003), indicating enhanced healing and Improved cosmesis of the experimentally immobilized scars.
Botullnum toxin-induced Immobilization of forehead wounds enhances healing and is suggested for use in selected patients to improve the eventual appearance of the scar.

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    • "Reduction of the tensile force during the course of cicatrisation and effective regulation of the balance between fibroblast proliferation and cellular apoptosis108 may represent a novel therapeutic option for the aesthetic improvement of post-surgical scars. Indeed, Gassner and colleagues could demonstrate that botulinum toxin injections into the musculature adjacent to the wound (15 U of BTA (Botox, Allergan, Irvine, CA, USA) per 2 cm intraoperative length) within 24 hours after wound closure resulted in enhanced wound healing and less noticeable scars compared with placebo.109 By injecting BTA 4–7 days prior to surgery, we have seen similar results using a slightly reduced dose regime, depending on the respective anatomic location (risk of severe asymmetry if injecting only one side of the musculus frontalis, brow ptosis). "
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    ABSTRACT: In the context of growing aesthetic awareness, a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. However, excessive scarring following surgery or trauma remains difficult to improve despite a plethora of advocated treatment strategies as frequently observed in daily clinical routine. It is thus still preferable to prevent scarring by minimizing risk factors as much as possible. Hence, it remains crucial for the physician to be aware of basic knowledge of healing mechanisms and skin anatomy, as well as an appreciation of suture material and wound closure techniques to minimize the risk of postoperative scarring. Next to existing, well known prophylactic and therapeutic strategies for the improvement of excessive scarring, this article discusses emerging techniques such as intralesional cryotherapy, intralesional 5-fluorouracil, interferon, and bleomycin. Some of them have been successfully tested in well-designed trials and already have extended or may extend the current spectrum of excessive scar treatment in the near future. Innovative options such as imiquimod 5% cream, photodynamic therapy, or botulinum toxin A may also be of certain importance; however, the data currently available is too contradictory for definite recommendations.
    Clinical, Cosmetic and Investigational Dermatology 04/2013; 6:103-14. DOI:10.2147/CCID.S35252
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    • "Kinetic models could help to identify what research gaps exist and which ones can be experimentally or clinically resolved. One gap that could be experimentally verified is to determine if the intracellular diffusion of botulinum toxin A [67] is influenced by other coinjected materials, for example, epinephrine and local anesthetics (lidocaine, Xylocaine), compounds that have been considered in controlling local diffusion and predicting the extent of this toxin's paralytic effect [15] [32]. As more realistic physiological-pharmacological models are developed, more free parameters and more sources of error, assumptions, and caveats will need to be evaluated. "
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    ABSTRACT: A relatively new approach in the treatment of specific wounds in animal models and in patients with type A botulinum toxin is the focus of this paper. The indications or conditions include traumatic wounds (experimental and clinical), surgical (incision) wounds, and wounds such as fissures and ulcers that are signs/symptoms of disease or other processes. An objective was to conduct systematic literature searches and take note of the reactions involved in the healing process and identify corresponding pharmacokinetic data. From several case reports, we developed a qualitative model of how botulinum toxin disrupts the vicious cycle of muscle spasm, pain, inflammation, decreased blood flow, and ischemia. We transformed this model into a minimal kinetic scheme for healing chronic wounds. The model helped us to estimate the rate of decline of this toxin's therapeutic effect by calculating the rate of recurrence of clinical symptoms after a wound-healing treatment with this neurotoxin.
    Journal of Toxicology 01/2012; 2012(1):159726. DOI:10.1155/2012/159726
    • "The half foreheads that were injected with botulinum toxin had a significantly better appearance than their placebo counterparts.[15] Further articles have tended to show improved outcomes of scars treated with botulinum toxin in humans.[16–19] "
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    ABSTRACT: Botulinum toxin has been utilised successfully in many facial and extra facial regions to limit superfluous movement. Scars, whether traumatic or disease-related, are treated with many modalities. To assess the available literature concerning the prophylactic use of botulinum toxin for the improvement in the cosmetic outcome of scars induced by surgery and to examine its role in the treatment of established scars alone, as also combined with other modalities. The results of the prophylactic use of botulinum toxin to limit the resultant scarring from surgery are examined by a literature review. The primary and adjunctive use of botulinum toxin in the treatment of post acne and post surgical and traumatic scars is explored by case examples. Literature review and personal experience shows good Improvement in the appearance of scars with the use of botulinum toxin alone or with other adjuvant modalities in the treatment of scars. Botulinum toxin would appear to be useful both in the prophylaxis and treatment of certain types of scars.
    Journal of Cutaneous and Aesthetic Surgery 05/2010; 3(2):90-2. DOI:10.4103/0974-2077.69019
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