How Botulinum toxin can help to prevent scars
If a patient has suffered a cut on their eyelid or their face as a result of surgery or trauma, a scar develops that may appear unsightly by becoming raised and broad. The final scar is more likely to be unacceptable if the incision runs against natural skin tension lines or crosses cosmetic boundaries between thin and thick skin or across creases.
Although scars can be treated surgically by Z or Y-plasties, by subcision, by intralesional injection of steroid and, of course, application of silicone gel, there is a new adjunctive treatment on the block, which is Botulinum toxin. The use of Botulinum toxin A is best recommended from about one to two weeks after surgery, particularly in periorbital eyelid reconstruction post-trauma or post-tumour excision reconstruction.
A small amount of Botox, approximately five units, or with Dysport approximately 20 units, is more than adequate to treat the area but has to be used very carefully so as not to compromise the deep musculature activity – this is because it could cause an adverse effect on function such as the development of eyelid ptosis.
The result is that the Botulinum toxin not only reduces the muscle activity that can contribute to adverse pressure vectors on the healing wound, but it also has an inhibitory effect on the fibroblasts. The fibroblast inhibitory effect of Botulinum toxin, therefore, adds to a potentially better outcome following eyelid surgery or trauma or scar revision.
There is now a lot of evidence to show that Botulinum toxin has a prophylactic role in the prevention of scars, not just a treatment role once the scar has formed.
At Clinica London, Jane Olver is the oculoplastic reconstructive surgeon for the periorbital area and face, and Jennifer Crawley is the dermatologist who also works on the face and other parts of the body, excising skin cancers and treating keloid scars.
We can both offer Botulinum toxin treatment for scars, depending on where a cut or developing or developed scar is, as an adjunct to other therapies.