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.
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Jane Olver BSc, MBBS, DO, FRCS, FRCOphth
Consultant Ophthalmic Surgeon
Eyelid & Lacrimal Specialist
Resident expert – Jane Olver
I am trained as an eye surgeon, and work both as a medical general ophthalmologist and oculoplastic (eyelid), lacrimal (tearduct) surgeon, and also do cosmetic rejuvenation and eyelid surgery.
In 2010, I founded Clinica London with the aim of providing a rapid access, high quality, Private Eye and Skin Clinic with several Consultant Specialists. Since 2014, I worked full time at Clinica London as both a Specialist Ophthalmologist and Medical Director.
I see many patients with general eye problems, dry eyes, eyelid and watering eye problems.
Dr Jennifer M. Crawley, MBChB, BSc (Hons), MRCP (Derm)
Resident expert – Jennifer Crawley
I am a Consultant Dermatologist at Clinica London. I am an expert in both adult and paediatric dermatology and have particular interests in research, teaching and leading audit projects. I love clinical dermatology and I do many mole checks and treat keloid scars, acne. I do cryotherapy and surgical removal of skin tumours, skintags and seborrhoic keratoses.
I gained a MBChB qualification from the University of Bristol in 2002, after gaining BSc.Hons Cellular & Molecular Pathology in 1999. While working at St. John’s, I was fully integrated in a wide range of research trials.
I am a Consultant in the NHS at the prestigious University College Hospital, where I am involved with undergraduate and postgraduate teaching. I also a course lecturer on an esteemed MRCP PACES course three times per year in central London.
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