Postoperative facial scarring can burden patients psychologically after surgery, often causing prolonged mental health dysfunction. Currently, several methods can prevent facial scar hyperplasia and improve scar quality; however, an established method to prevent facial scar formation is lacking. Botulinum toxin A (BTA) is popular due to its properties of muscle paralysis and known success in plastic surgery and cosmetology. The present study evaluated the efficacy of BTA in preventing postoperative facial scar hyperplasia and improving scar quality.

It searched PubMed, MEDLINE, EMBASE, web of science and Cochrane libraries for randomized controlled trials (RCTs) that used BTA to treat facial scars. The study scrutinized the efficacy and safety of BTA by the following scales: the Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), Observer Scar Assessment Scale (OSAS), Patient Scar Assessment Scale (PSAS) and Stony Brook Scar Evaluation Scale (SBSES); the BTA effect on scar width and also assessed the complications.

The study observed:

• Inclusion of 10 RCTs involving 114 cases. 
• The BTA injection group demonstrated a higher VAS score, lower VSS score, lower OSAS score and smaller scar width. 
• No significant difference in the incidence of postoperative complications between the two groups.

This meta-analysis demonstrated that BTA could safely improve the appearance of postoperative facial scars by significantly inhibiting scar hyperplasia and improving scar quality.

Source: Yue S, Ju M, Su Z. A systematic review and meta-analysis: botulinum toxin A effect on postoperative facial scar prevention. Aesthetic Plast Surg. 2022;46(1):395-405.