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Gawey L, Saedi N, Hausauer A. Neurotoxins and Combination Therapies. Dermatol Surg 2024; 50:S85-S90. [PMID: 39196840 DOI: 10.1097/dss.0000000000004359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
BACKGROUND Facial aging involves multilevel changes, extending from the skin to deep support structures. A comprehensive treatment approach targeting the many aspects of facial dynamics and architecture is often necessary to achieve optimal correction, prevent changes before they occur, and/or help highlight inherited features. OBJECTIVE To explore the integration of botulinum toxin type A (BoNT-A) into multimodal aesthetic treatment plans. MATERIALS AND METHODS This article reviews evidence supporting the combination of BoNT-A with other minimally invasive cosmetic therapies, including dermal fillers, lasers, and energy-based devices as well as with plastic and reconstructive surgeries for more controlled healing and improved scar cosmesis. RESULTS Combination treatment protocols including BoNT-A demonstrate higher patient satisfaction and retention rates compared to monotherapy or sequential treatments. Some guidelines for sequencing of treatments exist, but evidence is scant with certain combinations. CONCLUSION Integrating BoNT-A into a larger aesthetic treatment plan is crucial for achieving natural and satisfying results in facial rejuvenation. Evidence supports better outcomes when incorporating with both surgical and nonsurgical modalities. Understanding how to address anatomy over time through different aesthetic therapies together allows for individually tailored, more deeply impactful treatment plans.
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Affiliation(s)
- Lauren Gawey
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Nazanin Saedi
- Dermatology Associates of Plymouth Meeting, Plymouth Meeting, Plymouth Meeting, PA
| | - Amelia Hausauer
- Director of Dermatology and Head of Aesthetx Medicine, Aesthetx Plastic Surgery and Dermatology, Campbell, CA
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Rammal A, Mogharbel A. Effectiveness of Botulinum Toxin-A on Face, Head, and Neck Scars: A Systematic Review and Meta-Analysis. Facial Plast Surg Aesthet Med 2024; 26:379-385. [PMID: 37934126 DOI: 10.1089/fpsam.2023.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Background: Botulinum toxin A (BTA) temporarily paralyzes nearby muscles to reduce tension in wound sites, inhibiting scar hyperplasia. Objective: To evaluate the effectiveness of BTA injection on scar formation and quality in various face, head, and neck sites. Methods: A comprehensive search was conducted across four electronic databases and registries to identify relevant studies. We assessed the following outcomes: visual analog scale (VAS), Vancouver scar scale (VSS), scar width, patient self-assessment scale, Stony Brook scar evaluation scales, Observer scar assessment scale, Manchester scar scale, and patient scar-assessment scale. Results: This systematic review included 20 studies encompassing 894 patients, of which, 18 studies were eligible for meta-analysis. The VAS and VSS significantly improved with BTA compared to controls which significantly reduced scar width at the first and second measurement points compared to controls. Subgroup analyses revealed that BTA had better upper lip and forehead outcomes. Conclusion: This systematic review and meta-analysis found that scars of the face, head, and neck were improved with BTA treatment compared to controls. This highlights the need for further study, especially concentrating on the upper lip and forehead regions, where improved outcomes were identified on subgroup analysis.
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Affiliation(s)
- Almoaidbellah Rammal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Mogharbel
- Department of Otorhinolaryngology, Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Clague MD, Goodman G, Taing C, Stuart L, Orsatti ML, Holbrook J, Delaney J, Mackay B. Hyperdiluted Botulinum Toxin and Intense Pulsed Light Treatment: A Case Series to Illustrate a Novel Protocol for Hypertrophic Scar Reduction. PLASTIC AND AESTHETIC NURSING 2024; 44:116-123. [PMID: 38639968 DOI: 10.1097/psn.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Hypertrophic scars can have significant and far-reaching effects on patients that range from itching to creating difficulty with mobility, all of which can negatively impact the individual's quality of life. A recent study showed that many patients with recent scars report pain, burning, pruritus, erythema, in combination with psychological difficulties that impact bodily movement, choice of clothing, and participation in leisure activities. Botulinum toxin Type A (BoNTA) and intense pulsed light (IPL) have shown promise in treating such scars. We propose a novel treatment protocol involving a 4-week intervention with hyperdiluted BoNTA injections and supplemental treatment with IPL for erythema, and a 6-month scar scale assessment and photographic documentation that occurs before and 6 months after treatment. We report four cases where using hyperdiluted BoNTA, either alone or in conjunction with IPL, substantially reduced scar size, improved overall scar appearance, and diminished erythema in areas on the face and the breasts. Although this report suggests that a schedule of alternating treatments with BoNTA and IPL may be beneficial in reducing scar size and enhancing appearance, further research is necessary to better understand the most effective dosages, the relationship between BoNTA and IPL, and the optimal management of scarring.
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Affiliation(s)
- Mike D Clague
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
| | - Greg Goodman
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
| | - Cindy Taing
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
| | - Lauren Stuart
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
| | - Margo-Louise Orsatti
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
| | - John Holbrook
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
| | - John Delaney
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
| | - Bridgina Mackay
- Mike D. Clague, BSc , is at Facecoach, South Yarra, Victoria, Australia
- Greg Goodman, MD, MBBS, FACD , is at Facecoach, South Yarra, Victoria, Australia
- Cindy Taing, BSN , is at Facelove, St Kilda, Victoria, Australia
- Lauren Stuart, BSN , is at Facelove, St Kilda, Victoria, Australia
- Margo-Louise Orsatti, BSN , is at Facelove, St Kilda, Victoria, Australia
- John Holbrook, MBBS , is Founder, Fresh Clinics, Lavender Bay, New South Wales, Australia
- John Delaney, MBBS (Hons1) , is Founder Fresh Clinics, Lavender Bay, New South Wales, Australia
- Bridgina Mackay, MN, GradCert ICU , is Lecturer at Australian Catholic University, Melbourne, Victoria, Australia
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Hong N, Sheng B, Yu P. Early postoperative interventions in the prevention and management of thyroidectomy scars. Front Physiol 2024; 15:1341287. [PMID: 38523809 PMCID: PMC10958159 DOI: 10.3389/fphys.2024.1341287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Thyroidectomy scars, located on the exposed site, can cause distress in patients. Owing to the cosmetic importance of thyroidectomy scars, many studies have been conducted on its prevention and treatment. Scar formation factors mainly include inflammatory cell infiltration, angiogenesis, fibroblast proliferation, secretion of cytokines such as transforming growth factor (TGF)-β1, and mechanical tension on the wound edges. Anti-scar methods including topical anti-scar agents, skin tension-bearing devices, and local injections of botulinum toxin, as well as lasers and phototherapies, that target these scar formation factors have been developed. However, current studies remain fragmented, and there is a lack of a comprehensive evaluation of the impacts of these anti-scar methods on treating thyroidectomy scars. Early intervention is a crucial but often neglected key to control hyperplastic thyroidectomy scars. Therefore, we review the currently adopted early postoperative strategies for thyroidectomy scar reduction, aiming to illustrate the mechanism of these anti-scar methods and provide flexible and comprehensive treatment selections for clinical physicians to deal with thyroidectomy scars.
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Affiliation(s)
- Nan Hong
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Dermatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Sheng
- Department of Medical Cosmetology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Pan Yu
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Winayanuwattikun W, Vachiramon V, Rattananukrom T, Palakornkitti P, Sitpahul N. Efficacy of Botulinum Toxin Type A for Prevention of Post-Mastectomy Scar in Transmen: A Prospective, Randomized Study. Toxins (Basel) 2023; 15:636. [PMID: 37999499 PMCID: PMC10680993 DOI: 10.3390/toxins15110636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Subcutaneous mastectomies in transmen have been gaining popularity. However, post-operative scars are an inevitable consequence. Recently, Botulinum neurotoxin A (BoNT-A) has shown positive effects in scar prevention. The objective of this study is to investigate the effectiveness of BoNT-A in scar prevention. METHODS Fifteen patients who had undergone subcutaneous mastectomy were included. At 14 days post-surgery, either incoBoNT-A or a placebo was injected into the scar on each side. The primary outcome assessment measured the scar's severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The secondary outcome assessment evaluated the scar's color using a standard measurement device. Outcome assessments were conducted until 6 months post-surgery. RESULTS There were significantly lower VSS scores in the BoNT-A group compared to the placebo at the end of the study (7.43 ± 0.26 vs. 8.82 ± 0.26, p < 0.001). The objective assessment revealed a statistically significant decrease in redness values in the BoNT-A group compared to the placebo at 3 and 6 months. CONCLUSION BoNT-A has demonstrated effectiveness in scar prevention by reducing the severity of postoperative scar formation and improving overall scar appearance.
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Affiliation(s)
- Waranaree Winayanuwattikun
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Teerapong Rattananukrom
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Pasita Palakornkitti
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Ngamcherd Sitpahul
- Department of Plastic and Maxillofacial Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
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Tawfik AA, Ali RA. Evaluation of botulinum toxin type A for treating post burn hypertrophic scars and keloid in children: An intra-patient randomized controlled study. J Cosmet Dermatol 2023; 22:1256-1260. [PMID: 36718819 DOI: 10.1111/jocd.15634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Consequently, the management of post burn hypertrophic scars and keloid in children are a great challenge for the physicians, parents, and children themselves. PURPOSE OF THE STUDY To assess the efficacy and safety of treating hypertrophic and keloid scars with botulinum toxins injections. PATIENTS AND METHODS This is a randomized intra-patient comparative study was conducted on 15 children with post burn hypertrophic and keloid scars. Children were randomized to receive Intralesional injection of botulinum toxins on one part of the hypertrophic scar/keloid where the other part was left as a control. The assessment of clinical improvement was measured by the Vancouver scar scale (VSS) and by skin analysis camera system. Sessions were performed every month for 6 months. RESULTS Clinical and statistical dramatic improvement in the vascularity, pliability, and height of the lesions which have been injected with neuronox. Evaluation of the lesions by the Antera camera has proven marked changes in the vascularity and height. There was no correlations between Vancouver score improvement and variables such as the age, sex, skin type, and duration and lesion type. CONCLUSIONS The botulinum toxins proved its efficacy and safety in treatment of hypertrophic scars and keloid in children. It improved the associated itching and pain. Moreover it improves the pliability, erythema, and thickness of the scars.
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Affiliation(s)
- Abeer Attia Tawfik
- Nationonal Institute of Laser Enhanced Sciences Cairo University, Cairo University, Giza, Egypt
| | - Rama Ahmad Ali
- Kasar El Eni Faculty of Medicine, Cairo University, Giza, Egypt
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Concentration-Dependent Inhibition of Hypertrophic Scar Formation by Botulinum Toxin Type A in a Rabbit Ear Model. Aesthetic Plast Surg 2022; 46:3072-3079. [PMID: 35864206 DOI: 10.1007/s00266-022-03008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertrophic scar (HS), as a disappointing result of wound healing, adversely affects the patient, both physically and psychologically. Botulinum toxin type A (BTXA) has been revealed to prevent and improve HS. We conducted this study to assess the effect of different BTXA concentrations on inhibiting HS in a rabbit ear model. METHODS Eight healthy New Zealand long-eared rabbits were included in the experiment for modeling. Four wounds of 1 cm in diameter were created on both ears, which separately received an injection of a given BTXA concentration immediately after surgery. On postoperative days 40, scar tissue was obtained and subjected to hematoxylin and eosin (HE) staining for the hypertrophic index (HI) and immunohistochemical staining for CD31, Ki67, and transforming growth factor-beta 1 (TGF-β1) expression. The HI was assessed for scar proliferation, and CD31 and Ki67 expression were used to assess the effect of BTXA on angiogenesis and fibroblast proliferation, respectively. RESULTS All rabbits healed well without infection or mortality. From the HE staining, the HI showed a significant decrease with increasing BTXA concentration (p < 0.05). BTXA also inhibited angiogenesis and TGF-β1 expression in a concentration-dependent manner, with significant differences between the groups (p < 0.05). BTXA inhibited fibroblast proliferation with increasing BTXA concentration. However, there was no significant difference between the 0.5 U/0.1 ml and 0 U/0.1 ml groups (p > 0.05). CONCLUSION Immediate postoperative BTXA injection inhibited angiogenesis, fibroblast proliferation, and TGF-β1 expression in a concentration-dependent manner, thus suppressing HS formation in rabbit ears. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .
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Pereira IN, Hassan H. Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 1: therapeutic applications. Evid Based Dent 2022:10.1038/s41432-022-0256-9. [PMID: 35624296 DOI: 10.1038/s41432-022-0256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022]
Abstract
Objective An evidence-based review on the safety and efficacy of botulinum toxin type-A (BoNTA) in orofacial conditions, focusing on the therapeutic applications and role of BoNTA as an adjuvant treatment.Data source and selection Data was collected using PubMed (Medline), Cochrane Library of Systematic Reviews and Cochrane Central Register of Controlled Trials electronic databases. Having satisfied the search parameters, 32 studies for therapeutic applications and 26 for BoNTA as an adjunctive treatment were included. The quality of relevant studies was assessed using the Best Evidence Topics (BETs) Critical Appraisal Tool.Data extraction The highest level of evidence (LOE) behind BoNTA safety and efficacy was for wound healing and scar management in the orofacial surgery context, where BoNTA was presented as an adjunctive modality. Level-I evidence was controversial for temporomandibular disorders and bruxism. However, it showed promising results for painful temporomandibular disorders of myogenic origin refractory to conservative therapies, and to decrease muscle contraction intensity in sleeping bruxism. There was only one level-II study for persistent recurrent aphthous stomatitis. Data showed limited level-III evidence for orofacial pain conditions (temporomandibular joint recurrent dislocation and pain, burning mouth syndrome or atypical odontalgia), oral cancer complications, or as an adjuvant to maxillofacial and orthognathic surgeries. Benefits of BoNTA in prosthodontics had weak level-IV evidence. No evidence was found among the periodontology field.Conclusion There is growing evidence to support the safety and efficacy of BoNTA in the investigated orofacial pathological conditions, with high levels of satisfaction from the patient and clinician perspective. However, there are some inconsistencies and limited high-quality evidence available. Well-designed controlled clinical trials are necessary to evaluate long-term safety, efficacy and cost-effectiveness before BoNTA is widely adopted with irrefutable evidence-based clinical guidelines.
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Affiliation(s)
- Ines Novo Pereira
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK
| | - Haidar Hassan
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK.
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Wang W, Liu G, Li X. The Efficacy and Safety of Botulinum Toxin Type A Injections in Improving Facial Scars: A Systematic Review and Meta-Analysis. Pharmacology 2022; 107:241-249. [PMID: 35354154 DOI: 10.1159/000522396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTA) has a wide range of clinical applications, and its use in improving aesthetics is one of them. The aim of this study was to better assess the efficacy and safety of BTA in patients with facial scars. SUMMARY We extracted the data of the visual analog scale (VAS) score, Vancouver scar scale (VSS) score, scar width, observer scar assessment scale (OSAS), patient scar assessment scale (PSAS), and/or drug-related adverse events. Five studies provided the data of VAS score, and the results showed that the VAS score in the BTA group was significantly higher than that in the control group. Three randomized controlled trials (RCTs) reported the VSS score. A statistically significant difference exists between the BTA group and the control group. Three RCTs reported the scar width after BTA treatment. A more favorable change was found in the BTA group with scar width even without statistical significance. Data about the OSAS and PSAS scores were available in two trials. There was no significant difference in OSAS and PSAS scores between the BTA group and the control group. Only three studies recorded three slight adverse events. There were no reports of severe complications. In conclusions, this study demonstrated that BTA has the potential to improve facial scars with an acceptable safety profile.
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Affiliation(s)
- Wendi Wang
- Department of Plastic and Burn Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Guangjing Liu
- Department of Plastic and Burn Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Xiaobing Li
- Department of Plastic and Burn Surgery, Tianjin First Central Hospital, Tianjin, China
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10
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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; 46:395-405. [PMID: 34609526 DOI: 10.1007/s00266-021-02596-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Postoperative facial scarring can be a significant psychological burden for patients to carry after surgery, often resulting in prolonged mental health dysfunction. Currently, there is no established method to prevent facial scar formation; however, there are several methods to prevent facial scar hyperplasia and improve scar quality. Botulinum toxin A (BTA) has been widely used due to its properties of muscle paralysis and known success in plastic surgery and cosmetology. This meta-analysis aimed to evaluate the efficacy of BTA in preventing postoperative facial scar hyperplasia and improving scar quality. METHODS PubMed, MEDLINE, EMBASE, web of science, and Cochrane libraries were searched for randomized controlled trials (RCTs) (published before May 2021) wherein BTA was used for the treatment of facial scars. The efficacy and safety of BTA were evaluated 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 complications was also assessed. RESULTS Ten RCTs involving 114 cases were included. Through quantitative analysis, the BTA injection group had a higher VAS score, lower VSS score, lower OSAS score, and smaller scar width. However, no significant difference was noted in the incidence of postoperative complications between the two groups. CONCLUSIONS This meta-analysis demonstrated that BTA can safely improve the appearance of postoperative facial scars by significantly inhibiting scar hyperplasia and improving scar quality. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Shuai Yue
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China.
| | - Mengran Ju
- Department of Plastic and Reconstructive Surgery, Chengdu Badachu Medical Aesthetics Hospital, Chengdu, 610000, China
| | - Zhe Su
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China
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11
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Fu Z, Huang H, Huang J. Efficacy and safety of botulinum toxin type A for postoperative scar prevention and wound healing improvement: A systematic review and meta-analysis. J Cosmet Dermatol 2021; 21:176-190. [PMID: 34859567 DOI: 10.1111/jocd.14617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/05/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Botulinum toxin type A (BTXA) has shown underlying effects for wound healing improvement. New small clinical trials keep emerging every year and updated evidence-based information is warranted. This study aimed to evaluate the efficacy and safety of BTXA for preventing scarring. METHODS Four databases were searched to recruit randomized clinical trials (RCTs) which compared the surgical wounds treated with BTXA vs. those treated with placebo or blank control. The outcomes were primarily quantified by measures including the Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), Stony Brook Scar Evaluation Scales (SBSES), modified SBSES (mSBSES), and scar width. Patients' satisfaction and adverse events were also reported. RESULTS In total, 16 RCTs involving 671 cases (510 patients) were included. The outcome showed significant superiority of BTXA in VSS (mean difference [MD] = -1.32, 95% confidence interval [CI]: -2.00 to -0.65, p = 0.0001), VAS (MD = 1.29, 95% CI: 1.05-1.52, p < 0.00001), SBSES or mSBSES (MD = -0.18, 95% CI: -0.27 to -0.10, p < 0.0001), scar width (MD = -0.18, 95% CI: -0.27 to -0.10, p < 0.0001), and patients' satisfaction (risk ratio [RR] = 1.25, 95% CI: 1.06-1.49, p = 0.01). No significant difference of adverse events incidence was observed (RR = 1.46 95% CI: 0.64-3.33, p = 0.36). CONCLUSIONS Botulinum toxin type A is effective and safe for postoperative scar prevention and wound healing improvement, especially for facial wounds of Asians. Further studies should manage to standardize the treatment algorithm, while mSBSES is recommended for scar assessment.
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Affiliation(s)
- Ziyao Fu
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanzi Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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The Efficacy and Safety of Botulinum Toxin Injections in Preventing Postoperative Scars and Improving Scar Quality: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2350-2362. [PMID: 33674930 DOI: 10.1007/s00266-021-02196-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/15/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Scars exposed on the body surface lead to a large psychological burden on patients. However, no satisfactory scar treatments exist. Botulinum toxin type A is a neurotoxin that has been widely applied in the plastic and cosmetic surgery field. The purpose of this meta-analysis was to assess the efficacy and safety of botulinum toxin in scar management. METHODS PubMed, the Cochrane Library, EMBASE, MEDLINE, and Web of Science were searched for randomized controlled trials that evaluated the efficacy of botulinum toxin injections in preventing postoperative scars and improving scars quality and were published prior to Dec. 29, 2020. The outcome indicators were the visual analog scale score, Vancouver scar scale score, Stony Brook scar evaluation scales score, scar width, patient self-assessment results, and complications. RESULTS Seventeen randomized controlled trials with a total of 633 cases were identified in this meta-analysis. The quantitative synthesis results showed that compared with the control group, the botulinum toxin group had a significantly lower VSS score (MD = -0.97, 95%CI = -1.56 to -0.39, p = 0.001), higher VAS score (MD = 1.26, 95%CI = 1.04 to 1.47, p < 0.00001), thinner scar width (MD = -0.25, 95%CI = -0.37 to -0.12, p < 0.0001) and higher patient satisfaction (RR = 3.38 95%CI = 1.45 to 7.89, p = 0.005). There were no significant differences between the two groups in the number of adverse events. CONCLUSIONS This meta-analysis demonstrated that botulinum toxin injections can significantly improve cosmetic appearance and postoperative scar quality. At the therapeutic dose, no significant complications were observed, indicating that botulinum toxin injections are safe. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Pan L, Qin H, Li C, Yang L, Li M, Kong J, Zhang G, Zhang L. Safety and efficacy of botulinum toxin type A in preventing and treating scars in animal models: A systematic review and meta-analysis. Int Wound J 2021; 19:774-781. [PMID: 34402205 PMCID: PMC9013589 DOI: 10.1111/iwj.13673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022] Open
Abstract
Previous studies have used botulinum toxin type A (BTXA) to improve postoperative and hypertrophic scars; however, there is lack of detailed verification on the safety and effectiveness of this approach. This study aimed to evaluate the therapeutic effect of BTXA on postoperative hypertrophic scars and its influence on cytokine expression in animal models. A computerised search of different databases was performed, including PubMed, Web of Science, Scopus, Cochrane, Embase, CNKI, and Wanfang, up to 10 March 2021. A meta-analysis was performed using R 4.0.0 based on hypertrophic index, epithelialisation time, wound area, and vascular endothelial growth factor (VEGF) expression. Eleven studies were included. The meta-analysis showed a significant difference in hypertrophic index (standardised mean difference [SMD] = -2.63, 95% confidence interval [CI]: -3.50 to -1.76, P < .01), wound area (SMD = -0.54, 95% CI: -1.24 to 0.16, P < .01), and VEGF expression (SMD = -2.56, 95% CI: -3.50 to -1.62, P < .01). This study shows that BTXA is safe and effective in preventing and treating scar hypertrophy in animal models, but excessive doses of BTXA and BTXA to treat large areas should be avoided.
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Affiliation(s)
- Lingfeng Pan
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Haiyan Qin
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Caihong Li
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Liehao Yang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mingxi Li
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiao Kong
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guang Zhang
- Department of Thyroid Surgery, China Japan Union Hospital of Jilin University, Changchun, China
| | - Lianbo Zhang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Suh JM, Park SH, Lee JW, Lee SJ, Suh IS, Lee JW, Jeong HS. Clinical Outcomes Following the Early Application of Multimodal Scar Programs for Facial Incisional Wounds. Aesthetic Plast Surg 2021; 45:1772-1782. [PMID: 33973048 DOI: 10.1007/s00266-021-02330-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Even though scars are major issues for patients who undergo facial lacerations, programs for their prevention and early management are not well established. The purpose of this study was to evaluate the clinical outcomes of prophylactic scar assessments and early scar interventions in patients with lacerations. PATIENTS AND METHODS A total of 116 patients underwent suture line and scar prevention treatment in the emergency room from 2014 to 2015. In the retrospective study, 46 patients who met all the criteria were included in the study. They were assigned to one of the following two scar prevention programs: the standard scar program for prevention, which included taping, silicone sheets, and ointments, and the multimodality scar program for treatment, which included triamcinolone, botulinum toxins, or CO2 fractional lasers. The patterns of early scar program were investigated for the standard scar prevention program and the multimodality scar management program, and we evaluated the scar assessment scores of the patients at 3 and 6 months. RESULTS Scar scores for the patients who received multimodality scar management showed statistically significant improvements in Patient Scar Assessment (PSA) scales, Stony Brook Scar Evaluation Scales (SBSES), Vancouver Scar Scale (VSS) scores, and Visual Analog Scar (VAS) scales (the p values were 0.008, 0.007, 0.017, and 0.01, respectively). CONCLUSION The multimodality scar program is more effective for scar prevention than the standard scar program. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Joong Min Suh
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Hoon Park
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun Won Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong Joo Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - In Suck Suh
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Wook Lee
- Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, School of Medicine, Hallym University, Seoul, Korea
| | - Hii Sun Jeong
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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15
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Botulinum Toxin for a Better Scar in Cleft Lip Surgery: A Prospective Randomized Control Trial. J Craniofac Surg 2021; 33:198-202. [PMID: 34267122 DOI: 10.1097/scs.0000000000007836] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION An unsightly scar following cleft repair can undo the good work of even an experienced surgeon. A functioning orbicularis oris muscle beneath the lip scar maintains a zone of dynamic tension resulting in a stretched scar. Botulinum toxin type A (BTA) can be used to create a temporary paralysis of the orbicularis muscle during the healing phase. This may lead to better scar formation after a cleft lip repair. METHOD The present prospective randomized control trial enrolled 28 infants with unilateral cleft lip undergoing primary lip repair. They were randomized to receive injection of either BTA (botox group) or normal saline (control group) intraoperatively into adjacent orbicularis oris muscle immediately after completion of cleft lip repair. Blinded experts reassessed the scar after 6 months. Objective assessment was undertaken employing Visual Analogue Scale (VAS), Vancouver Scar Scale (VSS), and photographic scar width measurements. RESULTS Twenty-two subjects were able to complete a follow-up duration of 6 months. Children in the BTA (Botox Group) had a statistically significantly better VAS score and lesser scar width compared to the control group. However, the difference in the VSS score between both groups was not statistically significant. On comparing patients with cleft lip alone with cleft lip and palate, no statistically significant difference was found in VAS, VSS, and scar width. There were no complications associated with the use of botulinum toxin A. CONCLUSIONS Botulinum toxin type A injection is a safe and effective addition to improve scar appearance following cleft lip repair. There was improvement in appearance of the scar in terms of width, but no improvement was seen in the scar pigmentation. The scar outcome is independent of cleft lip classification.
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Li Y, Shan X, Mao Q, Xiang R, Cai Z. Botulinum toxin type a intralesional monotherapy for treating human hypertrophic scar in a dose-dependent manner: In an animal model. J Plast Reconstr Aesthet Surg 2021; 74:3186-3195. [PMID: 34158272 DOI: 10.1016/j.bjps.2021.03.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of Botulinum toxin type A (BTX-A) in treating or preventing a hypertrophic scar (HS) had been reported in clinical studies. However, the dose-effect relationship remains unclear. OBJECTIVE To study the dose-effect relationship of BTX-A intralesional monotherapy treating human HS. METHODS Six HS tissues were collected from six patients. Each tissue was segmented into 24 specimens and split into four groups: negative control (group A), 0.5U BTX-A (group B), 1U BTX-A (group C), and 2U BTX-A (group D). Six nude mice, each was prepared by implanting four specimens (one from each group) into the back for a total of 24 specimens. The process mentioned above were repeated six times. A re-entry operation was performed to obtain the specimens after 8 weeks. The weight of HS, the expression of decorin and TGF-β1, the proliferation, and migration ability of hypertrophic scar fibroblasts (HSFBs) were compared among groups. RESULTS The weight of HS, the expression of decorin and TGF-β1, the proliferation, and migration ability of HSFBs showed significant differences in groups C and D as compared to group A; there has been no statistical significance in group B. CONCLUSION BTX-A showed significant therapeutic efficacy when compared with the negative control group in a dose-dependent manner. BTX-A can reduce the weight of HS, upregulate the expression of decorin, downregulate the expression of TGF-β1, and inhibit HSFBs proliferation and migration ability. This study indicates that BTX-A intralesional monotherapy treating HS should reach a threshold dose to achieve an effective treatment, and a high dose of BTX-A is more effective than a low dose.
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Affiliation(s)
- Yawei Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China
| | - Xiaofeng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China
| | - Qianying Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China
| | - Ruolan Xiang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing, 100191, China.
| | - Zhigang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China.
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17
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Byun HJ, Park JH, Lee JH. Combination Treatment of Intra/Perilesional Botulinum Toxin-A Injection and Ablative Fractional Laser for Better Clinical Outcomes of Hypertrophic Fibrotic Thyroidectomy Scars Following Fractional Ablative Laser Resurfacing. Ann Dermatol 2021; 33:170-177. [PMID: 33935459 PMCID: PMC8082008 DOI: 10.5021/ad.2021.33.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent reports have shown that intralesional botulinum toxin type-A (BTX-A) works on scar cosmesis. OBJECTIVE To evaluate the clinical efficacy of combination treatment of laser and BTX-A injection and compare the effects of conventional intralesional injection and intra- and perilesional BTX-A injection on fibrotic thyroidectomy scars. METHODS Patients with fibrotic thyroidectomy scars showing insufficient responses to previous ablative fractional laser (AFL) treatment were enrolled. Combination treatment with AFL and BTX-A injection was performed. Patients who received intra/perilesional BTX-A injections were classified into group A. Group B was patients in whom the injection was performed only intralesionally. The improvement was assessed based on the Vancouver Scar Scale (VSS). RESULTS A total of 24 patients was included. Statistically significant improvement in pliability and total VSS score after the combination treatment were observed in overall patient group. Subgroup analysis demonstrated that pliability, height, and total VSS improved significantly in group A. In group B, only pliability significantly improved. CONCLUSION BTX-A injection combined with AFL can provide better relief for the previously treated fibrotic thyroidectomy scars. Injection of BTX-A not only into the scar itself, but also into perilesional muscles that can exert tension on the scar site may provide additional benefit in flattening scar height.
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Affiliation(s)
- Hyun Jeong Byun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medical Device Management & Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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Wang ZC, Zhao WY, Cao Y, Liu YQ, Sun Q, Shi P, Cai JQ, Shen XZ, Tan WQ. The Roles of Inflammation in Keloid and Hypertrophic Scars. Front Immunol 2020; 11:603187. [PMID: 33343575 PMCID: PMC7746641 DOI: 10.3389/fimmu.2020.603187] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/06/2020] [Indexed: 01/13/2023] Open
Abstract
The underlying mechanisms of wound healing are complex but inflammation is one of the determining factors. Besides its traditional role in combating against infection upon injury, the characteristics and magnitude of inflammation have dramatic impacts on the pathogenesis of scar. Keloids and hypertrophic scars are pathological scars that result from aberrant wound healing. They are characterized by continuous local inflammation and excessive collagen deposition. In this review, we aim at discussing how dysregulated inflammation contributes to the pathogenesis of scar formation. Immune cells, soluble inflammatory mediators, and the related intracellular signal transduction pathways are our three subtopics encompassing the events occurring in inflammation associated with scar formation. In the end, we enumerate the current and potential medicines and therapeutics for suppressing inflammation and limiting progression to scar. Understanding the initiation, progression, and resolution of inflammation will provide insights into the mechanisms of scar formation and is useful for developing effective treatments.
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Affiliation(s)
- Zheng-Cai Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wan-Yi Zhao
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yangyang Cao
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan-Qi Liu
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qihang Sun
- Department of Cardiology of the Second Affiliated Hospital, and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Peng Shi
- Department of Cardiology of the Second Affiliated Hospital, and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Qin Cai
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Z Shen
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Botulinum Toxin Type A Injection for Mammoplasty and Abdominoplasty Scar Management: A Split-Scar Double-Blinded Randomized Controlled Study. Aesthetic Plast Surg 2020; 44:2270-2276. [PMID: 32813130 DOI: 10.1007/s00266-020-01916-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/05/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Scars are inevitable results of surgical procedures, and prevention of them is still a major problem in the field of cosmetic surgery. Although various studies have been performed on botulinum toxin-A (BoNT-A) injection for the prevention of hypertrophic scars, the exact mechanism remains unclear. METHODS This prospective, double-blinded, randomized study was performed on 19 patients who underwent mammoplasty and abdominoplasty surgery in Razi Hospital from October 2018 to December 2019. Single session of treatment was performed, where XEOMIN was allocated to one half of the scar and 0.9% saline to the control half. 3 and 6 months later, scars were assessed using the modified Stony Brook Scar Evaluation Scale (SBSES). RESULTS In total, 19 patients who completed the study were analyzed. mSBSES at the third month (P value < 0.001; 3.34 ± 1.59 vs 1.5 ± 1.36) and the sixth month (P value < 0.001; 4.89 ± 1.83 vs 2.39 ± 1.82) showed a significant difference between the treatment and control groups. In the subset analysis, there was significant difference between BoNT-A and control in all four items including width, height, color, and scar visibility at months 3 and 6, and the BoNT-A-treated sides had higher scores in all items. CONCLUSION BoNT-A has a significant effect on scar prevention due to mammoplasty and abdominoplasty compared to placebo and results in decreased erythema, height, width and reduces incision line visibility. Moreover, its effect increases significantly over time from months 3 to 6. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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20
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Maina IW, Friedman O. The Role of Botulinum Toxins in Wound Management and Scar Revision. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Botulinum toxin type A (BoNTA) is a powerful neurotoxin that inhibits acetylcholine release from presynaptic vesicles. The potency and safety profile of BoNTA grant the toxin vast therapeutic potential. It has been used off-label for a variety of dermatologic conditions. This review aims to analyze published literature regarding the benefits and risks of the off-label use of BoNTA beyond facial lines, including eccrine hidrocystomas, enlarged pores, keloids and hypertrophic scars, hidradenitis suppurativa, hyperhidrosis, masseter muscle hypertrophy, and salivary gland hypertrophy, among others. A MEDLINE search from January 2000 to December 2019 was conducted on the off-label uses of botulinum toxin in dermatology.
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Affiliation(s)
- Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, 1430 K St NW, Suite 200, Washington, DC, 20005, USA.
| | - Iris S Harrison
- Washington Institute of Dermatologic Laser Surgery, 1430 K St NW, Suite 200, Washington, DC, 20005, USA
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22
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Zhang W, Li X, Li X. Efficacy and Safety of Botulinum Toxin Type A in Preventing Postoperative Scars and Improving the Cosmetic Appearance of Scars: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2020; 24:608-618. [PMID: 32608997 DOI: 10.1177/1203475420937963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scars with poor cosmesis that develop after wound healing may affect normal life. OBJECTIVE To assess the efficacy and safety of botulinum toxin type A (BTXA) in preventing postoperative hypertrophic scars or keloids. METHODS A systematic review was performed by searching the PubMed, Cochrane Library, and EMBASE databases from their inception date up to February 2020 for randomized controlled trials (RCTs) evaluating the efficacy of BTXA in preventing hypertrophic scars or keloids. The primary outcome measures included the Vancouver Scar Scale (VSS) score, Visual Analog Scale (VAS) score, scar width, patient satisfaction, and adverse events. RESULTS Twelve RCTs involving 497 cases (372 patients) were included. The meta-analysis showed significant differences in the VAS score (weighted mean difference [WMD] = 1.31, 95% CI = 1.06 to 1.55, P < .00001), VSS score (WMD = -1.02, 95% CI = -1.72 to -0.32, P = .004), scar width (WMD = -0.18, 95% CI = -0.29 to -0.08, P = .0008), and patient satisfaction (relative risk = 1.25, 95% CI = 1.06-1.49, P = .01). Four studies reported trivial adverse events. CONCLUSIONS This meta-analysis showed that BTXA was more effective than the control treatment in preventing postoperative scars and improving the cosmetic appearance of facial scars for East Asians, and no serious adverse events were found during the follow-up period. However, there was insufficient evidence to support the use of BTXA for the prevention of scars in patients from other ethnic groups and regions or scars in non-facial areas.
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Affiliation(s)
- Wei Zhang
- 36639 Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyi Li
- 36639 Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaojing Li
- 36639 Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Guo X, Song G, Zhang D, Jin X. Efficacy of Botulinum Toxin Type A in Improving Scar Quality and Wound Healing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthet Surg J 2020; 40:NP273-NP285. [PMID: 31155638 DOI: 10.1093/asj/sjz165] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Botulinum toxin type A-induced "chemoimmobilization" has long been utilized for improved scar quality and wound healing; however, current evidence is limited to small studies, and evidence-based information is inadequate to make well-informed decisions. OBJECTIVES The purpose of this study was to evaluate the efficacy of botulinum toxin type A (BTA) to improve scars and wound healing. METHODS The authors searched databases, including Pubmed, Embase, and Cochrane Library, to identify randomized clinical trials (RCTs) that compared outcomes of surgical scars and wounds treated with BTA vs those treated with blank or placebo controls. The Visual Analog Scale, Vancouver Scar Score, scar width, and reported patient satisfaction were utilized in evaluating outcomes. Adverse events were also recorded. RESULTS Eleven RCTs involved a total of 486 cases (374 patients). Quantitative synthesis suggested that compared with the control group, patients in the BTA treatment group had significantly higher Visual Analog Scale scores (mean difference [MD] = 1.30, 95% confidence interval [CI]: 1.05 to 1.55), lower Vancouver Scar Scores (MD = -1.62, 95% CI: -2.49 to -0.75, P = 0.0003), and thinner scars (MD = -0.15, 95% CI: -0.20 to -0.11, P < 0.00001). Patient satisfaction was higher in the BTA group than in the control group (risk ratio: 1.25, 95% CI: 1.06 to 1.49, P = 0.01). Trivial adverse events were reported. CONCLUSIONS This meta-analysis of RCTs provides reliable evidence that BTA injection is superior to placebo or blank control group in improving scar quality and wound healing in the face and neck for Asians, and negative outcomes for BTA treatment in these patients include only trivial adverse events. However, inadequate evidence supports utilization of BTA in Caucasians for primary surgical scars or for scars in locations other than the face and neck. Further studies on the standardized injection regimen and technique of BTA are warranted for clinical practice. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Xiaoshuang Guo
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guodong Song
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Dong Zhang
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaolei Jin
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Appropriate Timing of Early Postoperative Botulinum Toxin Type A Injection for Thyroidectomy Scar Management: A Split-Scar Study. Plast Reconstr Surg 2020; 144:659e-668e. [PMID: 31568312 DOI: 10.1097/prs.0000000000006064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTxA) injection is effective for surgical scar prevention. Although some studies have aimed to confirm the efficacy of BTxA injection at different time points, none has been conducted to determine the most appropriate timing of injection for scar management. The authors predicted that the injection of BTxA at different times during the wound healing process would cause differing scar quality improvement and clarify unknown molecular mechanisms. METHODS The study included adults who underwent thyroidectomy. All patients received paralesional BTxA injections on the day of the surgery on either the right or left side of the operative site. The same dose was injected on the noninjected side by means of the same method after 2 weeks. At 2, 4, 12, and 24 weeks postoperatively, the modified Stony Brook Scar Evaluation Scale, visual analogue scale, and erythema index were used for objective, subjective, and quantitative evaluations of the scar. At week 24 postoperatively, a quantitative scar assessment was performed with respect to the erythema index, skin elasticity, melanin index, and friction. RESULTS On objective evaluation of the scar and patient satisfaction at 24 weeks postoperatively, the operation-day injection side showed better outcomes than the 2-week-postoperative injection side. These differences were significant from postoperative week 4. In the final quantitative scar assessment at postoperative week 24, significant improvements were observed in the erythema index and skin elasticity. CONCLUSION These results suggest that immediate postoperative BTxA injection is more effective for thyroidectomy scar management in terms of erythema, skin elasticity, and patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Sohrabi C, Goutos I. The use of botulinum toxin in keloid scar management: a literature review. Scars Burn Heal 2020; 6:2059513120926628. [PMID: 32637157 PMCID: PMC7323272 DOI: 10.1177/2059513120926628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Administration of botulinum toxin is an increasingly popular procedure in the medical and aesthetic field. There is emerging evidence that it can influence fibroblast activity and minimise tension around the scar by virtue of muscular chemoimmobilisation. This review aims to explore the current evidence base behind the treatment of keloid scars with botulinum toxin. METHODS A detailed literature review was conducted using PubMed Medline, Embase and Web of Science databases. Manuscripts were appraised and classified in accordance with the Joanna Briggs Institute Levels of Evidence by an independent consultant in evidence synthesis. The results of this search are presented in descending order of evidence for botulinum toxin as a primary management agent as well as a secondary adjunct following extralesional keloid excision. DISCUSSION On the basis of level 1 evidence, botulinum toxin appears to be equivalent to triamcinolone in producing a short-term reduction in keloidal volume, height and vascularity. A number of level 1 and 2 studies also suggest that botulinum toxin may be particularly helpful in alleviating symptoms of keloid associated pain and itch. There are currently limited studies appraising the value of botulinum toxin in the postoperative management of keloid scars. CONCLUSION Botulinum toxin may represent a promising agent in the management of keloid scars. However, further research involving large-scale studies with comparative designs and long-term follow-up is warranted to delineate the value of this therapeutic modality in scar management protocols.
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Affiliation(s)
- Catrin Sohrabi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Wang Y, Wang J, Zhang J, Hu C, Zhu F. Effectiveness and Safety of Botulinum Toxin Type A Injection for Scar Prevention: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2019; 43:1241-1249. [PMID: 30903249 DOI: 10.1007/s00266-019-01358-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of active scar prevention in postoperative scar management is important. Botulinum toxin type A (BTXA) has been shown to improve postoperative scars in the past decades. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of BTXA injection for scar prevention. METHODS The authors searched the databases of Medicine, Embase, the Cochrane Library, Web of Science, and CINAHL from inception through November 2018 for randomized controlled trials (RCTs) reporting the use of BTXA in scar prevention. The outcomes were the visual analogue scale (VAS) score, Vancouver Scar Scale score, scar width, patient satisfaction and adverse events. RESULTS A total of nine RCTs were identified in this systematic review and meta-analysis. The VAS score was significantly higher in the BTXA group than in the control group (weighted mean difference (WMD) = 1.32, 95% confidence interval (CI) = 1.06-1.58, P < 0.00001). The Vancouver Scar Scale score was significantly lower in the BTXA group (WMD = - 1.25, 95% CI = - 2.23 to - 0.26, P = 0.01). The scar width was also significantly smaller in the BTXA group (WMD = - 0.18, 95% CI = - 0.24 to - 0.12, P < 0.00001). There was a significant difference in terms of patient satisfaction between the BTXA group and the control group (relative risk (RR) = 1.38, 95% CI = 1.09-1.74, P = 0.007). Only two studies reported complications, and other studies reported no complications during the follow-up period. CONCLUSIONS This systematic review and meta-analysis demonstrates that BTXA injection can reduce scar width in wounds and improve the overall appearance of postoperative scars and suggests that BTXA may be a safety therapy for scar prevention. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Yang W, Li G. The Safety and efficacy of botulinum toxin type A injection for postoperative scar prevention: A systematic review and meta‐analysis. J Cosmet Dermatol 2019; 19:799-808. [PMID: 31513335 DOI: 10.1111/jocd.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Wenhui Yang
- Department of Plastic and Reconstructive Surgery Peking University People ‘s Hospital Beijing China
| | - Guangxue Li
- Department of Plastic and Reconstructive Surgery Peking University People ‘s Hospital Beijing China
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Park GS, An MK, Yoon JH, Park SS, Koh SH, Mauro TM, Cho EB, Park EJ, Kim KH, Kim KJ. Botulinum toxin type A suppresses pro-fibrotic effects via the JNK signaling pathway in hypertrophic scar fibroblasts. Arch Dermatol Res 2019; 311:807-814. [PMID: 31501922 DOI: 10.1007/s00403-019-01975-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/01/2019] [Accepted: 08/30/2019] [Indexed: 01/23/2023]
Abstract
Hypertrophic scar is a dermal fibroproliferative disease characterized by the overproduction and deposition of extracellular matrix, and the hyperproliferation and enhanced angiogenesis of fibroblasts, along with their enhanced differentiation to myofibroblasts. Botulinum toxin type A shows potential for prevention of hypertrophic scar formation; however, its effectiveness in attenuating skin fibrosis and the related mechanism are unclear. In this study, human scar fibroblasts were cultured and stimulated with botulinum toxin type A, and the changes in fibroblast proliferation, migration, and protein expression of pro-fibrotic factors were evaluated with colorimetric, scratch, and enzyme-linked immunosorbent assays and western blotting, respectively. Botulinum toxin type A treatment decreased the proliferation and migration of human scar fibroblasts compared with those of untreated controls. Protein expression levels of pro-fibrotic factors (transforming growth factor β1, interleukin-6, and connective tissue growth factor) were also inhibited by botulinum toxin type A, whereas the JNK phosphorylation level was increased. Activation of the JNK pathway demonstrated the inhibitory effects of the toxin on human scar fibroblast proliferation and production of pro-fibrotic factors, suggesting that the suppressive effects of botulinum toxin type A are closely associated with JNK phosphorylation. Overall, this study showed that botulinum toxin type A has a suppressive effect on extracellular matrix production and scar-related factors in human scar fibroblasts in vitro, and that regulation of JNK signaling plays an important role in this process. Our results provide a theoretical basis, at the cellular level, for the therapeutic use of botulinum toxin type A.
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Affiliation(s)
- Gil Soon Park
- Department of Dermatology, Hallym Institute for Translational Medicine, Anyang, South Korea
| | - Min Kyun An
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Ji Ha Yoon
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Seok Soon Park
- Department of Convergence Medicine, Asan Medical Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Hoon Koh
- Department of Plastic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, South Korea
| | - Theodora M Mauro
- Department of Dermatology, VA Medical Center, University of California, San Francisco, CA, USA
| | - Eun Byul Cho
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea.
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
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The safety and efficacy of botulinum toxin for management of scars: A systematic review with meta-analysis and trial sequential analysis. Toxicon 2019; 166:24-33. [DOI: 10.1016/j.toxicon.2019.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
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Bi M, Sun P, Li D, Dong Z, Chen Z. Intralesional Injection of Botulinum Toxin Type A Compared with Intralesional Injection of Corticosteroid for the Treatment of Hypertrophic Scar and Keloid: A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:2950-2958. [PMID: 31006769 PMCID: PMC6489528 DOI: 10.12659/msm.916305] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal treatment for hypertrophic scar and keloid remains controversial. Therefore, the aim of this systematic review and meta-analysis was to compare the effectiveness of intralesional injection of botulinum toxin type A compared with placebo and intralesional injection of corticosteroid compared with placebo in patients with hypertrophic scar and keloid. MATERIAL AND METHODS Six databases were searched using Medical Subject Headings (MeSH) keywords and included Web of Science, PubMed, EMBASE, the Cochrane Library, WanFang, and CNKI from their inception to March 1 2019, without language restriction. Randomized controlled trials (RCTs) and prospective controlled trials (PCTs) were identified that compared intralesional injection of botulinum toxin type A with placebo and corticosteroid with placebo in hypertrophic scar and keloid. The quality of controlled trials was assessed by the Newcastle-Ottawa Scale (NOS). RESULTS Comparison of intralesional botulinum toxin type A and corticosteroid showed significant differences in the Visual Analog Scale (VAS) (P<0.001) (WMD, -4.30; 95% CI, -4.44 to -4.16) and effective rate (P=0.012) (RR=0.82; 95% CI, 0.70-0.96). Intralesional injection of botulinum toxin type A compared with placebo showed significant differences in the VAS (P<0.001) (WMD, 1.41; 95% CI, 1.21-1.62), the width of scar (P=0.00) (WMD, -0.15; 95% CI, -0.19 to -0.10) and Vancouver Scar Scale (VSS) (P=0.003) (WMD, -0.69; 95% CI, -1.14 to -0.23). CONCLUSIONS Systematic review and meta-analysis showed that injection of intralesional botulinum toxin type A was more effective in the treatment of hypertrophic scar and keloid than injection of intralesional corticosteroid or placebo.
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The use of botulinum toxin type A to minimize scarring in cleft lip repair: A literature review. Arch Plast Surg 2019; 46:181-184. [PMID: 30812070 PMCID: PMC6446031 DOI: 10.5999/aps.2018.01284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/12/2019] [Indexed: 12/20/2022] Open
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Abstract
This year, many publications have focused on understanding, avoiding and treating vascular complications when injecting fillers. New protocols for the use of hyaluronidase have shown their effectiveness in preventing skin necrosis or blindness after vascular embolism when injecting hyaluronic acid. Other areas of interventional dermatology have been well documented: myomodulation is an interesting concept that describes the impact of the injection depth of a filler on muscle forces in order to correct the balances between the lowering and elevators during congenital or acquired defcits with aging. Treatment of melasma remains diffcult but the prescription of oral tranexamic acid could be useful. Botulinum toxin is expanding its feld of activity for both aesthetic and medical treatments. Pulsed dye laser remains the reference treatment for port wine stains, but the rate of recurrence by post laser neo-angiogenesis justifes the need of reliable and effective adjuvant treatments.
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Affiliation(s)
- C Raimbault
- Dermatologue libérale, 30, rue des Clercs, 57000 Metz, France, présidente du Groupe de dermatologie esthétique et correctrice (gDEC) de la Société française de dermatologie, past présidente de l'Association de dermatologie esthétique et laser de l'Est (ADELE).
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Kasyanju Carrero LM, Ma W, Liu H, Yin X, Zhou B. Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review. J Cosmet Dermatol 2018; 18:10-15. [PMID: 30548742 DOI: 10.1111/jocd.12828] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/30/2022]
Affiliation(s)
| | - Wei‐wei Ma
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Hou‐fang Liu
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xu‐feng Yin
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Bing‐rong Zhou
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
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Abstract
PURPOSE OF REVIEW Periocular rehabilitation of the patient with a facial nerve palsy has evolved over time. Although protection of the ocular surface is paramount, application of disfiguring tarsorrhaphies should be utilized only in special situations. The purpose of this review is to discuss current surgical and medical strategies in treatment of the periocular area in patients with facial nerve palsy to give maximal functional and cosmetic results. RECENT FINDINGS Upper lid lagophthalmos is preferentially treated with upper eyelid weights. Platinum has distinct advantages over gold. A supratarsal position of the upper lid weight is preferred over a pretarsal location. Lower lid malposition should be treated as a retraction, rather than an ectropion. Recalcitrant ocular surface disease can be effectively managed with a scleral lens. Tearing in the patient with a facial nerve palsy is often multifactorial; small lumen Jones tubes and botulinum toxin injection to the lacrimal gland should be considered to treat epiphora in these patients. SUMMARY A facial nerve palsy can be devastating for patients from both a functional and cosmetic perspective. Although seismic shifts in treatment of the periocular subunit have not occurred, there are a number of small, yet significant, changes in treatment that should be adopted in taking care of these patients.
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