The latest Plastic & Reconstructive Surgery Journal September 2024 had an article on Botox other uses, “Using Neuromodulators to Improve Scar Formation & Keloids.”
This is not new news. I wrote about this years ago. They discuss the action of treatment. It was originally thought to decrease tension on wound edges by relaxing the muscles, but now they think the mechanism is more complex.
- It affects the cellular response of tension
- It may affect fibroblasts directly by transforming growth factors, myosin, alpha smooth muscle actin, and connective tissue growth factor
- It may affect collagen indirectly
- It may reduce inflammation
- It may upregulate phophatase and tensin homolog expression
They discuss how fibroblasts play significant role in making Types I and III collagen, which are prevalent in hypertrophic and keloid scars. Studies show that in those who were treated with Botox, there was a decreased percent of fibroblasts compared to control. Another studied echoed these results and showed that Botox had NO effect in normal tissue, just the scar tissue.
The Botox decreased growth factors which contributed to wound scar contraction. In vitro studies showed the treated group had lower fibroblast markers.
As for the inflammation reduction theory, it is thought that skin pull in the surrounding tissue leads to inflammation. A study looked at macrophages, which are proinflammatory markers seen in wound healing. In a mouse model, the Botox treated group had lower macrophage percent.
Botox may affect gene expression. It increases tensin homolog expression, which lowers fibroblast proliferation.
Treatment studies show
- It is safe
- Can work in conjunction with steroids
- 23 studies have been done (randomized, controlled trials) which show in 20/23 Botox gave improved scars. (less scar width)
- Animal studies support its use, showing less scar thickness and wound area. In animals combined studies with a steroid show the best reduction was in combined therapy.
- Higher doses give better scar reduction.
- There are no dosing guidelines yet, and the way to inject varies- in the scar? next to it? fan it out?
- Early treatment is best- a study looking at immediately vs. 2 weeks out showed immediate was better.
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