I have a small, linear hypertrophic scar on my cheek. It blends in well and it's small, but it bothers me a lot still. I have brown skin, 24 years old, of E. Indian descent. Can excision with Botox revise this scar better? The scar resulted from a prematurely ripped off scab. I did not have it stitched or treated, previously.
Excision and Botox for Hypertrophic Cheek Scar?
Doctor Answers 10
Evidence for botox in scar revisions
There was a reoprt in the journal Plastic & Reconstructive Surgery a couple of years ago reporting that botox helped with scar revisions on the face, by relaxing the muscles that theoretically put tension on the wound as it heals. It was not a controlled study however, meaning that they didn't compare revisions directly with and without Botox. Your plastic surgeon is in the best position to evaluate whether or not the muscles might influence how the scar will heal after revision.
Better options for hypertrophic cheek scar available
Assuming your scar is not located near your eyelid or your lip and depending on its orientation, it is quite feasible to excise it so it lies in one of your natural skin lines and perhaps perform a steroid injection just as the incision is being closed and a few times afterwards to make sure you do not develop the scar hypertrophy again.
Botox may be useful if the scar is located in an area where facial expression affects the movement of the scar while it is healing.
Botox will be of little if any help
This is clearly a problem that might be helped by excision and/or treatments with certain types of lasers including the Diode 532 but I do not see a role for Botox.
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Scar revison and botox
A superficial wound that had a scab and healed in a short time is probably not a good scar to attempt a scar revision surgical procedure on. Botox has been shown to possibly improve the final scar result in areas treated that have a lot of motion.
Probably nothing is required, but botox may help rarely.
The attached image indeed shows, if anything, a very tiny linear scar. I'm not sure that I would even call it hypertrophic and certainly it does not look like a keloid. As you mentioned, it does indeed blend well. In fact, it's hard for me to see much of anything in this image.
You also did not mention how old this wound was. Many scars...even hypertrophic ones...improve greatly with time (keloids do not, but this doesn't appear to be a keloid).
That said, there have been several studies in recent years looking specifically at Botox and its effect on scarring, including studies in Archives of Facial Plastic Surgery, Aesthetic Plastic Surgery, and others. Results have been positive (including in controlled animal model studies). I'm still a bit of a skeptic, though, primarily because there is no good explanation of the mechanism for this effect other than the effect of minimizing underlying muscle movement.
On a final note, surgical scar revision, such as broken line closures, w-plasties and the like, would be reserved for more significant deformities than what is presented here.
All the best,
Hypertrophic scarring can be a tendency or trait for some people. If the hypertrophic scar was due to manipulation and irritation while healing you may benefit from an excision with close follow up and if it begins to hypertrophy or thicken, you can quickly get low dose steroid injections or laser treatment. Be very careful with steroids as it can cause permanent hypopigmentation i.e. whitening of the skin. So start conservative topical tretinoin (Retin-A) or Tri-luma which has bleaching cream and mild steroid or with fractionated lasers then get more agressive if results are not satisfactory.
Botox is not helpful for scar revisions. What you may be thinking of is steriod injections to help calm down the scar a bit. This usually takes about three injections spaced out every 6 weeks. The result you will get really depends on the patient and everyone is different.
Cutting out a hypertrophic scar can result in an even larger hypertrophic scar
Botox can prevent movement of a muscle, and thus at times improve cosmetic wound healing. However, on the cheek this may temporarily affect your ability to smile.
Cutting out a hypertrophic scar can result in an even larger hypertrophic scar. There are other treatments, such as injections of steroids into the scar and feathering around the scar with a filler, such as Restylane, to camouflage it.
Do everything to avoid surgery.
Indian Skin Hypertrophic Scar
Do not go for scar excision. Indian skin can develop hyperpigmentation, and hypertrophy easily.
If your existing scar is hypertrophic (raised above the surrounding skin level) get steroid injections. If it is dark use sunscreen and Triluma cream.
You can try microdermabrasion and pulse dye laser treatment (on conservative settings) after the scar becomes more flat.
Botox is generally not for scars
If you choose to have the scar evaluated by a board certified plastic surgeon, he or she may suggest several treatment options. These include' revision, injection of a anti inflammatory steroid, laser treatment, bleaching cream, silicone gel, etc. The one treatment option that you most likely will not hear is Botox. This is used primarily for the treatment of wrinkles caused by hyperactive muscles, particularly in the forehead and between the eye brows. The only logical reason to inject Botox into a scar is if an underlying muscle contraction exacerbates the scars appearance.