Botox for Relaxing Scar Tension?

Will Botox help relax the tension from a healing raised horizontal scar in the small hollow at the base of my neck, where the Fraxel Repair laser treatment ended?

This area took a couple of weeks to heal and is still healing. The scar is between the two big neck tendons, in the hollow where they join the collar bone. I am thin, so the hollow is deep and the scar is obvious. Also, this is an area where there is an extreme amount of movement. I am really hoping that Botox somewhere in that area will stop this scar from worsening. Do you have any other suggestions?

Doctor Answers 10

Botox Will Decrease Scar Tension, But Unfortunately Not in the Neck

Hi Aphro,

Sorry to hear about your complication from Fraxel re:pair.

I doubt that Botox will be able to keep the area from moving as the muscles that move your neck are very large.

Once your wound has healed, I would recommend that you use Rejuveneck cream (available on line), and have a series of Fraxel re:store treatments on the scar. Please consult with your treating physician before using the cream.

Good luck and be well.


Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Botox not likely to help.

Thanks for your question.

Scar contraction is a normal part of healing. Scar contracture is an abnormal amount of contraction within the scar that limits movement.

Scars contract parallel to their length. The contraction is mediated by scar tissue (collagen largely) not by muscle.

Botox works by paralyzing muscle.

Because of this it is unlikely for you to get significant improvements with botox alone.

A technique called z-plasty or w-plasty would be a better choice to release this scar and reorient the lines of contraction.

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Botox for scars

There are some anectodal reports of Botox being beneficial to relaxing skin tension and achieving improved scars. However, this has not been proven in large studies and is an off-label use of the product.

This is partially due to the fact that we don't completely understand wound healing. Although your assumption that decreased wound tension produces better scars is generally logical, this is not always true in practice. Sometimes excellent scars are the results of marked wound tension and thick scars are the result of diminished wound tension. Typically scars that form across hollows such as the neck notch you describe or the armpits can produce prominent scars.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Botox may be helpful

Botox may possibly be helpful for scar control. This would be in areas where the underlying pull of the muscle is placing tension on the wound (scar). I am unable to tell you if this would be helpful in your case as thorough examination is needed. I would advise you to make an appointment with a board certified/eligible plastic surgeon that is experienced with Botox to take a close look at you and discuss your options. There are other means of reducing scar formation that may be applicable and should be considered. Thanks for your question.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Scar Healing and Botox

A photograph would be helpful to give you specific advice. From your description, it sounds like you received a burn from a fractionated CO2 laser at the base of your neck. While Botox may decrease some movement of the Platysma, it will not prevent the bigger movements of the SCM and other big muscles that move the head and neck. I'm not sure what you are applying to the burn, but I would focus on maximal skin care.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 45 reviews

If Botox in that area reduces movement, it may have a positive effect

Without a picture it is difficult to give you specific advice. Botox works by paralyzing the underlying muscles which helps decrease tension and wrinkles on the overlying skin. The movement of the neck is complex and contraction of distant muscles can cause movement of the skin (such as twisting and bending the neck). We do inject Botox in the platysma bands frequently. Injecting them in you may help reduce the tension of the overlying scar and help healing. Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Botox and scars

Botox is not a magical elixir, but there have been some studies with wound closures using sutures that in areas of motion if the area was treated with Botox to paralyze the muscles, the wounds healed better.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Botox for Scar Healing?

It's unlikely based on what we can tell from your description that Botox would help. There are several options for scar revision including the following:

  • Surgical Scar Revision
  • CO2/Erbium Resurfacing. May not be appropriate depending on the type of scar, skin type and wound healing histroy. This neck does not heal as well as the face.
  • Fractional Resurfacing. Given that this is similar to the device that caused the scar, this may not be appropriate either. It depends on the scar itself and how/why the scarring occurred after the Fraxel treatment.
  • Pulse dye lasers if redness is an issue.
  • Steroid injections for hypertrophic issues (raised part of the scarring).

It's difficult to say without seeing the exact nature of the scar, what the best course of action is, but we do not think that Botox will help.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Botox for relaxing scar tension

While Botox may help, it has not been proven in controlled trials to help improve the final appearance of scarring. Other things that may be helpful:

1. If the scar is not only raised but also pink or red, treatment with the IPL or pulsed-dye laser can help. With conservative settings, you need not be afraid of additional scarring since these are not re-surfacing lasers.
2. Nightly application of silicone gel sheeting (e.g. Cicacare or Curad Scar Therapy) - there is something about occlusion to a healing scar that does improve its final appearance.
3. Cortisone injections if the scar is thick. This can thin out the scar.
4. Massage: Firm massage a few minutes a day to a thickened scar can help to flatten the scar over time.

Good luck!

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Save your money

Botox is not proven or approved for use in scar reduction. It sounds like the wound is still early. I would recommend perhaps silicone sheeting, Post Balm, or Mederma. Keep UV light off of it. This will take time to heal and fade, and if you let it take its course, it may be the best thing. One other thing to help while it is fading- conseder concealing makeup.

Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.7 out of 5 stars 101 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.