Aesthetic Outcomes of Botulinum Toxin Injection for Management of Disfiguring Forehead Scars

Abstract

Objectives: The evaluation of the aesthetic outcomes of Botulinum toxin A (BTXA) injection after the excision of disfiguring forehead scars. 
 Patients and Methods: 30 patients with forehead scars underwent surgical excision under local anesthesia and BTXA injection (50U/ml) after skin closure. Patients were evaluated preoperatively, at 6 and 12 months postoperatively (PO) for the evaluation of outcomes using the patient's self-assessment scar scale, the Patient and Observer Scar Assessment Scale (POSAS), and The Stony Brook Scar Evaluation Scale (SBSES). Patients' satisfaction was evaluated before and after PO using a 10-point visual analogue scale (VAS).
 Results: At 12-months PO, the aesthetic outcome was very satisfactory by 18 patients, satisfactory by 5 patients, and good by 3 patients, while 4 patients found the aesthetic outcome fair and poor with a significantly higher PO satisfaction score compared to the preoperative score. PO scores of the scar-assessment scales showed progressive improvements with significant differences in comparison to preoperative scores and between 6- and 12-months scores. The satisfaction score was negatively related to female gender and body mass index (BMI). Regression analysis defined a high pre-procedural patient's self-assessment scar scale and low SBSES scores as negative significant predictors of high satisfaction.
 Conclusion: BTXA injection after excision of disfiguring forehead scars provided highly satisfactory outcomes with a reduction of the scar width, irrespective of the scar shape.