The use of Botulism Toxin (Botox) in the treatment of wide donor scars.

Wide donor scars from previous transplants are a problem all hair restoration surgeons have to deal with. Often, attempts at scar reduction fail, as the scar stretches back to the original wide state over the course of six months.

After reading an article on the use of Botulism toxin to improve facial wound healing, Dr Jones decided to try using Botulism toxin to reduce the tension across a tight closure after a scar reduction procedure.

The patient chosen had a previous unsuccessful scar reduction about 18 months prior to this procedure. The scar was 1.3 cm prior to the reduction and stretched back to 1.3 cm within 6 months. The first photos are of the scar prior to the second revision. Dr Jones repeated the scar reduction, this time injecting 60 U of botulism toxin into the left side of the incision and the same volume of .9 % normal saline into the right side of the incision at the time the stitches were removed. (Dr Jones is familiar with the use of Botox for other indications.)

After six months, the scar was measured at 1 cm intervals and the average value was taken for each side of the scar. The average scar width for the side treated with botulism toxin was .3 mm, while the side treated with normal saline had an average width of 1.1 cm. Although the patient was unaware which side was treated with Botox, he came into the office at 6 months well aware of which side was treated as the scar was much less visible on the left hand side.

In the patient, it appears that the botulism toxin has allowed the incision to heal with less tension and avoid stretch back that we commonly see. Further study is needed to explore the use of botulism toxin in the treatment and prevention of wide scars in reductions as well as all tight closures after hair restoration surgery.

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