Use of Botulinum Toxin Type A to Prevent Widening of Facial Scars

Reverse tissue expansion by liposuction deflation for revision of post-surgical thigh scars

“…Scars hypertrophy and widen when stretching mechanical forces are applied to resilient newly formed collagen before it reaches final maturity, a process that can take several months before being completed (38,39). Tensile distracting forces can be caused by factors such as muscle pull, elastic forces of adjacent skin, and external pressure (38,39). Widening of scars is thus mainly the result of mechanical influences on resilient and, as yet, immature collagen.…”

“…This concept is probably validated by the outcome of healing wounds relative to the lines of Langer. These lines lie perpendicular to the tension vector of underlying muscular contraction (38,39). Anecdotal evidence suggests that incisions created parallel to skin tension lines rarely form abnormal scars.…”

“…Corticosteroid injections, although more indicated for hypertrophic rather than stretched scars, are still quite popular, however, the final even more disfiguring outcome, consisting of thin, atrophic, telangiectatic, erythematous skin, has made many reluctant to use them. Other modalities include irradiation, ultrasound, and silicone applications, as well as many others, but these treatment modalities do nothing to prevent or diminish the underlying distracting force which constitutes the main pathologic process (39). Millard (41) has described almost 40 years ago scar repair by the double‐breasted vest principle to overcome the problem of tension.…”

“…Immobilisation is a basic therapeutic principle in wound healing, common to the treatment of lesions of all kinds. Casts, plates, and sutures minimise the negative effects of muscle tension on healing wounds, including skin lesions (39). Microporous tape has been reported to be a reliable way to support a scar (5,33).…”

“…Repeated microtrauma caused by continuous displacement of injured tissue induces a prolonged inflammatory response and distortion of healing tissues before they achieve strength and maturity. Clinically, this would manifest as scar widening, hypertrophy, or both (39). Anecdotal techniques of annulling muscle contraction by putting the face in a bandage mask for 3 months have been described but were poorly tolerated by the patients (39).…”