The ‘New’ Way Botox Is Being Used Really Isn’t New at All

Botox Cosmetic, as well as its neuromodulator counterparts Dysport and Xeomin, are some of the most popular in-office treatments for the simple fact that they really make lines and wrinkles disappear. But, that’s not all they’re good for. Because of their ability to “freeze” muscles that play a role in causing pain (think migraines and TMJ, among others), they can be injected into other areas of the body as well, and have proven successful in providing temporary relief for multiple concerns. 

One of these so-called “concerns” is scarring, and particularly scarring on the face that results from facial reconstruction surgery. You’re probably thinking, what can Botox do for a scar? But it turns out, it serves a very good purpose by relieving tension on the scar that results from everyday muscle movements and facial expressions so the scar can heal better, and surgeons have been using it this way for a long time. 

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So how does it work exactly? After a surgeon stitches up an incision post surgery, he or she injects Botox around the scar (off-label), similarly to the way Botox for cosmetic is injected to treat wrinkles. “Botox is being used to minimize the movement of facial muscles, thus allowing the surgical scars to heal better without being able to stretch,” says Los Angeles facial plastic surgeon Kian Karimi, MD. “We have been utilizing Botox for this reason for many years—it’s simply not talked about a lot—and I know it works. I do believe this could, and should, be an FDA-approved indication for Botox in the future.”

Although the concept of using the injectable this way isn’t “new” per se, new research conducted by a team at Shanghai Jiao Tong University School of Medicine and published in the March issue of Plastic and Reconstructive Surgery further proves the effectiveness of this technique, hence the recent headlines surrounding the topic. The clinical trial analyzed 16 patients undergoing facial plastic and reconstructive surgery over a four-month period (most of them to remove a large birthmark), and half of each patient’s facial scar was randomly assigned to treatment with Botox or a placebo (an inactive saline solution), injected immediately at the end of surgery. After six months, the scars were measured and rated by a team of independent plastic surgeons, and the scars treated with Botox were lower and narrower than the ones treated with the placebo. 

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In addition to facial reconstruction, Dr. Karimi says he also uses this technique in conjunction with cosmetic surgeries. “I routinely use a variation of this where I inject a neuromodulator before performing browlift, facelift and necklift procedures, as the muscles in these regions can pull at the stitches and cause poor scars, diminished results or scar ‘bands.’” 

Although more research is necessary, this preliminary study is yet another great example of how versatile neuromodulators can be. The ability to produce smaller, flatter surgical scars, especially on the face, is a huge win, and we’re excited to see what the future holds for even more Botox applications.