Laser treatment of facial scars:

A Meta-Analysis of the Efficacy and Safety of Botulinum Toxin Type A for the Management of Scars After Facial Surgery

BACKGROUND

Postoperative scarring of the face can cause a serious psychological burden on people. Botulinum toxin type A has shown potential effectiveness in preventing scarring after facial surgery. The study aims to evaluate the role of botulinum toxin type A in postoperative scar management.

METHODS

We searched PubMed, Embase, MEDLINE, the Cochrane Library (CENTRAL), and Web of Science for all randomized controlled trials (RCTs) on the use of botulinum toxin type A in the treatment of postoperative facial scars, including all English articles published up to April 15, 2024.

RESULTS

Twelve randomized controlled trials involving 351 patients undergoing facial surgery were included. Quantitative analysis, STATA 17.0 software was used for meta-analysis, and fixed-effect and random-effects models were selected according to the size of heterogeneity, and the results were expressed as SMD and 95% CI for continuous data and OR and 95% CI for dichotomous data. Subgroup analyses were performed according to the different control groups. The OR and 95% CI of adverse effects were 1.74 (0.41-7.43). The p value of adverse reactions and PSAS results was greater than 0.05.

CONCLUSION

Due to the small heterogeneity of scar width, OSAS, and PSAS, SMD and 95% CI were -1.00 (-1.20 to 0.80), -0.61 (-1.0 to 0.13), and -0.08 (-0.56 to 0.39), respectively, using a fixed-effect model. Due to large heterogeneity, VAS and VSS scores were scored using a random-effects model, with SMDs and 95% CIs of 1.00 (0.47-1.53) and -0.41 (-0.73 to 0.1), respectively.

TRIAL REGISTRATION

PROSPERO number: CRD42024538070.

The Efficacy and Safety of Botulinum Toxin Type A Injections in Improving Facial Scars: A Systematic Review and Meta-Analysis

BACKGROUND

Botulinum toxin type A (BTA) has a wide range of clinical applications, and its use in improving aesthetics is one of them. The aim of this study was to better assess the efficacy and safety of BTA in patients with facial scars.

SUMMARY

We extracted the data of the visual analog scale (VAS) score, Vancouver scar scale (VSS) score, scar width, observer scar assessment scale (OSAS), patient scar assessment scale (PSAS), and/or drug-related adverse events. Five studies provided the data of VAS score, and the results showed that the VAS score in the BTA group was significantly higher than that in the control group. Three randomized controlled trials (RCTs) reported the VSS score. A statistically significant difference exists between the BTA group and the control group. Three RCTs reported the scar width after BTA treatment. A more favorable change was found in the BTA group with scar width even without statistical significance. Data about the OSAS and PSAS scores were available in two trials. There was no significant difference in OSAS and PSAS scores between the BTA group and the control group. Only three studies recorded three slight adverse events. There were no reports of severe complications. In conclusions, this study demonstrated that BTA has the potential to improve facial scars with an acceptable safety profile.

Combined Non-Ablative Laser and Microfat Grafting for Burn Scar Treatment

BACKGROUND

Burn scar treatment persists as an unsolved problem, involving thousands of affected patients disfigured for life.

OBJECTIVES

We sought to present our experience with the use of combined treatments for patients with burn scars.

METHODS

This was a case series report of the senior author's experience during 8 years utilizing the combined treatments of Fraxel Restore (fractional laser) and microfat graft injection for 288 patients with burn scars.

RESULTS

Laser treatment reduced scar intensity and attenuated skin irregularities and hyperpigmentation. All patients demonstrated marked improvement of skin texture and an increase in scar softness after 3 sessions of microfat grafting. However, the degree of improvement varied between patients and was related to the severity of the scar and the type of tissue. Overall, a 40% to 80% improvement was noted in our patients. All patients and their families expressed satisfaction with the results.

CONCLUSIONS

The combined treatment of Fraxel and microfat grafting is an effective technique for improving the appearance of a hypertrophic scar or keloid on burn patients. Fat tissue stem cells may have helped to repair the damaged skin.

LEVEL OF EVIDENCE: 4

Peri-Procedure Laser Scar Therapy Protocol: A Pilot Survey of Plastic Surgeons' Practices

BACKGROUND

Scar management using laser phototherapy continues to evolve as it gains wide acceptance among patients and providers. Despite widespread use of laser therapy, there are no guidelines or consensus published regarding optimal pre- and post-procedure patient management. Our objective is to gain insight into the best laser practices; we decided to poll colleagues nationwide.

METHODS

An online survey was distributed to members of the American Society of Plastic Surgeons. The survey consisted of 34 questions regarding pre- and post-procedure protocols related to laser scar therapy.

RESULTS

Forty plastic surgeons responded to the survey. The survey demonstrated that ten types of lasers are currently used to treat scars. The most commonly used lasers are fractional Er:YAG (44.7%), pulsed dye (42.1%), and fractional CO₂ (36.8%). On a Likert 3-point scale, providers favored the use of pre-procedural sunblock (2.12), topical analgesics (1.91), and oral antivirals (1.83). They also preferred the use of topical moisturizer (2.45), oral analgesics (2.29), and oral antivirals (1.97) as a part of the post-laser treatment regimen.

CONCLUSION

The study verified there is no consensus regarding peri-procedure laser scar therapy regimens. As laser scar management continues to grow in popularity, this lack of consensus suggests the need for experts in the field to come together and propose agreeable protocols to be used as guidelines.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Split face evaluation of long-pulsed non-ablative 1,064 nm Nd:YAG laser for treatment of direct browplasty scars

PURPOSE

To investigate 1,064 nm long-pulse Nd:YAG laser for postoperative treatment of direct browplasty scars.

METHODS

Nine patients who underwent direct browplasty were enrolled in this prospective study. Subjects were randomized to unilateral laser treatment at 2-week intervals for six total treatments, with the contralateral scar used as a control. Prior to each treatment, subjects rated treated and control scars on overall cosmesis. Post-treatment, subjects rated each for erythema, swelling, discomfort, and perceived hair loss. Finally, examiners masked to treatment side were asked to judge side-by-side photographs of first and final visits for improvement and side effects.

RESULTS

Subjects rated the overall appearance of the treated scar significantly higher at the time of treatment number 5 (mean score 5.13 ± 2.03, P = 0.008) and treatment number 6 (6.25 ± 1.98, P = 0.005) compared to treatment 1 (3.75 ± 2.12); by contrast, they failed to rate the control scar more highly. On masked examination of photographs, the treated scar was selected as most improved 50.0 ± 12.5% of the time. Both subjects and graders reported side effects as transient and mild to moderate (mean score 1-4), with no reports of hair loss from either subjects or observers.

CONCLUSIONS

The 1,064 nm Nd:YAG laser provided significant improvement in scar cosmesis after direct browplasty, as rated by subject self-report, but not by masked observers, and appears to be a useful tool for increasing satisfaction among those dissatisfied with direct browplasty scars. Side effects-including erythema, edema, and discomfort-were transient and universally rated as mild to moderate. Lasers Surg. Med. 48:742-747, 2016. © 2016 Wiley Periodicals, Inc.

Squamous cell carcinoma developing after CO2 laser resurfacing

BACKGROUND

Skin resurfacing with the carbon dioxide (CO(2)) laser is currently a popular means of improving rhytides and scars and has been reported useful in the treatment for photodamaged skin, including precancerous and benign skin lesions, as well as superficial benign pigmented lesions.

METHODS

We describe a 68-year-old man who developed rapid squamous cell carcinoma (SCC) on the resurfaced areas 3 weeks following CO(2) laser resurfacing.

RESULTS

Rapid occurrence of SCC should be considered a rare complication, and we recommend carefully considering CO(2) laser resurfacing after excision of an SCC and surveying any cancer recurrences.

CONCLUSIONS

We report a rare complication of CO(2) laser resurfacing. This report suggests that additional work in this area is warranted.