Meta-analysis finds prophylactic botulinum toxin reduces postoperative scar width

A systematic review and meta-analysis of 17 comparative trials (656 treatment sites, 456 participants) evaluated prophylactic botulinum toxin type A (BoNT-A) for postoperative scar prevention. The analysis reported moderate-certainty evidence for reduced objective scar width and low-certainty improvement in clinician composite scores, with pooled analyses suggesting larger effects with delayed injection than immediate injection, though direct within-site timing studies showed conflicting findings; effects were largest at chest sites and smallest at fine facial sites, and dose escalation within 4-10 U/cm was not associated with additional benefit. The authors note patient-reported outcomes and immediate-injection evidence remain uncertain.

Most relevant for: Patients undergoing surgical procedures where postoperative scarring at sites such as the chest or face is a concern.

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