Q: I have several questions in regards to scar revision. When you perform a geometric broken pattern scar revision, then will you be cutting out more skin beside the original scar? What is the role of injecting Botox in the scar revision surgery?
A: Your assumption in how geometric scar revision works is correct. To make the various limbs and angles, some normal tissue in addition to the scar must be removed. This does not lengthen the scar in total visual length as the small tissue areas are taken from the sides of the scar not from the ends. If you straightened out the scar ins a single straight line, it would in fact be longer than the original scar by actual length measurement. But this increase in scar length is ‘internal’, staying within the original length of the scar.
The use of Botox in scar revision remains, at this point, entirely theoretical. Its use in scars is more hope than proven science. While Botox does seem to be good for a lot of problems, it is not good for everything. Botox works by decreasing nerve output, usually to muscle. Scar and any resultant hypertrophy or widening is not usually a muscle or nerve problem in most cases. Poor scarring is more related to tension on the wound edges and the type of skin and mechanism of injury. It is not clear why Botox would work for most scars unless it is weakening any pull on the scar edges from the underlying muscles in the critical scar phase of the first six months after its creation.
Dr. Barry Eppley