Multimodal Scar Prevention Using Botulinum Toxin Type A, Fractional CO2 Laser, and Topical Silicone: A Randomized Split-Scar Clinical Trial
In brief
Three-part scar treatment scores better than simpler regimens at six months
In a randomized split-scar trial of 36 people with head and neck wounds, botulinum toxin, fractional CO2 laser, and silicone cream together produced better clinician- and patient-reported scar scores at six months than either two-part treatment or silicone alone. No serious adverse events occurred, but the small trial and six-month follow-up leave longer-term benefit uncertain.
- Journal
- Aesthetic surgery journal (Q1)
- Published
- 2 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Gamil Al-Madhagy, Omar Hamadah, Khaldoun Darwich
- PMID
- 42969753
- DOI
- 10.1093/asj/sjag199
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 5 November 2026): Randomized trial compares multimodal surgical scar treatments
Abstract
BACKGROUND: Scar formation is a common consequence of surgical and traumatic wounds. Although botulinum toxin Type A (BTX-A), fractional CO2 laser (fCO2L), and topical silicone cream (TSC) are widely used for scar modulation, evidence regarding their combined use remains limited. OBJECTIVES: The aim of the study was to evaluate combined BTX-A, fCO2L, and TSC compared with BTX-A+TSC, fCO2L+TSC, and TSC alone using a randomized split-scar design. METHODS: Thirty-six patients with head and neck wounds were enrolled in an assessor-blinded, randomized split-scar trial. Each scar half received either combination therapy (BTX-A+fCO2L+TSC) or a comparator treatment (BTX-A+TSC, fCO2L+TSC, or TSC). Scar outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline, 1, 3, and 6 months and the SCAR-Q Appearance, Symptoms, and Psychological Impact scales at baseline and 6 months. Linear mixed-effects models were used for statistical analysis. RESULTS: All groups improved over time (all P < .001). At 6 months, the combination group achieved the lowest Observer Scar Assessment Scale (10.33 ± 1.42) and Patient Scar Assessment Scale (8.11 ± 1.06) total scores (all P < .001 vs comparators) and the highest SCAR-Q scores across all domains. Both dual-modality regimens outperformed TSC. Although BTX-A+TSC and fCO2L+TSC showed comparable POSAS outcomes, BTX-A+TSC achieved higher SCAR-Q Appearance and Psychological Impact scores. Significant treatment, time, and treatment × time effects were observed across all outcomes (all P < .001). No serious adverse events occurred. CONCLUSIONS: Combined BTX-A, fCO2L, and TSC produced better clinician- and patient-reported scar outcomes compared with dual-modality regimens or TSC alone. LEVEL OF EVIDENCE: 1 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.