Improving the Appearance of Surgical Facial Scars With IncobotulinumtoxinA and Microneedling

June 2020 | Volume 19 | Issue 6 | Original Article | 611 | Copyright © June 2020

Published online May 8, 2020

Gabriela R. Casabona , Thais Bello Giacomo

Ocean Clinic, Marbella, Spain


Since the face is the location for the majority of NMSCs,1 the appearance of postsurgical scars are a significant concern when Mohs surgeons plan their interventions. This applies not only to aesthetic appearance, but also to potential functional impact. We showed the use of incobotulinumtoxinA 7 days post-surgically with microneedling significantly improved the appearance of facial scars.

Previous studies have demonstrated the ability of postoperative incobotulinumtoxinA monotherapy to reduce scar severity in animal models5 and clinically when used pre-surgically,6 and post-surgically immediately following wound closure.7,8

In some anatomic areas, incobotulinumtoxinA aids wound healing by reducing the tensile force of muscles on wound borders.7,9 The beneficial effects of incobotulinumtoxinA on scar formation also appear to be the result of its ability to inhibit fibroblast proliferation, 10,11 transform growth factor expression10 and decrease collagen deposition.12

Microneedling has previously been shown to improve the appearance of atrophic acne scars13,14 and stabilized burn scars.15-18 Based on VSS and Visual Analogue Scale scores, treated subjects rated mean improvement in burn scar appearance by a mean of ≥80%.16 Examination of treated tissue revealed these improvements are associated with substantial scar tissue modeling. 16,18 Microneedling has also been shown to decrease burn scar erythema by 55%.19

To our knowledge, this is the only published experience with combined treatment of incobotulinumtoxinA and microneedling for treating post-surgical scars, although a weakness of the study is its retrospective nature. Additional studies are needed to determine the relative contribution of each intervention on scar appearance.


The use of incobotulinumtoxinA is a promising therapeutic option for improving the appearance of postsurgical facial scars. Combining incobotulinumtoxinA with microneedling significantly improved the appearance of postsurgical facial scars and increased overall subject satisfaction.


The authors have no conflicts of interest to disclose.


The authors acknowledge the editorial assistance of Dr. Carl S. Hornfeldt, Apothekon, Inc., during the preparation of this manuscript with funding provided by Merz North America, Raleigh, NC.


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