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 MD and Thais Bello Giacomo PhD

Ocean Clinic, Marbella, Spain

Background: The appearance of post-surgical scars on the face is a major concern for surgeons and a source of anxiety for patients after Mohs surgery due to nonmelanoma skin cancer (NMSC). The objective of this retrospective study was to assess the effectiveness of combining incobotulinumtoxinA and microneedling to improve the appearance of post-operative facial scars. Enrolled subjects underwent surgical removal of facial NMSCs followed by flap reconstruction by the same surgeon during 2014 (n=35) and 2015 (n=35). Sutures were removed 7 days after the procedure. Subjects treated during 2014 received no additional treatment and served as a control group. Subjects treated during 2015 also received micro-doses of incobotulinumtoxinA along the scar border and microneedling of the surgical area. Microneedling was repeated after 15 days. Scar severity was determined by the surgeon and an independent dermatologist using the modified Vancouver Scar Scale (VSS) scores on day 7 and day 30 following suture removal. Patient Satisfaction Scale scores were also determined using a 5-point scale on day 30. Mean (SD) VSS scores were 10.4 (1.14) on day 7 among treated subjects vs. 9.5 (1.88) among control subjects (P<0.05). On day 30, mean VSS scores had decreased to 1.1 (0.89) for treated subjects vs. 7.6 (1.72) for control subjects (P<0.05). Patient Satisfaction Scores were significantly higher among treated patients vs control subjects (4.45 vs 3.14; P<0.001). The use of incobotulinumtoxinA is a promising therapeutic option for improving scar appearance. Combined with microneedling, it significantly reduced VSS scores and improved overall satisfaction of treated subjects following surgery for NMSCs.

J Drugs Dermatol. 2020;19(6): doi:10.36849/JDD.2020.4772


More than 80% of nonmelanoma skin cancers (NMSC) occur on the face1 where the appearance of post-surgical scars is a major concern for surgeons and a source of anxiety for patients as they have a potential for a negative functional and social impact. While surgeon adherence with technical aspects of the procedure directly affect the final scar quality, local and genetic factors can also play a role in scar development.2 Recognizing these mechanisms allows one to identify therapeutic opportunities to optimize appearance and functionality of the surgical area. Thus, various treatments and techniques have been proposed to improve the appearance of scars.3 The objective of this study was to assess the combined effect of incobotulinumtoxinA and microneedling in improving post-operative facial scars.


Study Subjects
This retrospective study enrolled otherwise healthy subjects who underwent surgical removal of facial NMSCs followed by flap reconstruction performed by the same surgeon during 2014 and 2015.

Treatment Protocol
During 2014, subjects who were treated with Mohs surgery for NMSC received no specific treatment after the procedure and served as a control group. During 2015, subjects were treated with Mohs surgery for NMSC and received a combined treatment of incobotulinumtoxinA (Xeomin®; Merz North America, Raleigh, NC) and microneedling (Dermapen®; FD Holdings LLC, Loveland, CO).

The excised NMSC lesions were primarily located on the forehead, nose and cheek and ranged from 2.0 to 4.0 cm in diameter. All subjects underwent facial skin flap reconstruction (ie, advancement, rotation, or transposition). Subsequently, subjects returned for suture removal on day 7. The 2014 subjects were instructed to wear sunscreen after suture removal but received no additional treatment. The 2015 subjects received 0.3 U incobotulinumtoxinA injected every 5 mm along both sides of the scar border. Scar length ranged from 2 to 12 cm, depending on the reconstruction. On post-surgery day 7, all subjects were treated with 20 passes of microneedling over the scars and their borders (2 mm, speed 70) with an endpoint of mild bleeding. Midoi