Ideally, Botox is injected as soon as possible for a scar to help scar modulation during the early phases of scar development. It is more powerful as a preventative measure before a scar sets in than when the scar has already developed. In the double-blind evaluation study, the scar was treated at one week postoperatively following a thyroid surgery in the area of the incision. However, Dr. Lam has seen improvement in scars that are even many years old.

If a scar is truly a keloid, not just a hypertrophic scar, then Dr. Lam really needs to remove the keloid and treat the area with timed radiation. Botox will be insufficient to manage the scar. With a hypertrophic scar, which is just a thickened scar, Dr. Lam usually will start with 5-fluorouracil and dilute steroid to more quickly reduce the scar tissue and will repeat that typically between every 3 to 6 weeks depending on the severity of the scar and the scar response to the injection. Botox would be used to manage the scar either in alternating doses with the other injections or to follow a course of these treatments when the thickness of the scar is already improved.

As mentioned, he prefers 5-fluorouracil and dilute steroid as his main way to improve actually hypertrophic scars to get the scar more quickly into a flatter appearance. He will oftentimes combine that therapy with KTP laser that also helps with redness and manages thickness. The opposite of a hypertrophic scar is an atrophic scar, with the classic example being acne scarring. In those cases, he may use Botox. See the section on Botox for acne scarring for more information. However, he may use other treatments for acne scarring like microsilicone treatments, radiofrequency microneedle, etc. Only a consultation with Dr. Lam will help you decide which method or methods and at what interval that he would recommend for you.

Botox for scarring is actually permanent. Scar modulation creates a molecular healing in the scar that is durable, long lasting, and in general permanent.

Yes, Botox is safe in all skin types from fair-skinned Irish to dark, central African Fitzpatrick skin types.

Not really, except that 1) Botox for scar improvement cannot be guaranteed 2) it may take multiple sessions 3) in the area of the cheeks for example it may cause a few weeks of reduced movement on the side of treatment (although this is rare) 4) there may be some temporary bruising and/or swelling from the injection (although this is usually very temporary and mild).

No, there are almost no providers in the world offering Botox for scar management and he really does not know of anyone that would take insurance for this type of treatment.

It depends. For rhinoplasty and facelift scars, the incision heal so well that he does not routinely use Botox. However, if he removes a mole or performs a scar revision in an area where the incision is not well camouflaged like in the central cheek or in the middle of the forehead then he will most likely inject a little bit of Botox into the scar at the time or surgery or a week after the surgery.

Usually, the result becomes slowly apparent a few weeks to a month following the injection.

If there is some improvement in the scar and additional therapy is desired, a second session may be warranted 3 months or so after the first session.

This is hard to say because it depends on the severity of the scar, the location of the scar, and your body’s response. Sometimes you only need one treatment but in most cases improvement is seen with 2 to 5 rounds of treatment performed every 3 to 4 months until the scar is either satisfactory in improvement or you no longer see any improvement.

Usually, Botox will help modulate the color, texture, thickness, and overall appearance of a scar. Botox may not improve all of these aspects during each session with usually more obvious changes in texture than in color during the initial treatment sessions.

Yes, silicone sheets and gels can help with scar modulation after the initial 10 days of injury. He recommends Scar Smart brand of sheets and gels on Amazon, which he developed. Silicone sheets work better than silicone gels but can only be used in areas without a lot of movement. For example, silicone sheets are hard to be maintained on the lower half of the face, especially around the mouth, so silicone gels may be preferred there. If you can keep the silicone over the wound at least 12 hours a day that would be ideal or at least over night while you sleep. That would be helpful especially in the first 6 months following injury but can have benefits even after that time.

It is not entirely clear but Botox absolutely provides molecular healing to the tissues oftentimes more potently than almost any other therapy for scars.

Botox is pretty much safe for any part of the body that has skin and that can develop a scar including following any body types of surgeries like tummy tucks and breast lifts that cause unfavorable scarring.