INTRODUCTION
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.
MATERIALS AND METHODS
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
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
