2nd Edition of Dermatology and Plastic Surgery World Conference 2026

Abstract

Keloids are characterized by excessive fibroblast activity and abnormal collagen deposition, leading to high recurrence rates after surgical excision. Botulinum toxin type A (BoNT A) has been shown to reduce mechanical tension and inhibit fibroblast to myofibroblast differentiation. However, the optimal timing of BoNT A administration in relation to wound healing phases remains unclear.

This study presents a clinical case series evaluating the effect of botulinum toxin injection during the proliferative phase following keloid excision. Three patients with recurrent keloids following prior excision were treated with re excision and intralesional BoNT A injection (12 units per lesion). BoNT A was administered at the time of suture removal, corresponding to the early proliferative phase of wound healing. All patients received standard postoperative care including silicone gel sheet therapy and photoprotection.

Follow up evaluations were performed at 1, 3, 6, and 9 months. Serial assessments of scar height and firmness were conducted.

No recurrence was observed in all patients during the 9 month follow up period. Serial assessments demonstrated an initial increase in scar height during the early proliferative phase, followed by progressive reduction over time. The expected early hypertrophic response was attenuated. A mild plateau was observed during the intermediate phase, followed by continued improvement during later remodeling. Improvements in scar firmness were also observed across all cases. Findings were consistent across all cases. No significant adverse events were reported.