title: Botulinum toxin to improve results in cleft lip repair: a double-blinded, randomized, vehicle-controlled clinical trial.
abstract: BACKGROUND
  Most patients with facial scarring would value even a slight improvement in scar quality. Botulinum toxin A is widely used to alleviate facial dynamic rhytides but is also believed to improve scar quality by reducing wound tension during healing. The main objective was to assess the effect of Botulinum toxin on scars resultant from standardized upper lip wounds.
  
  
  METHODS
  In this double-blinded, randomized, vehicle-controlled, prospective clinical trial, 60 consecutive consenting adults undergoing cleft lip scar revision (CLSR) surgery between July 2010 and March 2012 were randomized to receive botulinum toxin A (n = 30) or vehicle (normal saline; n = 30) injections into the subjacent orbicularis oris muscle immediately after wound closure. Scars were independently assessed at 6-months follow-up in blinded fashion using: Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS) and photographic plus ultrasound measurements of scar widths.
  
  
  RESULTS
  58 patients completed the trial. All scar assessment modalities revealed statistically significantly better scars in the experimental than the vehicle-control group.
  
  
  CONCLUSIONS
  Quality of surgical upper lip scars, which are oriented perpendicular to the direction of pull of the underlying orbicularis oris muscle, is significantly improved by its temporary paralysis during wound healing.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01429402.
authors.affiliation: Graduate Institute of Chemical and Materials Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Department of Medical Research, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chun-Shin
authors.initials: CS
authors.lastname: Chang
authors.affiliation: Craniofacial Research Center, Department of Medical Research, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Christopher Glenn
authors.initials: CG
authors.lastname: Wallace
authors.affiliation: Craniofacial Research Center, Department of Medical Research, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Yen-Chang
authors.initials: YC
authors.lastname: Hsiao
authors.affiliation: Graduate Institute of Clinical Medical Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.affiliation: Craniofacial Research Center, Department of Medical Research, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Philip Kuo-Ting
authors.initials: PK
authors.lastname: Chen
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000494:pharmacology* / Q000627:therapeutic use; D002921:Cicatrix / Q000188:drug therapy / Q000517:prevention & control*; D002971:Cleft Lip / Q000503:physiopathology* / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A