Donor site aesthetic enhancement with preoperative botulinum toxin in forehead flap nasal reconstruction

Jonathan A. Zelken, Shih Yi Yang, Chun Shin Chang, Cheng Jen Chang, Jui Yung Yang, Shiow Shuh Chuang, Hung Chang Chen, Yen Chang Hsiao

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Background: Donor site scarring after forehead flap nasal reconstruction is acceptable. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. We recently demonstrated the cosmetic benefit of botulinum toxin type A (BTX-A) for cleft lip cheiloplasty outcomes. We hypothesize that similar mechanism(s) benefit forehead flap donor scars. Methods: A single surgeon performed 26 forehead flap reconstructions. Indications were cancer (n = 17), trauma (n = 3), and congenital deformity (n = 6). In this split-scar study half the forehead was pretreated with BTX-A and half with normal saline after random assignment. Photographs were evaluated at most recent follow-up. Scar evaluation was based on photographs by 3 plastic surgeons using a composite subjective visual analogue score (VAS). Results: Photographic follow-up was 27 months (range, 10-60 months). Botulinum toxin type Awas assigned to the upper forehead in 16 cases and lower forehead in 10 cases. Intrarater reliability among 4 evaluators of 104 VAS scores was 78.1%. Upper forehead VAS (7.9 ± 1.2) was not different than lower forehead VAS (7.9 ± 1.2) regardless of treatment (P = 0.62). The VAS score of BTX-A' treated scars (8.5 ± 1.0) was significantly higher than the control (7.3 ± 1.1; P < 0.0001). Among 104 individual comparisons (26 patients - 4 observers), there were 73 instances (70.2%) where the experimental VAS score was higher than the control. Conclusions: Preoperative BTX-A injection is feasible and enhances donor site scar appearance after forehead flap nasal reconstruction in an Asian population.

Original languageEnglish
Pages (from-to)535-538
Number of pages4
JournalAnnals of Plastic Surgery
Volume77
Issue number5
DOIs
Publication statusPublished - Nov 1 2016
Externally publishedYes

Fingerprint

Forehead
Botulinum Toxins
Esthetics
Nose
Tissue Donors
Cicatrix
Type A Botulinum Toxins
Reconstructive Surgical Procedures
Cleft Lip
Cosmetics
Injections
Wounds and Injuries

Keywords

  • Asian
  • botulinum toxin
  • forehead flap
  • reconstruction
  • rhinoplasty
  • scar
  • wound

ASJC Scopus subject areas

  • Surgery

Cite this

Donor site aesthetic enhancement with preoperative botulinum toxin in forehead flap nasal reconstruction. / Zelken, Jonathan A.; Yang, Shih Yi; Chang, Chun Shin; Chang, Cheng Jen; Yang, Jui Yung; Chuang, Shiow Shuh; Chen, Hung Chang; Hsiao, Yen Chang.

In: Annals of Plastic Surgery, Vol. 77, No. 5, 01.11.2016, p. 535-538.

Research output: Contribution to journalReview article

Zelken, Jonathan A. ; Yang, Shih Yi ; Chang, Chun Shin ; Chang, Cheng Jen ; Yang, Jui Yung ; Chuang, Shiow Shuh ; Chen, Hung Chang ; Hsiao, Yen Chang. / Donor site aesthetic enhancement with preoperative botulinum toxin in forehead flap nasal reconstruction. In: Annals of Plastic Surgery. 2016 ; Vol. 77, No. 5. pp. 535-538.
@article{b4b7bb475ae44c89906db0ccd1a62054,
title = "Donor site aesthetic enhancement with preoperative botulinum toxin in forehead flap nasal reconstruction",
abstract = "Background: Donor site scarring after forehead flap nasal reconstruction is acceptable. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. We recently demonstrated the cosmetic benefit of botulinum toxin type A (BTX-A) for cleft lip cheiloplasty outcomes. We hypothesize that similar mechanism(s) benefit forehead flap donor scars. Methods: A single surgeon performed 26 forehead flap reconstructions. Indications were cancer (n = 17), trauma (n = 3), and congenital deformity (n = 6). In this split-scar study half the forehead was pretreated with BTX-A and half with normal saline after random assignment. Photographs were evaluated at most recent follow-up. Scar evaluation was based on photographs by 3 plastic surgeons using a composite subjective visual analogue score (VAS). Results: Photographic follow-up was 27 months (range, 10-60 months). Botulinum toxin type Awas assigned to the upper forehead in 16 cases and lower forehead in 10 cases. Intrarater reliability among 4 evaluators of 104 VAS scores was 78.1{\%}. Upper forehead VAS (7.9 ± 1.2) was not different than lower forehead VAS (7.9 ± 1.2) regardless of treatment (P = 0.62). The VAS score of BTX-A' treated scars (8.5 ± 1.0) was significantly higher than the control (7.3 ± 1.1; P < 0.0001). Among 104 individual comparisons (26 patients - 4 observers), there were 73 instances (70.2{\%}) where the experimental VAS score was higher than the control. Conclusions: Preoperative BTX-A injection is feasible and enhances donor site scar appearance after forehead flap nasal reconstruction in an Asian population.",
keywords = "Asian, botulinum toxin, forehead flap, reconstruction, rhinoplasty, scar, wound",
author = "Zelken, {Jonathan A.} and Yang, {Shih Yi} and Chang, {Chun Shin} and Chang, {Cheng Jen} and Yang, {Jui Yung} and Chuang, {Shiow Shuh} and Chen, {Hung Chang} and Hsiao, {Yen Chang}",
year = "2016",
month = "11",
day = "1",
doi = "10.1097/SAP.0000000000000625",
language = "English",
volume = "77",
pages = "535--538",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Donor site aesthetic enhancement with preoperative botulinum toxin in forehead flap nasal reconstruction

AU - Zelken, Jonathan A.

AU - Yang, Shih Yi

AU - Chang, Chun Shin

AU - Chang, Cheng Jen

AU - Yang, Jui Yung

AU - Chuang, Shiow Shuh

AU - Chen, Hung Chang

AU - Hsiao, Yen Chang

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: Donor site scarring after forehead flap nasal reconstruction is acceptable. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. We recently demonstrated the cosmetic benefit of botulinum toxin type A (BTX-A) for cleft lip cheiloplasty outcomes. We hypothesize that similar mechanism(s) benefit forehead flap donor scars. Methods: A single surgeon performed 26 forehead flap reconstructions. Indications were cancer (n = 17), trauma (n = 3), and congenital deformity (n = 6). In this split-scar study half the forehead was pretreated with BTX-A and half with normal saline after random assignment. Photographs were evaluated at most recent follow-up. Scar evaluation was based on photographs by 3 plastic surgeons using a composite subjective visual analogue score (VAS). Results: Photographic follow-up was 27 months (range, 10-60 months). Botulinum toxin type Awas assigned to the upper forehead in 16 cases and lower forehead in 10 cases. Intrarater reliability among 4 evaluators of 104 VAS scores was 78.1%. Upper forehead VAS (7.9 ± 1.2) was not different than lower forehead VAS (7.9 ± 1.2) regardless of treatment (P = 0.62). The VAS score of BTX-A' treated scars (8.5 ± 1.0) was significantly higher than the control (7.3 ± 1.1; P < 0.0001). Among 104 individual comparisons (26 patients - 4 observers), there were 73 instances (70.2%) where the experimental VAS score was higher than the control. Conclusions: Preoperative BTX-A injection is feasible and enhances donor site scar appearance after forehead flap nasal reconstruction in an Asian population.

AB - Background: Donor site scarring after forehead flap nasal reconstruction is acceptable. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. We recently demonstrated the cosmetic benefit of botulinum toxin type A (BTX-A) for cleft lip cheiloplasty outcomes. We hypothesize that similar mechanism(s) benefit forehead flap donor scars. Methods: A single surgeon performed 26 forehead flap reconstructions. Indications were cancer (n = 17), trauma (n = 3), and congenital deformity (n = 6). In this split-scar study half the forehead was pretreated with BTX-A and half with normal saline after random assignment. Photographs were evaluated at most recent follow-up. Scar evaluation was based on photographs by 3 plastic surgeons using a composite subjective visual analogue score (VAS). Results: Photographic follow-up was 27 months (range, 10-60 months). Botulinum toxin type Awas assigned to the upper forehead in 16 cases and lower forehead in 10 cases. Intrarater reliability among 4 evaluators of 104 VAS scores was 78.1%. Upper forehead VAS (7.9 ± 1.2) was not different than lower forehead VAS (7.9 ± 1.2) regardless of treatment (P = 0.62). The VAS score of BTX-A' treated scars (8.5 ± 1.0) was significantly higher than the control (7.3 ± 1.1; P < 0.0001). Among 104 individual comparisons (26 patients - 4 observers), there were 73 instances (70.2%) where the experimental VAS score was higher than the control. Conclusions: Preoperative BTX-A injection is feasible and enhances donor site scar appearance after forehead flap nasal reconstruction in an Asian population.

KW - Asian

KW - botulinum toxin

KW - forehead flap

KW - reconstruction

KW - rhinoplasty

KW - scar

KW - wound

UR - http://www.scopus.com/inward/record.url?scp=84944346009&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84944346009&partnerID=8YFLogxK

U2 - 10.1097/SAP.0000000000000625

DO - 10.1097/SAP.0000000000000625

M3 - Review article

VL - 77

SP - 535

EP - 538

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 5

ER -