Keloids and hypertrophic scars could impair the psychological, physical, and cosmetic
aspects of the patient's quality of life. Unfortunately, there is no curative treatment
available till now. This study aimed to evaluate the efficacy and safety of intralesional
vs topical botulinum toxin A combined with Fractional CO2 laser in the treatment of
hypertrophic scars and keloids. Twenty patients with Keloids and hypertrophic scars
were enrolled in the study. Each scar was divided into two halves, one subjected to
intralesional injection of botulinum toxin type A once a month for 4 months and the
other was subjected to four sessions of CO2 laser therapy at 1 month interval
followed by topical application of botulinum toxin A. Significant improvement was
noted in Vancouver Scar Scale in hypertrophic scars in laser group than intralesional
botulinum toxin A. In keloid cases, the improvement was significantly higher with
intralesional botulinum toxin A. Clinical improvement showed significant negative
correlation with scar duration and size. Botulinum toxin A is a promising treatment
for hypertrophic scars and keloids. The use of fractional CO2 laser as a mode of delivery
enhanced the efficacy of botox in hypertrophic scars.