摘要

Objectives: To highlight practical strategies for using botulinum toxin type A (BTA) as a standalone treatment and in combination with fractional laser therapy or microneedling radiofrequency (RF) in daily clinical practice. Introduction: Effective scar management requires not only aesthetic improvement but also restoration of skin quality and patient comfort. While monotherapies provide partial results, combined protocols allow for more predictable and stable outcomes. Materials / method: Clinical observations and protocol-based approaches were reviewed, focusing on dosage, timing, and sequencing of treatments. BTA was applied intralesionally or perilesionally to modulate fibroblast activity and decrease tension. In combination protocols, fractional laser or microneedling RF sessions were performed prior to or following BTA injection, depending on scar type and patient tolerance. Results: • BTA monotherapy: Reduced hypertrophy, improved pliability, and minimized recurrence of tension-related scarring. • BTA + fractional laser: Enhanced surface texture, pigment uniformity, and softening of rigid scars. • BTA + microneedling RF: Improved dermal remodeling and scar depth reduction, particularly in atrophic and mixed scars. Across all modalities, patient satisfaction increased, recovery time was acceptable, and adverse events were minimal. Conclusion: In clinical practice, combining BTA with energy-based treatments provides faster and more pronounced results compared to monotherapy. The choice of combination should be tailored to scar morphology, with attention to timing and individual tolerance. These protocols can be easily integrated into routine practice to optimize scar management outcomes.