Successful Topical Application of Botulinum Toxin After Microneedling Versus Microneedling Alone for the Treatment of Atrophic Post Acne Scars: A Prospective, Split-face, Controlled Study.

Background: Acne scars are a source of cosmetic concern for most of the patients.

Objective: We sought to compare the clinical efficacy and safety of topical botulinum toxin A (BTX-A) application immediately after microneedling (Mn) versus Mn with saline in the treatment of atrophic acne scars.

Methods: Forty patients with atrophic acne scars (rolling, boxcar, and mixed types) were enrolled in a split-face study; microneedling was performed on both sides of the face followed by an application of topically diluted botulinum toxin on one side (Side A) and saline on the other (Side B) for two sessions both two weeks apart. Evaluation was done at baseline, two and four weeks after the session. Follow-up was performed after six months. The assessments included blinded clinical assessment and patient's satisfaction.

Results: After the treatment, acne scars in (Side A) showed 70 percent overall improvement versus zero percent in Side B (<0.0001). A statistically highly significant reduction of acne scars severity occurred in (Side A) (=0.0008). Patient's satisfaction was higher in (Side A) (<0.0001). No serious side effects were reported.

Conclusion: Microneedling delivery of BTX-A could be simple, safe, and innovative modality improving the appearance and decrease the depth of atrophic acne scars.