This article is more than 5 years old. Information may no longer be current.

Botox provides relief from intractable pain after facelift with brow lift

Botox injection provided pain relief for a patient who developed refractory pain in the scars following rhytidectomy, including an anterior hairline brow lift, according to recently published study results.

Researchers studied a 65-year-old white woman with a history of previous blepharoplasty who underwent traditional rhytidectomy with superficial muscular aponeurotic system (SMAS) tightening, platysmaplasty and anterior hairline brow lift. A W-plasty type incision along the hairline centrally, behind the temporal hairline laterally and extending down to the lower temporal areas, was the surgical technique used for the brow lift. Nylon sutures and staples were used for closure.

The patient experienced normal recovery, and had no complaints for the subsequent year following surgery. At a year and a half after the procedure, she developed tightness in the temporal areas within the surgical scar. The tightness was associated with burning pain and became progressively more intense, with intensity fluctuating and worse on the right. Symptoms were not associated with nausea, vomiting, photophobia or phonophobia.

Symptoms were exacerbated by heat and sinus congestion, and the received only mild relief through massage. The patient was eventually unable to perform daily functions due to symptoms.

A well-healed mature scar was present during multiple follow-up, with normal MRI. There was no definitive diagnosis, such as tension, headache or migraine by two independent neurologists.

Due to concerns of side effects, the patient declined treatment of oral gabapentin. Chiropractic, acupuncture and occupational therapy, and topical therapies provided little to no relief.

The patient had 10 units of Botox (onabolutlinumtoxinA, Allergan) injected directly into the scar along the temporal hairline, with injections 1.5 cm apart and 2-3 mm deep. Within a few days following the procedure, she had complete resolution of burning pain. The patient continued to experience moderate tightness, while the quality of life was significantly improved, according to the researchers.

Ten units of onabotulinumtoxinA have been injected quarterly for 3 years, with pain relief satisfactorily maintained.

“Chronic pain after facial surgery is rare, yet can be severe and debilitating,” the researchers wrote. “In recent years botulinum toxins, particularly onabotulinumtoxinA, have been effective for a wide spectrum of pain disorders, including persistent inexplicable postsurgical pain after head and neck surgery.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.