ABSTRACT
This chapter reviews the literature and provides a framework of treatment guidelines for the indication; evolving trends in the field. In dermatology, plastic surgery, and otolaryngology literature, the neuromodulator also has a long history of use for cosmetic indications, such as the improvement of facial rhytids. The primary pharmacodynamic effect of neuromodulators is chemical denervation of the treated muscle. Neuromodulators and fillers have become important additions to the field of scar management and should be considered in the appropriate clinical settings. In evaluation of a depressed scar, bacteriostatic saline can often be used to ascertain whether a filler may improve its cosmetic appearance. This method is inexpensive and short-acting; while the saline expansion effect lasts only several minutes, it gives the patient the chance to see the potential improvement in scar contour. Neuromodulators demonstrate promise in the prevention and treatment of hypertrophic and keloid scars, whereas fillers have been shown to improve depressed scars.
