Wound modulation with botulinum toxin
Prevention and treatment of abnormal scarring present a challenge to the medical fraternity. Herein, we report the beneficial effect of botulinum toxin A (BTA) for wound modulation in a case with post-traumatic lower lid cicatricial ectropion.

A 20-year-old male patient presented with severe cicatricial ectropion in his left lower lid with a scar going down to his cheek and to the ala of the nose due to trauma 6 months before. Pentagonal excision with direct suturing of the lid margin along with scar revision was performed. Botulinum toxin A (2.5 IU, Allergan India Private Limited, Bangalore, India) was injected into five different sites to allow healing of the wound in a relaxed manner; two injections were given on each side of the scar to offset horizontal traction and one was applied at the upper margin of the scar in the lower lid retractors to offset vertical traction. The lid margin was kept stretched for one week postoperatively by traction sutures. Three months after surgery, the lid margin was well apposed, and a good contour was achieved with no residual ectropion.