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Elhage et al. Plast Aesthet Res 2020;7:16 Plastic and
DOI: 10.20517/2347-9264.2020.03 Aesthetic Research

Review Open Access

The use of botulinum toxin A in chemical component
separation: a review of techniques and outcomes

Sharbel A. Elhage, Eva B. Deerenberg, Jenny M. Shao, Vedra A. Augenstein, B. Todd Heniford

Department of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA.
Correspondence to: Dr. B. Todd Heniford, Department of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical
Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA. E-mail: todd.heniford@gmail.com

How to cite this article: Elhage SA, Deerenberg EB, Shao JM, Augenstein VA, Heniford BT. The use of botulinum toxin A in chemical
component separation: a review of techniques and outcomes. Plast Aesthet Res 2020;7:16.
http://dx.doi.org/10.20517/2347-9264.2020.03
Received: 3 Jan 2020 First Decision: 12 Mar 2020 Revised: 18 Mar 2020 Accepted: 26 Mar 2020 Published: 10 Apr 2020
Science Editor: Sahil Kuldip Kapur Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Fascial closure is crucial for abdominal wall reconstruction (AWR) but can be especially difficult in patients with
massive ventral hernias or loss domain. Recently, botulinum toxin A (BTA) has been increasingly utilized as an
adjunct in AWR to aid in fascial closure. This review aims to evaluate the current literature on the use of BTA in
AWR to assess current treatment regimens, side effects, outcomes and complications. A literature search was
performed, yielding 10 studies that met the inclusion criteria. There was a significant amount of heterogeneity
in treatment regimens, with studies differing in BTA injection timing, dosage, concentration, and location. The
majority of studies showed that injection of BTA preoperatively was able to augment abdominal wall musculature,
with many showing a decrease in mean transverse defect size and high rates of successful fascial closure. No
major complications were reported from BTA administration, with only mild side effects reported by some studies.
The most common side effects include a weak cough or sneeze, bloating, and back pain, which generally all
resolved prior to surgery. While BTA appears to be a promising adjunct for AWR, further investigation is needed to
determine optimal patient selection and treatment regimens.

Keywords: Hernia, abdominal wall reconstruction, botulinum toxin, botox, chemical component separation

INTRODUCTION
Ventral hernias are a frequent complication after open abdominal surgery and up to 30% develop
[1-3]
incisional hernias . Repair of incisional hernias is difficult due to scarring and the distortion of tissue
planes innate to a reoperative field. In complex cases, such as massive hernias, those with loss of domain,
recurrent hernias, or hernias with infection or contamination, patient morbidity can be greatly increased.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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