Pre-Expanded Fronto-Scalp Flaps Combined With Botulinum Toxin and Laser Therapy for Secondary Large-Scale Craniofacial Defects - Original Article

Sep 30, 2026

Uploaded by Jake

Large secondary craniofacial defects, especially those involving the midface, forehead, and scalp, remain a central challenge in reconstructive plastic surgery. Pre-expanded fronto-scalp flap tissue expansion can provide adequate tissue, but the long expansion period, peri-expander pain, and postoperative flap retraction limit patient compliance and outcomes. This prospective comparative study evaluates whether botulinum toxin, given before expander implantation and after surgery, improves expansion efficiency and reduces postexpansion retraction force.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Background on secondary facial defects

Reconstruction options and limitations

Tissue expansion and the fronto-scalp flap approach

Clinical challenges motivating botulinum toxin use

Journal of Cosmetic Dermatology ORIGINAL ARTICLE OPEN ACCESS Pre-Expanded Fronto-Scalp Flaps Combined With Botulinum Toxin and Laser Therapy for Secondary Large-Scale Craniofacial Defects Feifei Chu1 | Shiqiang Liu2 | Yinke Tang1 | Jian Geng1 1Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China | 2Department of Dermatology, 987th Hospital of the Joint Logistic Support Force, Baoji, China Correspondence: Jian Geng ([gengjian144@163.com](gengjian144@163.com)) Received: 1 August 2025 | Revised: 1 August 2025 | Accepted: 19 November 2025 Keywords: botulinum toxin | fronto-scalp flaps | secondary facial defects | tissue expander ABSTRACT Background: Secondary facial defects remain a primary focus in plastic surgery, particularly large defects involving the midface, forehead, and scalp. While tissue expansion of the fronto-scalp flap offers a viable reconstructive option, the lengthy expansion period and the issue of post-expansion flap retraction necessitate further solutions. Objective: We conducted a prospective, comparative clinical study to investigate the role of Botulinum toxin in the expansion of fronto-scalp flaps. Method: Between December 2019 and December 2024, 40 patients with large upper facial or scalp lesions were enrolled and randomly assigned to either the experimental group or the control group. Control group patients underwent tissue expansion combined with postoperative laser hair removal. Experimental group patients received the same tissue expansion and laser therapy, supplemented with Botulinum toxin injections administered both preoperatively (prior to expander implantation) and postoperatively in the forehead and scalp regions. We analyzed and compared parameters including expansion efficiency, postexpansion flap retraction force, postoperative pain scores, and complication rates between the two groups. Results: Baseline characteristics showed no significant differences between the two groups before expander implantation. During the tissue expansion phase, the experimental group demonstrated significantly higher expansion efficiency compared to the control group. At both 3 and 6 months following flap transfer surgery, the post-expansion flap retraction force was significantly lower in the experimental group than in the control group. However, no significant differences were observed in pain scores or complication rates between the two groups. Conclusion: Our prospective, comparative study demonstrates that Botulinum toxin application enhances the efficiency of tissue expansion using the fronto-scalp flap for reconstructing large secondary facial and scalp defects. It also reduces postexpansion flap retraction force, ultimately contributing to favorable functional and aesthetic surgical outcomes. Trail Registration: ChiCTR1900027702 . | Feifei Chu and Shiqiang Liu contributed equally. | | --- | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2026 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC. | Journal of Cosmetic Dermatology, 2026; 25:e70624 1 of 6 [https://doi.org/10.1111/jocd.70624](https://doi.org/10.1111/jocd.70624) 1 | Introduction As a vital anatomical structure and core identity marker, the face is essential to human function and social engagement [1]. Consequently, secondary facial defects have consistently been a primary focus and challenge in plastic and reconstructive surgery [2]. Etiologies leading to secondary facial defects include posttraumatic scars, pigmented nevi, verrucous nevi, and facial tumors [3–5]. Multiple factors underlie the high incidence of these defects. Reconstructive options include skin grafting, local/regional flaps, and free flaps. However, each method entails limitations for largearea facial defe

FAQs

Why are secondary large-scale craniofacial defects difficult to treat?

They commonly involve midface, forehead, and scalp and are associated with multiple etiologies. Available reconstruction methods can be limited for large defects or carry higher surgical risk.

What was the study design and how were patients assigned?

A prospective, comparative clinical study enrolled 40 patients with large upper facial or scalp lesions and randomly assigned them to an experimental group or a control group.

What outcomes improved with botulinum toxin in fronto-scalp flap expansion?

The experimental group showed higher expansion efficiency during the expansion phase and lower postexpansion flap retraction force at 3 and 6 months. Pain scores and complication rates were not significantly different between groups.

Sep 30, 2026

Uploaded by Jake