Treatment of hypertrophic scars using fractional CO2 laser alone in comparison with adding botulinium toxin either intalesional injection or assisted drug delivery.

Burns result in hypertrophic scarring, causing functional impairment, cosmetic and psychological concerns. Fractional CO₂ laser and botulinum, have shown promise in treatment. To evaluate the effectiveness of fractional laser treatment alone and combined with botulinum toxin A, delivered either through injections or topical application as fractional laser-assisted drug delivery in hypertrophic burn scar. A randomized comparative trial involving 16 patients with post-burn hypertrophic scars. The scar of each patient was divided into 3 sections: (1) fractional CO₂ laser combined with intralesional botulinum toxin type A, (2) fractional CO₂ laser monotherapy, and (3) fractional CO₂ laser with laser-assisted drug delivery of BTXA. Patients received three treatment sessions at monthly intervals, followed by a three-month follow up. Clinical outcomes were evaluated using the Vancouver Scar Scale. Intralesional BTXA demonstrated superior efficacy, achieving the greatest reductions in VSS (- 58.25%). Intralesional BTXA in combination with fractional CO₂ laser represents a highly effective treatment for post-burn hypertrophic scars, offering superior improvements in scar pliability, contour, and patient comfort compared with laser monotherapy or LADD. These findings support intralesional BTXA as the preferred therapeutic approach, while highlighting the potential of combination protocols for optimizing scar outcomes.