Combination Therapy of Intense Pulsed Light and Fractional Carbon Dioxide Laser Versus Botulinum Toxin Type A in Post-thyroidectomy Scar Prevention: A Prospective, Randomized Controlled Trial

Objective This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO 2 ablative fractional laser combined with intense pulsed light (CO 2 AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. Approach In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO 2 AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Results Both BTX-A and CO 2 AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months ( p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Conclusion Both BTX-A and CO 2 AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO 2 AFL-IPL serving as an effective alternative where laser therapy is available. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .