When performing botulinum toxin treatment for scars, first we need to consider the following 3 questions: Is there dysfunction due to scarring? Are there symptoms such as pain and itching caused by scar proliferation? Does the scar affect the aesthetics? Patients who meet these criteria can undergo Botox treatment. Botulinum toxin treatment can reduce the incision tension, thus reducing the formation of keloid scars; it can soften and flatten hyperplastic scars, reducing the proliferation of keloid scars; and reduce the pain and itching caused by keloid scars. Botulinum toxin type A can affect the production of transforming growth factor B (TGF-B) in scar tissue; it can inhibit the proliferation of human proliferative scar fibroblasts as well as collagen synthesis; Botulinum toxin type A also affects the growth cycle of proliferative scar fibroblasts, so that the majority of the cells shift from the functionally active proliferative phase to the quiescent phase, and the synthesis ability is reduced. At the same time, botulinum toxin inhibits the release of substance P from nerve endings, thus reducing the sensation of intractable pain and itchiness of scarring; it acts directly on injury receptors and acts as an anti-injury sensation in the central pathway of nerve afferents; in addition, botulinum toxin or its degradation products can act at the level of the spinal cord to reduce pain. Botulinum toxin injections can cause redness, pain, erythema, swelling, and ecchymosis, etc. Cold compresses immediately after injection can significantly reduce such adverse reactions. Botulinum toxin injections may also cause atopic reactions, including headache, cold, nausea rash, itching, and metrorrhagia, etc. These reactions are uncommon and usually resolve on their own. Research has found that Botox can better reduce the itchiness of persistent scarring and inhibit scarring; scarring that is not treated with hormonal therapy can also be treated with Botox injections.