Abstract

Background: Scar appearance after cleft lip repair affects function, aesthetics, and psychosocial outcomes. The impact of timing on scar management effectiveness remains unclear. This review examined whether early initiation (≤4 weeks postoperatively) improves scar outcomes.
Methods: A systematic search of major databases included RCTs on infants/children undergoing primary or secondary cleft lip repair. Exclusions were animal studies, case reports/series, syndromic cases without separate outcomes, and studies with undefined timing. Primary outcome: scar quality (VSS, POSAS, ultrasound scar width). Secondary outcomes: patient/caregiver satisfaction, complications, and revision surgery.
Results: Six RCTs investigated interventions including fractional CO₂ laser, botulinum toxin, and platelet-rich plasma. Early intervention consistently improved scar quality, with lower VSS/POSAS scores and narrower scars. Botulinum toxin and PRP also enhanced healing and aesthetic outcomes. Complications were minor and rare; no increase in revision surgery was reported. Patient satisfaction, though infrequently measured, favored early treatment.
Conclusion: Early scar management after cleft lip repair appears to improve scar outcomes safely. Evidence is limited by few and heterogeneous RCTs, highlighting the need for larger, standardized studies to determine optimal timing and intervention type.