The Effects of Aloe Vera Cream on the Alar Scar in Rhinoplasty, A Randomized Double-Blind Controlled Trial

Document Type : Original

Authors

1 Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Department of Phytopharmaceuticals (Traditional medicine), School of Pharmacy, Shiraz University of Medical sciences, Shiraz, Iran.

3 Molecular Dermatology Research Center, Shiraz University of Medical Sciences.

4 Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical sciences, Shiraz, Iran AND Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

10.22038/ijorl.2024.77572.3601

Abstract

Introduction:
Many studies have been done on the use of aloe vera in wound healing, but fewer studies were done on the influence of this material on the reduction of the alar scar. Therefore, we evaluated the effect of a newly made aloe vera cream on alar wound healing after rhinoplasty.
Materials and Methods:
This was a randomized, double-arm, parallel-group, double-blind controlled trial and was done from June 2021 to February 2022.  External wedge resection was done for all patients. The patients were randomly assigned to receive aloe vera cream (n=31) (intervention group) or Face Doux cream (comparison group) (n = 29). A pharmacist prepared the aloe vera cream. The primary outcome measure was the wound scar status which was assessed by two Questionnaires, including the mean Patient Scar Assessment Questionnaire (PSAQ) and Vancouver Scar Scale (VSS). Randomization and Blinding were done.
Results:
The mean PSAQ was significantly lower in group A after two weeks (26.9 versus 31.5, P<0.001), after two months (15.7 versus 19.6, P=0.04), and six months follow-up (8.8 versus 11.8, P=0.005). The mean VSS was significantly lower in group A after two weeks (5.6 versus 7.1, P=0.001), after two months (3.5 versus 4.9, P=0.002), and six months (1.2 versus 2.7, P<0.001). Repeated measurement analysis showed that both interventions significantly affected PSAQ and VSS.
Conclusion:
Although both interventions had a significant effect on PSAQ and VSS, compared to Face Duox, the topical use of Aloe Vera cream significantly reduced scar formation after alar resection, both statistically and clinically.

Keywords

Main Subjects


  1. Sahraian A, Janipour M, Tarjan A, Zareizadeh Z, Habibi P, Babaei A. Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates. Aesthetic plastic surgery. Feb 2022; 46(1): 332-337. doi:10.1007/s00266-021-02603-x
  2. Rothholtz VS, Wong BJ. Laser/Light Applications in Otolaryngology. Lasers in Dermatology and Medicine. 2011:495.
  3. Surowitz JB, Most SP. Complications of rhinoplasty. Facial plastic surgery clinics of North America. Nov 2013;21(4):639-51. doi:10.1016/j .fsc. 2013.07.003
  4. Kim JH, Park JP, Jang YJ. Aesthetic Outcomes of Alar Base Resection in Asian Patients Undergoing Rhinoplasty. JAMA facial plastic surgery. Dec 1 2016;18(6):462-466. doi:10.1001/jamafacial.2016.0800
  5. Becker DG, Weinberger MS, Greene BA, Tardy ME, Jr. Clinical study of alar anatomy and surgery of the alar base. Archives of otolaryngology--head & neck surgery. Aug 1997;123(8):789-95. doi:10.1001/ archotol.1997.01900080021001
  6. Foda HM. External rhinoplasty for the Arabian nose: a columellar scar analysis. Aesthetic plastic surgery. Sep-Oct 2004;28(5):312-6. doi:10.1007/ s00266-003-3126-7
  7. Serin GM, Polat S, Aksoy E, İnanlı S. Postoperative wound care regimen in open septorhinoplasty. The Journal of craniofacial surgery. Nov 2010;21(6):1880-1. doi:10.1097/SCS. 0b0 13e3 181f4aee2
  8. Verim A, Duymuş R, Çalim Ö F, et al. Effect of nose skin on the columellar incision scar in a Turkish population. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. Sep 2013; 149(3): 438-44. doi:10.1177/0194599813496961
  9. Liang J, Cui L, Li J, Guan S, Zhang K, Li J. Aloe vera: A Medicinal Plant Used in Skin Wound Healing. Tissue engineering Part B, Reviews. Oct 2021; 27(5):455-474. doi:10.1089/ten. TEB. 2020. 0236
  10. Maan AA, Nazir A, Khan MKI, et al. The therapeutic properties and applications of Aloe vera: A review. Journal of Herbal Medicine. 2018/06/01/ 2018;12:1-10. doi:https://doi.org/10. 1016/j.hermed. 2018.01.002
  11. van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP. Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plastic and reconstructive surgery. Aug 2005;116(2):514-22. doi:10.1097/01.prs.0000172982.43599.d6
  12. Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. The Journal of burn care & rehabilitation. Sep-Oct 1995;16(5):535-8. doi:10.1097/00004630-199509000-00013
  13. Chae JK, Kim JH, Kim EJ, Park K. Values of a Patient and Observer Scar Assessment Scale to Evaluate the Facial Skin Graft Scar. Ann Dermatol. 2016;28(5):615-623. doi:10.5021/ad.2016.28.5.615
  14. Mazzarello V, Donadu MG, Ferrari M, et al. Treatment of acne with a combination of propolis, tea tree oil, and Aloe vera compared to erythromycin cream: two double-blind investigations. Clin Pharmacol. 2018;10:175-181. doi:10.2147/CPAA. S180474
  15. Warner JP, Chauhan N, Adamson PA. Alar soft-tissue techniques in rhinoplasty: algorithmic approach, quantifiable guidelines, and scar outcomes from a single surgeon experience. Archives of facial plastic surgery. May-Jun 2010;12(3):149-58. doi:10. 1001/archfacial.2010.30
  16. Fallahi HR, Raesian S, Hajizadeh F, Habibagahi R, Sattari E. The effects of CO2 fractional laser on improving the scar of alar base incision in rhinoplasty patients. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2021/03/01/ 2021; 33(2): 120-125. doi: https://doi. org/10. 1016/j. ajoms. 2020. 10.004
  17. Yahyavi S, Jahandideh H, Izadi M, Paknejad H, Kordbache N, Taherzade S. Analysis of the Effects of Isotretinoin on Rhinoplasty Patients. Aesthet Surg J. Nov 19 2020;40(12):Np657-np665. doi:10. 1093/asj/ sjaa219
  18. Mazzarello V, Donadu MG, Ferrari M, et al. Treatment of acne with a combination of propolis, tea tree oil, and Aloe vera compared to erythromycin cream: two double-blind investigations. Clin Pharmacol. 2018;10:175-181. doi: 10.2147/ cpaa. s180474
  19. Tarameshloo M, Norouzian M, Zarein-Dolab S, Dadpay M, Mohsenifar J, Gazor R. Aloe vera gel and thyroid hormone cream may improve wound healing in Wistar rats. Anat Cell Biol. Sep 2012;45(3):170-7. doi:10.5115/acb.2012.45.3.170
  20. Takzare N, Hosseini MJ, Hasanzadeh G, Mortazavi H, Takzare A, Habibi P. Influence of Aloe Vera gel on dermal wound healing process in rat. Toxicology mechanisms and methods. Jan 2009;19(1):73-7. doi:10.1080/15376510802442444