5-Fluorouracil in Facial Plastic Surgery: Indications, Efficacy, and Safety - A Systematic Review and Narrative Synthesis

5-Fluorouracil (5-FU) is an antimetabolite that inhibits fibroblast proliferation and collagen synthesis, making it valuable in facial plastic surgery for scar modulation and other conditions. This systematic review examines the indications, outcomes, and safety of 5-FU in facial plastic surgery. Due to methodological heterogeneity across studies, a narrative synthesis was performed. A comprehensive search of MEDLINE, Cochrane, SCOPUS, EMBASE, PubMed, and Web of Science identified 32 eligible studies (1,456 patients) from 4,772 screened articles. Indications included keloids, hypertrophic scars, contractures, periocular scars, granulomas from filler complications, nasal skin thickening, infections following thread lifts, resistant facial warts, and hypochromic lesions. Most studies reported reductions in scar size, erythema, and recurrence rates, with combination therapies enhancing outcomes. Adverse effects were mild and transient. However, variability in dosing, administration frequency, and follow-up underscores the need for standardized treatment guidelines and long-term studies.