During wound healing, abnormal proliferation of fibroblasts and excessive deposition of extracellular matrix can lead to the formation of pathological scar. In recent years, studies have confirmed that type A botulinum toxin plays an important regulatory role in the formation of pathological scar, including regulating the tension of periscar tissue, fibroblast proliferation, inflammatory factor release, angiogenesis, and scar pain symptoms. Meanwhile, it has also shown positive effects in the prevention and treatment of scar. Based on this, this paper reviews the mechanism of action of type A botulinum toxin in regulating pathological scar and its current clinical application status, aiming to provide new ideas for the clinical treatment of pathological scar.