Hernia defects after abdominal surgery represent a challenge for the surgeon due to the retraction of the lateral muscles. The presurgical application of botulinum toxin type A causes temporary flaccid paralysis of the lateral muscles and thus closure with less tension during abdominal wall reconstruction (AWR). The preoperative administration of botulinum toxin A (BTA) can be done by using ultrasound or CT scan guidance or following the map of Dr. Tomás Ibarra. Although it is true that it has been described as a method under local anesthesia and sedation, it is possible to carry out the direct procedure, without pain medication, and the infiltration of the biological is very well tolerated by the patient, in a session at the doctor’s office. After infiltration, the therapeutic effect occurs within the first 24 h until 6 months, the maximum effect is achieved at 4 weeks after application. BTA-induced chemical paralysis contributed to a diminished transverse hernia defect and consequently to a less tensioned AWR, with subsequent successful ventral hernia repair.