Surgical closure of giant abdominal wall hernia defects remains challenging. We report our initial experience with administration of botulinum toxin type A (BTA) for this approach in a 51-year-old female with a giant primary umbilical hernia and abdominal loss of domain. Four weeks prior to surgery, BTA was injected into the transverse abdominal and oblique muscles. During surgery the linea alba was reconstructed without lateral release procedures. At one-month follow-up, muscle relaxation had diminished and no surgical site occurrences were experienced.