Face: Scar Revision

One of the most sensitive aesthetic concerns individuals have about their face is facial scarring. Facial scarring can be somewhat traumatic, disheartening, and can lead to significant self-conscious doubt and lower one’s self-esteem. Thousands of individuals each year undergo surgical and cosmetic treatment to improve the appearance of facial scarring.

Scar Formation

After an injury to the skin, healing will naturally take place. This natural healing process occurs over a six-week period of time generally speaking, although complete healing is not achieved until approximately one year after the injury. Optimally wounds will heal with a reasonably thin line, such that the color difference between the scar and the surrounding tissue is minimized. The best wound is one that occurs along the natural lines of the face and neck. For example, in the forehead region, horizontal scars are more reasonable because they line up with the natural creases of the forehead.

Types of Scars

Normal scars are thin and generally not that visible; however hypertrophic scars result from a more aggressive healing process after wound formation. Hypertrophic scars tend to become thick, raised, red and appear swollen. These scars tend to remain within the bounds of the wound and take longer to heal. They tend to be wider than typical scars and treatment is important during the healing phase in order to minimize the aesthetic long-term problem.

Topical steroid applications are beneficial in the treatment of hypertrophic scars, as well as some surgical treatments depending on the character and location of the scar.

Keloid scars are much more aggressive than hypertrophic scars and they tend to develop more prominently in the upper chest, neck, and facial regions. The earlobes for instance are very commonly affected by keloid development. Individuals of darker pigment, particularly African-Americans tend to be at higher risk for developing keloids. A keloid acts as a "growth", different than a hypertrophic scar, which swells and widens the healing wound. Treatment for keloid scars is somewhat similar to that of hypertrophic scars. Nonetheless it should be understood that long-term effective treatment for keloids is difficult and long-term cures presently do not exist.

The Solution

Many times surgical treatment is necessary to significantly improve unsightly scars. When dealing with prominent scars there are a few important goals to keep in mind. First it is important to make the scar thinner. Additionally it is important to diminish the rough edges, irregularities, prominences, grooves and deficiencies in the skin that occur because of the wound and its healing. Moreover, it is important to realize that the direction and position of scars significantly influences the visibility of the wound. Redirecting the scar helps minimize its prominence.

Surgical scar revision includes multilayer closure techniques that diminish the pressure on the wound site while it heals. Outer layer support tape is often times used to decrease the tension during the healing phase. Scars can be broken up into geometric configurations or “z-plasty” which help further to minimize the visibility of the scar.

Laser resurfacing techniques using CO₂ laser and/or pulse Dialaser are also an important part of scar revision. Typically, laser resurfacing is performed approximately three to eight weeks after the initial injury, surgery, or revision surgical treatment. The majority of individuals who pursue resurfacing will achieve some additional improvement in the ultimate appearance of the wound long term.

Expectations

The degree of revision depends on the wound site and individual circumstances. Some individuals will only require simple revision and others are encouraged to have a combination of surgical revision plus skin resurfacing treatment. Each individual has a unique set of circumstances, which determines the best treatment. Generally, most individuals will achieve improvement with treatment. Rarely wounds are worsened by revision treatments. Indeed, once the scar forms the scar will always remain, however plastic surgeons can reduce the prominence and make the wound site generally more aesthetically pleasing.