Any time a layer of skin on the body is divided, whether by surgery, injury or disease, the body repairs the wound through a process that involves scarring. Because the wound has many layers, scarring occurs at different layers. We only see the scarring on the surface, but sometimes it is the deep scarring that causes visible surface changes.
We commonly hear patients refer to any visible facial scar as a “keloid”, and in most cases, this is incorrect. Scarring on the face is a form of disfigurement and may look keloid simply because we notice it much more than scarring on the scalp or back.
The most common cause of facial scars is disease like acne. The second most common cause is injury, whether sharp injury like glass, or blunt injury. Visible scarring after facial surgery is relatively uncommon, but all facial surgery, including facial cosmetic surgery, heals with scarring. The trick is to hide the scar.
What can be done?
An active scar is one which is changing whilst a mature scar has settled into its final appearance. Treatments to settle the wound healing process are indicated for a scar that is active. Such treatments include injections to settle the healing process, dermabrasion to improve texture and blend skin margins, and skin laser to diminish redness. Compression of the wound is also a simple and sometimes effective way to improve the appearance.
Treatment for a mature wound that is disfiguring begins with surgical scar revision (hyperlink to scar revision page). Key to a successful outcome of wound revision is the quality of skin, and general health including diabetes and smoking.
Where treatment occurs
- Non-surgical treatments are carried out as office procedures.
- Minor surgical scar revision can be carried out as an office procedure.
- Larger surgical scar revision will need to be carried out in an operating theatre. The type of surgery will vary with location and extent of the scar.
This refers to surgery that makes a visible disfiguring scar less visible, and more aesthetically pleasing.
All surgical incisions heal by scarring…the trick to aesthesis is to hide the scars so that they are difficult to spot with the naked eye, and to restore symmetry. The revision process occurs in stages, and continues many months after revision surgery
Steps to scar revision
- Cease smoking, reduce alcohol, improve weight, diet and blood sugar management.
- Wait until scar is mature. Wound healing can continue for months, even up to one year. It is not advised to operate on an active wound, as this incites 2 healing processes and increases the unpredictability of the outcome
- Surgically excise the disfiguring scar
- Repair with a diffusing incision that distributes healing to make it more symmetrical
- Close monitoring during the postoperative period is required to modify wound healing early on
- Compression can help speed up the process
- Wound management intervention including dermabrasion, injections, skin laser and oral medications help improve aesthetic outcome
- Topical medication including steroid creams and silicone gel can improve outcome.
Remember that wound healing differs between people and at different times in a person’s life. Patients of Asian descent and pigmented skin may exhibit a more prolonged inflammatory healing response.