Scar Revision and Camouflage

CHAPTER 21 Scar Revision and Camouflage

The head and neck is a prominent part of the human body and can frequently be injured as a result of trauma, burns, or surgery. With superficial injuries, most facial wounds will heal with little to no scar formation. However, once the reticular dermis has been violated, some amount of residual scarring is destined to occur. Several factors that are beyond the surgeon’s control can affect the final appearance of the scar, including the mechanism of injury, position of the wound, health status of the patient, the patient’s skin type, and the tendency to form robust scars. Factors that are under the surgeon’s control include proper realignment of wound edges, conservative débridement of injured tissues, meticulous handling of tissues during primary repair, and aesthetically favorable alignment of scars whenever possible.

After complete maturation and healing, an ideal scar should be flat and level with the surrounding skin, a good color match with the surrounding skin, narrow, parallel to the RSTLs (Fig. 21-1) or on the border of aesthetic facial subunits, and without straight, unbroken lines that can be easily followed with the eye (Fig. 21-2).1 Scars with aesthetically unfavorable characteristics include those that are wide or misaligned with relaxed skin tension lines or aesthetic subunits, and those that are thickened, hypertrophied, or keloid (Fig. 21-3).1 The facial plastic surgeon has many options to improve, but not eliminate, these aesthetically unfavorable scars. Successful application of various treatments requires an understanding of which techniques are best indicated when performing scar revision or treating hypertrophic and keloid scars.

Successful scar revision begins with a precise analysis of both the scar and the patient’s expectations. Patients often have the false perception that plastic surgery can make an existing scar invisible. The surgeon should educate the patient on the true realistic goal of surgery, which is to modify the scar to a point of maximized camouflage within the natural shadows, lines, and borders that exist within the head and neck.

Expansion with Excision

Jun 5, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Scar Revision and Camouflage

Full access? Get Clinical Tree

Get Clinical Tree app for offline access