Treating Scars in Relation to Facial Regions
Soft Tissue Principles to Minimize Scarring: An Overview 1
Jamie L. Welshhans and David B. Hom
This article is a broad overview of measures and techniques that can be used to minimize soft tissue scarring.
Management of Forehead Scars 15
Ryan Heffelfinger, Akshay Sanan, and Lucas M. Bryant
This article provides an overview of scar management within the forehead region. It addresses the unique challenges specific to the treatment of forehead wounds. A logical, stepwise approach is used. A subsite based treatment algorithm is provided along with a review of current best practices. Pertinent case examples are included for demonstration purposes.
Periorbital Scar Correction 25
Christopher B. Chambers and Kristen S. Moe
Periorbital scarring with eyelid retraction can have serious visual effects and can lead to loss of vision or even loss of the eye. Understanding of eyelid anatomy and the delicate balance of its structural supports is critical for the identification of the eyelid disorder responsible for the cicatrix and helps to guide treatment. The 2-finger test and lateral distraction of the lid can also be of significant help in proper diagnosis of the underlying disorder. Proper reconstruction with respect to the anterior and posterior lamellae helps to ensure a favorable outcome.
Treating Scars of the Cheek Region 37
Kofi Derek Boahene and James A. Owusu
Scars of the cheek resulting from all causes can extol significant psychological toll. The cheek is the largest facial subunit and visually and aesthetically prominent making scars in this region difficult to ignore. An approach to scar management that targets specific characteristics of a scar using a combination of surgical and nonsurgical modalities can significantly improve the appearance of most scars. The ideal time to revise a scar should be based on the extent of scar maturation and presence or absence of any functional distortion.
Unique Clinical Aspects of Nasal Scarring 45
Benjamin P. Caughlin, Christian Barnes, J. Stuart Nelson, and Brian J.F. Wong
Various methods are available for refining scars of the external nose and optimal scar revision frequently requires the utilization of multiple techniques. Differing anatomy of nasal subunits and their underlying structural framework limit surgical options in nasal scar revision compared with other areas of the face. An understanding of a variety of laser technologies and their specific applications can vastly aid in fine, controlled scar revision. Achieving optimal scar reduction regularly requires multiple stages of intervention, close follow-up, and repeat procedures.
Treating Scars of the Chin and Perioral Region 55
Jessyka G. Lighthall and Fred G. Fedok
Lip and chin scarring occurs owing to reconstruction of congenital, cancer resection, or traumatic defects. Knowledge of lip anatomy and function is critical to optimize results. Realistic expectations should be established before intervention. Scar revision and reconstruction is ideally performed with a subunit approach, placing scars along aesthetic borders and performing subunit reconstruction to camouflage scars. Surgical techniques include direct excision, scar reorientation, local flap rearrangement, pedicled flaps, and regional or free flaps. Resurfacing/adjunctive procedures play important roles in the treatment of scars. This article reviews the anatomy, patient assessment, and techniques used in scar revision of the perioral region.
Treating Scars in the Auricle Region 73
Deborah Watson and Bharat Panuganti
This article provides a review of the surgical and nonsurgical options available to manage a variety of auricular scars. The basics of wound healing are discussed in addition to the etiology of keloids and the cauliflower ear. Many auricular scars can be revised with scar excision techniques, but separate discussions for the treatment of keloids and the cauliflower ear are provided. The management plan for auricular scarring requires appropriate patient counseling regarding the risk of recurrence in keloids, regrowth of scar tissue in cauliflower ears, scar hypertrophy at the line of closure, widening of the scar, and persisting ear contour deformities.
Treatment of Scalp Scars 83
John Kim
The scalp presents many challenges to the reconstructive surgeon given its visible nature and the various considerations that must be given for optimal reconstruction. In this article, we review the anatomy of the scalp, the various options for reconstruction, and important considerations for improving the chances of optimal reconstruction of scalp defects.
Treating Scars on the Oral Mucosa 89
Erik William Evans
Mucosal wounds tend to heal more rapidly than skin wounds and with minimal to no scar formation and hence have a minimal impact on function or aesthetics. This is likely due to differences in the magnitude and timing of the various factors that contribute to wound healing. Some examples of these differences are fibroblast proliferation, transforming growth factor-β, macrophages, neutrophils, and T cells. Other factors, such as the moist environment, contribute to the favorable wound-healing characteristics of mucosa.
Treating Scars to the Neck 99
Richard D. Gentile
Scarring of the neck affects millions of people every year. The appearance of neck scarring can be disturbing both physically and psychologically. Scarring of the neck can be accompanied by morbidities because of the limitation of functional motion of the neck. Treatment options and modalities for reduction and prevention of scar formation include topical steroids, intralesional steroids, interferon, 5-fluorouracil, silicone gel, radiation, laser therapy, and surgeries. There is no general consensus in the literature as to the optimal treatment of neck scarring. Patients should understand that the scar is likely to be improved but not eliminated by treatment.
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