A

Abbe lip switch procedure, in scar management, of chin and perioral region, 59

Ablative lasers, in scar management. See also specific anatomical scar.

LAD and, 106–107, 109

limitations of, 115

of nose, 51–52

Abrasion techniques, in scar management. See Dermabrasion; Lasers/laser resurfacing.

Absorbable sutures, properties of common, 7–8

Absorption, of topical drugs, 106

Acne scars, of cheek, revision of, 42–43

Acoustic device, topical application with, in LAD, 114–115

Adjunctive procedures. See also Nonsurgical interventions.

in scar management, of auricle scars, 78–79

calcium antagonism as, 78

chemotherapeutic agents as, 78

cryosurgery as, 78

imiquimod as, 78

intralesional steroids as, 78–79

pressure therapy as, 79

radiation therapy as, 78–79

radiofrequency tissue volume reduction as, 79

silicon sheeting as, 78–79

of cheek, dermabrasion as, 41

laser resurfacing as, 41–42

tissue expander as, 40

of chin and perioral region, 65–69

botulinum toxin as, 66–67

camouflage as, 68–69

dermabrasion as, 65

intralesional injections as, 67–68

laser as, 65–67

silicone gel sheeting as, 68

topical agents as, 68

volume restoration with grafts or fillers as, 66, 68

of forehead, 21–23

dermabrasion as, 22–23

goals of, 21

laser resurfacing as, 21–22

of neck, 102

of nose, 49

in scar minimization, 11

Advancement flaps, in scar management, of chin and perioral region, 58–64

of neck, 102

of paramedian forehead, bipedicle, 17

of temple region, 19

Aesthetic units/subunits, of face. See Facial analysis; Facial subunits.

Age, as scarring factor, 4–5

5-Aminolevulinic acid (ALA), LAD of, 106, 108, 114–115

Anatomy, in scar management, of auricle, 73

of cheek, 37–39

of chin and perioral region, 55–57

of forehead, 16–17

of hair follicle, 84

of periorbital region, 25–27

of scalp, 83–84

in scar minimization, 2–3

facial areas prone to, 2, 5

facial subunits and, 5–7

Animal models, of LAD, porcine, 108

of wound healing, skin vs. mucosa, 91–92

Antimicrobial prophylaxis, for minimizing scarring, 5

with LAD, 109

Ascorbic acid, LAD of, 106, 112–113

Atrophic facial scars, LAD for, 111–112

Atrophic lichen planus, oral mucosa scars and, 93

Auditory canal, external, stenosis of, 75

Auricle scars, 73–81

adjunctive procedures for, 78–79

calcium antagonism as, 78

chemotherapeutic agents as, 78

cryosurgery as, 78

imiquimod as, 78

intralesional steroids as, 78–79

pressure therapy as, 79

radiation therapy as, 78–79

radiofrequency tissue volume reduction as, 79

silicon sheeting as, 78–79

anatomy of, 73

cauliflower ear and, 74–75

management of, 79

cutaneous wound healing and, 73–74

embryology and, 73

from rhytidectomies, 75

hematoma and, 74–75

hypertrophic, 74

introduction to, 73

keloids as, 74

Chang-Park classification of, 78

management of, nonsurgical, 78–79

surgical, 77–78

key points of, 73

management and treatment of, 75–79

adjunctive procedures in, 78–79

for cauliflower ear, 79

for keloids, 77–79

general principles of, 75–76

nonsurgical therapies in, 78–79

surgical options for, 76–78

summary of, 79–80

surgical techniques for, 76–78

fusiform elliptical excision as, 76

GBLC as, 76

nonsurgical therapies vs., 78–79

wide excision as, 76–77

W-plasty as, 76

Z-plasty as, 76–77

Auricular hematoma, cauliflower ear and, 74–75

Autologous platelet-rich plasma, in scar management, of cheek, 42

B

Barrier properties, of skin, 106

treatment strategies and, 105–106

Basal cell cancer, nasal, MMS for, nasal scarring and, 50–52

Basement membrane, in skin vs. mucosa anatomy, 90–92

Basement membrane disease, oral mucosa scars associated with, 94–95

Bernard non Burow flap, in scar management, of chin and perioral region, 60, 62

Bilirubin, in skin color/pigmentation perception, 119–120

Bimatoprost, in scar management, LAD of, 112–113

Biopsy, of pemphigus vulgaris, 94–95

Bipedicle advancement flap, in scar management, of paramedian forehead, 17

Bleomycin, in scar management, of chin and perioral region, 68

of neck, 100

of perioral region, 58

Bone, exposed, in scalp scar management, 85–86

Bossing, in scar management, of paramedian forehead, 17

Botulinum toxin, in scar management, of chin and perioral region, 57–58, 66–67

of forehead, 23

Brow, in scar management. See Eyebrow.

Buccal mucosa harvest, as donor tissue, oral mucosa scars from, 95

B

Barrier properties, of skin, 106

treatment strategies and, 105–106

Basal cell cancer, nasal, MMS for, nasal scarring and, 50–52

Basement membrane, in skin vs. mucosa anatomy, 90–92

Basement membrane disease, oral mucosa scars associated with, 94–95

Bernard non Burow flap, in scar management, of chin and perioral region, 60, 62

Bilirubin, in skin color/pigmentation perception, 119–120

Bimatoprost, in scar management, LAD of, 112–113

Biopsy, of pemphigus vulgaris, 94–95

Bipedicle advancement flap, in scar management, of paramedian forehead, 17

Bleomycin, in scar management, of chin and perioral region, 68

of neck, 100

of perioral region, 58

Bone, exposed, in scalp scar management, 85–86

Bossing, in scar management, of paramedian forehead, 17

Botulinum toxin, in scar management, of chin and perioral region, 57–58, 66–67

of forehead, 23

Brow, in scar management. See Eyebrow.

Buccal mucosa harvest, as donor tissue, oral mucosa scars from, 95

C

Calcium antagonism, in scar management, of auricles, 78

Camouflage, in scar management, of cheek, 37

of chin and perioral region, 68–69

of neck, 99, 101

Canthal tendons, in scar management, of periorbital region, 26–27

Canthus, in scar management, of periorbital region, anatomy of, 26–27

reconstruction of medial, 32–34

Capsulopalpebral fascia (CPF), in scar management, of periorbital region, 27

Carotene, in skin color/pigmentation perception, 119–120

Cartilage, in auricles, 73

cauliflower ear and, 79

Cauliflower ear, auricle scars and, 74–75

hematoma in, 74–75

management of, 79

Cautery, in scar management, of periorbital region, 34

in scar minimization, 6

Cavitation force, with LAD, 114

CelluTome, in epidermal skin harvesting, 113

Chang-Park classification, of auricular keloids, 78

Channel density, and LAD, 107, 109

Channel depth, effect on LAD, 107–109

Channel filling, PVP, in LAD, 115

Cheek scars, revision of, 37–43

acne scars and, 42–43

adjunctive procedures in, dermabrasion as, 41

laser resurfacing as, 41–42

tissue expander as, 40

anatomic considerations of, 37–39

introduction to, 37

key points of, 37

nonsurgical techniques for, autologous platelet-rich plasma as, 42

cosmetics as, 42

5-FU as, 42

mechanical force as, 42

silicone sheets/gels as, 42

steroids as, 42

patient evaluation for, 38, 40

summary of, 43

surgical techniques for, 38, 40–42

excision as, 40

GBLC as, 41

overview of, 38, 40

running W-plasty as, 40–41

scar irregularization as, 40

scar repositioning as, 41

scar resurfacing as, 41–42

subscision as, 41

timing of, 38

Chemical modifications, of topical drugs, for delivery enhancement, 106

Chemotherapeutic agents, in scar management, LAD of, 106

of auricles, 78

of cheek, 42

of chin and perioral region, 68

of neck, 100

of periorbital region, 34

oral mucosa scars associated with, 96

Chin scars, treating, 55–71

adjunctive procedures in, 65–69

botulinum toxin as, 66–67

camouflage as, 68–69

dermabrasion as, 65

intralesional injections as, 67–68

laser as, 65–67

silicone gel sheeting as, 68

topical agents as, 68

volume restoration with grafts or fillers as, 66, 68

anatomy of, 55–57

functional attributes of, 56

introduction to, 55

key points of, 55

patient evaluation for, 56

subunity organized approach to, 57–64

lower lip in, 59–62

oral commissure in, 64

overview of, 57–58

red lip (vermilion) in, 61–64

border of, 63–64

upper white lip in, 58–61

vermilion border in, 63–64

vermilion (red lip) in, 61–64

summary of, 69

surgical techniques in, 64–66

GBLC as, 65–66

subunit organized approach to, 57–64

W-plasty as, 58, 65

Z-plasty as, 58, 61, 63–65

Chronic mucosal irritation, oral mucosa scars associated with, 95

Cicatricial retraction with ectropion, in scar management, of periorbital region, 30

with free tarsal graft, 30–31

Cicatricial retraction with entropion, in scar management, of periorbital region, 30

Clinical evaluation. See Patient evaluation.

Coagulation zone, in LAD, 108

Collagen, in keloid vs. hypertrophic scarring, 74

in neck, 100, 102

LAD effect on, 113

remodeling of, in nasal scarring, 51

Color, human perception of, 119–120

in ethnic skin, 119–125 . See also Skin color.

Comorbidities. See Medical conditions/comorbidities.

Constitutive skin pigmentation, in ethnic skin, 120

control mechanism of, 122–123

Contour status, in scar management, of cheek, 40

of neck, 99–100

case study of, 102–103

Contraction, in scar management, buccal mucosa harvest and, 95

of chin and perioral region, 58, 62, 64

wound, as scarring factor, 6–7

Corticosteroids, in scar management. See Steroids.

Cosmeceuticals, as irritants, susceptibility to, 124

in scar management, LAD of, 115

of cheek, 42

CPF (capsulopalpebral fascia), in scar management, of periorbital region, 27

Cryosurgery, intralesional, in scar management, of auricles, 78

Curettage, for LAD, 107

Cushing’s syndrome, related to LAD, 115

Cutaneous delivery systems, for topical drugs, 106. See also Laser-assisted delivery (LAD).

Cutaneous (white) lip, upper, in scar management, of chin and perioral region, 58–61

Cutaneous wound healing, basics of, 73–74

vs. mucosa, 90–92

animal model of, 91–92

Cytokines, antiproliferative, in scar minimization, 11–12

in wound healing. See Inflammation.

D

DE junction, in skin anatomy, 3

Debridement, of cauliflower ear, 79

Decision-making tree, for eyelid laxity correction, 28–29

Dermabrasion, in scar management, of cheek, 41

of chin and perioral region, 65

of forehead, 22–23

of neck, 101

in scar minimization, 11

Dermis, color of, 119–120

in skin anatomy, 2–3

vs. oral mucosa, 90–92

Digital imaging, for skin color quantitation, 121–122

Direct immunofluorescence microscopy, of pemphigus vulgaris, 94–95

Disease states, as scarring factor, 2, 4

DNA, damage to, from chemotherapy. See specific agent.

with UV exposure, 120

Dosimetry, laser, for LAD, 107

Drug delivery, laser-assisted, for facial scars, 106, 109

5-FU in, 109–111

bimatoprost in, 112

current treatments vs., 105–106

FDA stance on, 115

molecular weight and, 108

PLLA in, 111–112

topical, 106, 114–115

topical with acoustic device, 114–115

topical with meretes article, 114–115

triamcinolone acetonide in, 109–111

vitamins in, 106, 112–113

Drug diffusion, molecular weight and, in LAD, 108

Dry–wet border, of chin and perioral region, in scar management, 56–57, 64

E

Ears, external, scarring of, 73–81 . See also Auricle scars.

Ectropion, 28–29

cicatricial retraction with, in scar management, of periorbital region, 30

with free tarsal graft, 30–31

Effacement, in scar management, of cheek, 37

Elliptical excision, fusiform, in scar management, of auricles, 76

Embryology, of auricle, 73

Entropion, 28–29

cicatricial retraction with, in scar management, of periorbital region, 30

Environment, in skin vs. mucosa anatomy, 90–92

Epidermal skin transplantation, LAD in, 113–114

Epidermis, color of, 119–120

in skin anatomy, 2–3

vs. oral mucosa, 90–92

Epithelium, in skin vs. mucosa, anatomy of, 90, 92

wound healing and, 90–92

Erosive lichen planus, oral mucosa scars and, 93–94

Erythema, in nasal scarring, vascular laser for, 51

in skin pigmentation, 120

ethnic skin response to stress and, 124

Estlander cross-lip flap, in scar management, of chin and perioral region, 59, 61

Ethnicity, as scarring factor, 2, 4

in response to stress, skin color related to, 123

treatment implications of, 123–124

melanin content for unexposed skin per, 120

skin color and pigmentation influences of, 119–125 . See also Skin color; Skin pigmentation.

Eumelanin, skin color variations related to, 121–122

Evolutionary aspects, of skin pigmentation, 123

Excision, in scar management, fusiform. See Fusiform excision.

of auricles, for keloids, 77–78

fusiform elliptical, 76

wide, 76–77

of cheek, 40

of chin and perioral region, 58

of neck, 101

Exposed bone, in scalp scar management, 85–86

External auditory canal, stenosis of, 75

External ears, scarring of, 73–81 . See also Auricle scars.

Extirpation, of keloid core, in auricles, 77–78

Extramarginal excision, of keloids, in auricles, 77

Eyebrow, in scar management, of forehead, 18, 20

Eyelid, horizontal tightening of, in scar management, of periorbital region, 31–34

combining procedures for, 34

lateral tarsal strip procedure in, 31–32

medial canthal region reconstruction in, 32–34

Eyelid laxity, in scar management, of periorbital region, 27–29

Eyelid retraction, in scar management, of periorbital region, 27–29

F

Facial analysis, in scar management, of forehead, 16–17, 19–20

Facial areas, prone to scarring, 2, 5

Facial nerves, in scar management, of forehead, 17, 19

Facial scars. See also Scars/ scarring; specific anatomy.

laser-assisted delivery to treat, 105–117 . See also Laser-assisted delivery (LAD).

Facial subunits, in scar management, of cheek, 38–39

of chin and perioral region, 55–57

of forehead, 16–17

of nose, 52–53

of periorbital region, 25

in scar minimization, 5–7

Facultative skin pigmentation, in ethnic skin, 120

Fan flaps, in scar management, of chin and perioral region, 59, 62

Ferulic acid, LAD of, 112–113

Fever blisters, scar minimization and, 5

Fibroblasts, in skin color/pigmentation variations, 122

in skin vs. mucosa wound healing, 90–92

neck scars and, 100, 102

Fillers, in scar management, intralesional. See Intralesional fillers.

of chin and perioral region, for volume restoration, 66, 68

of nose, injectable, 50–52

Fitzpatrick skin types, as scarring factor, 2, 4, 7

ethnic skin response to stress and, 124

melanin content for unexposed skin and, 120

skin color classification and, 120, 122

5-Fluorouracil (5-FU), in scar management, LAD of, 106, 109–111

of cheek, 42

of neck, 100

of periorbital region, 34

Flaps. See also specific anatomy or flap.

local vs. regional, for neck scars, 101–102

for scalp scars, 85

Follicle. See Hair follicle.

Follicular unit transplants, for scalp scars, 86

Force, cavitation, with LAD, 114

mechanical, in scar management, of cheek, 42

Forceps, in scar minimization, 6

Forehead analysis, for scar management, 16–17, 19–20

Forehead scars, 15–24

introduction to, 15–16

key points of, 15

management and treatment of, 16–23

adjunctive techniques for, 21–23

dermabrasion as, 22–23

goals of, 21

laser resurfacing as, 21–22

anatomical subunits in, 16–17

facial analysis in, 16–17, 19–20

mid-forehead in, 16–17

nonsurgical techniques for, 21–23

botulinum toxin as, 23

goals of, 21

intralesional fillers as, 23

steroids as, 21

overview of, 16

paramedian forehead in, 16–18

specific to forehead, 19–20

surgical techniques for, 20–21

GBLC in, 20–21

goals of, 19–20

hair transplantation in, 20

W-plasty in, 20–21

Z-plasty in, 20

temple region in, 18–19

Free flaps, in scar management, of neck, 102

Free tarsal graft, in scar management, of periorbital region, harvesting, 30–31

retraction repair and implant site preparation, 31

with cicatricial retraction with ectropion, 30–31

Free tissue transfer, for scalp scars, 86

Functional attributes, of chin and perioral region scarring, 56

Fusiform excision, in scar management, elliptical, of auricles, 76

of neck, 101

G

GBLC. See Geometric broken line closure (GBLC).

Gel matrix model, of LAD, 113–114

Gene expression, in skin color/pigmentation variations, 123

Genetics, of skin irritants susceptibility, 124

of skin pigmentation, 123

Geometric broken line closure (GBLC), in scar management, of auricles, 76

of cheek, 41

of chin and perioral region, 65–66

of forehead, 20–21

of neck, 101

in scar minimization, 7, 10, 12

Geo-topographic approach, to scar minimization, 5

of cheek, 38–39

of forehead, 16–17, 19

Gilles fan flap, in scar management, of chin and perioral region, 59, 62

Grafts/grafting. See also specific anatomy or type.

as scarring factor, 6–7

in scar management, for volume restoration, of chin and perioral region, 66, 68