Scars: Clinical Evidence Base and Patient Impact









Steven Ross Mobley, MD, Guest Editor
As Facial Plastic Surgeons, we are trained to evaluate scars in terms of clinical variables. Are they flat? Are they wide? Are they in parallel to relaxed skin tension lines? For many patients, though, the potential impact of scars is far greater than simple, measurable assessments, and that effect is much more difficult to assess.


As an example from my own life, I have had a premalignant lesion removed from my cheek. I left the dermatologist’s office with a small circular bandage over the repair site. While this adhesive bandage was probably no more than one inch in diameter, I still remember being stared at by complete strangers in the halls of the hospital, each of them seeming to wonder, “What happened to him?” I was experiencing firsthand how the treatment of this small facial lesion was altering the way in which I normally interacted with other people. This admittedly minor experience nevertheless gave me pause and has helped me to have better empathy for all facial reconstruction patients.


At times, doctors may forget the profound impact a facial scar can have on a patient’s self-perception. I have treated a patient with 70% burns from mining slag who seemed to be unaffected by what any casual observer would consider a completely disfiguring facial injury. I have also treated a very attractive 55-year-old female who had lost nearly half her nose and underwent a near-flawless reconstruction with a paramedian forehead flap. For this woman, however, her experience with facial scarring marked the beginning of her life into a downward spiral. For her, no longer being “perfectly” beautiful was too great a burden to bear. She lost her family and her career as a result of depression and feeling incapable of interacting in public. While most people would say she had an excellent surgical result, for her, things would never be the same.


I thank each author for their excellent contributions to this Facial Plastic Surgery Clinics of North America . The information within this volume should help each of us to improve our techniques, to follow guidelines established by evidenced-based literature, and, in the final result, to relieve both the physical and the psychosocial burdens of facial scars. As a patient with significant facial scarring once wrote me, “My bark is much worse than my bite. Don’t be frightened by first impressions—In my heart I truly am smiling.”


As Facial Plastic Surgeons, we must remember that each patient we care for can, and will, have a different reaction to facial scarring. I hope that the articles contained within this Facial Plastic Surgery Clinics review will bestow some new knowledge on surgeons across the country. If just one surgeon is able to improve his or her practice by implementing a few of the “pearls” included here, then the efforts and contributions of the authors of this volume will have been worth it.

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Feb 8, 2017 | Posted by in General Surgery | Comments Off on Scars: Clinical Evidence Base and Patient Impact

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