Facial Plast Surg 2019; 35(06): 666-671
DOI: 10.1055/s-0039-3401642
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Facial Scars

1   Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
,
Sangati Kadakia
2   School of Medicine, Saint George's University, Saint George, Grenada
,
Jerry Barker
3   Radiation Oncology, Texas Oncology, Fort Worth, Texas
,
Moustafa Mourad
4   Department of Otolaryngology - Head and Neck Surgery, Jamaica Hospital Medical Center, Jamaica, New York
,
Masoud Saman
5   Saman ENT & Facial Plastic Surgery, Plano, Texas
,
Yadranko Ducic
6   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
29 November 2019 (online)

Abstract

Scarring is a natural process of healing after damage to the skin that extends to the reticular dermis. While some scars may be socially acceptable, even admirable, scars of the face can be viewed as disfiguring or ugly. Minimizing the appearance of facial scars and optimizing their cosmetic outcome ideally begin before surgery or, in the cause of trauma, at the initial reconstruction. Even when there has been poor initial healing, a scar's appearance can be improved. Herein, we review conservative, medical, and surgical therapies to improve the appearance of facial scars.

 
  • References

  • 1 Heffelfinger R, Sanan A, Bryant LM. Management of forehead scars. Facial Plast Surg Clin North Am 2017; 25 (01) 15-24
  • 2 Levine E, Degutis L, Pruzinsky T, Shin J, Persing JA. Quality of life and facial trauma: psychological and body image effects. Ann Plast Surg 2005; 54 (05) 502-510
  • 3 Boyce ST, Lalley AL. Tissue engineering of skin and regenerative medicine for wound care. Burns Trauma 2018; 6: 4
  • 4 Lighthall JG, Fedok FG. Treating scars of the chin and perioral region. Facial Plast Surg Clin North Am 2017; 25 (01) 55-71
  • 5 Chambers CB, Moe KS. Periorbital scar correction. Facial Plast Surg Clin North Am 2017; 25 (01) 25-36
  • 6 Al-Shaqsi S, Al-Bulushi T. Cutaneous scar prevention and management: overview of current therapies. Sultan Qaboos Univ Med J 2016; 16 (01) e3-e8
  • 7 Welshhans JL, Hom DB. Soft tissue principles to minimize scarring: an overview. Facial Plast Surg Clin North Am 2017; 25 (01) 1-13
  • 8 Hassouneh B, Newman JP. Lasers, fillers, and neurotoxins: avoiding complications in the cosmetic facial practice. Facial Plast Surg Clin North Am 2013; 21 (04) 585-598
  • 9 Larrabee WF, Sherris DA. Principles of Facial Reconstruction. Philadelphia, PA: Lippincott Williams & Wilkins; 1995
  • 10 Gillanders SL, Anderson S, Mellon L, Heskin L. A systematic review and meta-analysis: do absorbable or non-absorbable suture materials differ in cosmetic outcomes in patients requiring primary closure of facial wounds?. J Plast Reconstr Aesthet Surg 2018; 71 (12) 1682-1692
  • 11 Boahene KD, Owusu JA. Treating scars of the cheek region. Facial Plast Surg Clin North Am 2017; 25 (01) 37-43
  • 12 Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg 2008; 34 (03) 301-305 , discussion 305–307
  • 13 Rahman Z, MacFalls H, Jiang K. , et al. Fractional deep dermal ablation induces tissue tightening. Lasers Surg Med 2009; 41 (02) 78-86
  • 14 Fisher GH, Geronemus RG. Short-term side effects of fractional photothermolysis. Dermatol Surg 2005; 31 (9 Pt 2): 1245-1249 , discussion 1249
  • 15 Surowitz JB, Shockley WW. Enhancement of facial scars with dermabrasion. Facial Plast Surg Clin North Am 2011; 19 (03) 517-525
  • 16 Thomas JR, Somenek M. Scar revision review. Arch Facial Plast Surg 2012; 14 (03) 162-174
  • 17 Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician 2009; 80 (03) 253-260
  • 18 Capon A, Iarmarcovai G, Gonnelli D, Degardin N, Magalon G, Mordon S. Scar prevention using Laser-Assisted Skin Healing (LASH) in plastic surgery. Aesthetic Plast Surg 2010; 34 (04) 438-446
  • 19 Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg 1999; 25 (03) 224-232
  • 20 Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology 2002; 204 (02) 130-132
  • 21 Yoo DB, Azizzadeh B, Massry GG. Injectable 5-FU with or without added steroid in periorbital skin grafting: initial observations. Ophthal Plast Reconstr Surg 2015; 31 (02) 122-126
  • 22 Khaw PT, Sherwood MB, MacKay SL, Rossi MJ, Schultz G. Five-minute treatments with fluorouracil, floxuridine, and mitomycin have long-term effects on human Tenon's capsule fibroblasts. Arch Ophthalmol 1992; 110 (08) 1150-1154
  • 23 Shah VV, Aldahan AS, Mlacker S, Alsaidan M, Samarkandy S, Nouri K. 5-Fluorouracil in the treatment of keloids and hypertrophic scars: a comprehensive review of the literature. Dermatol Ther (Heidelb) 2016; 6 (02) 169-183
  • 24 Massry GG. Commentary on: preoperative use of neuromodulators to optimize surgical outcomes in upper blepharoplasty and brow lift. Aesthet Surg J 2018; 38 (09) 949-950
  • 25 Ducic Y, Pontius AT, Smith JE. Lipotransfer as an adjunct in head and neck reconstruction. Laryngoscope 2003; 113 (09) 1600-1604
  • 26 Wilson AM. Use of botulinum toxin type A to prevent widening of facial scars. Plast Reconstr Surg 2006; 117 (06) 1758-1766 , discussion 1767–1768
  • 27 Zhang DZ, Liu XY, Xiao WL, Xu YX. Botulinum toxin type A and the prevention of hypertrophic scars on the maxillofacial area and neck: a meta-analysis of randomized controlled trials. PLoS One 2016; 11 (03) e0151627
  • 28 Foo CW, Tristani-Firouzi P. Topical modalities for treatment and prevention of postsurgical hypertrophic scars. Facial Plast Surg Clin North Am 2011; 19 (03) 551-557
  • 29 Jacobsson F. The treatment of keloids at Radium-hemmet, 1921-1941. Acta Radiol 1948; 29 (03) 251-267
  • 30 Hintz BL. Radiotherapy for keloid treatment. J Natl Med Assoc 1973; 65 (01) 71-75
  • 31 Hoang D, Reznik R, Orgel M, Li Q, Mirhadi A, Kulber DA. Surgical excision and adjuvant brachytherapy vs external beam radiation for the effective treatment of keloids: 10–year institutional retrospective analysis. Aesthet Surg J 2017; 37 (02) 212-225
  • 32 Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and treatment. Plast Reconstr Surg 2006; 117 (01) 286-300
  • 33 Mankowski P, Kanevsky J, Tomlinson J, Dyachenko A, Luc M. Optimizing radiotherapy for keloids: a meta-analysis systematic review comparing recurrence rates between different radiation modalities. Ann Plast Surg 2017; 78 (04) 403-411
  • 34 Shen J, Lian X, Sun Y. , et al. Hypofractionated electron-beam radiation therapy for keloids: retrospective study of 568 cases with 834 lesions. J Radiat Res (Tokyo) 2015; 56 (05) 811-817
  • 35 Ollstein RN, Siegel HW, Gillooley JF, Barsa JM. Treatment of keloids by combined surgical excision and immediate postoperative X-ray therapy. Ann Plast Surg 1981; 7 (04) 281-285
  • 36 Eaton DJ, Barber E, Ferguson L, Mark Simpson G, Collis CH. Radiotherapy treatment of keloid scars with a kilovoltage X-ray parallel pair. Radiother Oncol 2012; 102 (03) 421-423
  • 37 Bischof M, Krempien R, Debus J, Treiber M. Postoperative electron beam radiotherapy for keloids: objective findings and patient satisfaction in self-assessment. Int J Dermatol 2007; 46 (09) 971-975
  • 38 Bijlard E, Verduijn GM, Harmeling JX. , et al. Optimal high–dose–rate brachytherapy fractionation scheme after keloid excision: a retrospective multicenter comparison of recurrence rates and complications. Int J Radiat Oncol Biol Phys 2018; 100 (03) 679-686
  • 39 Hafkamp CJH, Lapid O, Dávila Fajardo R. , et al. Postoperative single-dose interstitial high-dose-rate brachytherapy in therapy-resistant keloids. Brachytherapy 2017; 16 (02) 415-420
  • 40 Ferreira C, Johnson D, Rasmussen K, Leinweber C, Ahmad S, Jung JW. A novel conformal superficial high-dose-rate brachytherapy device for the treatment of nonmelanoma skin cancer and keloids. Brachytherapy 2017; 16 (01) 215-222
  • 41 Renz P, Hasan S, Gresswell S, Hajjar RT, Trombetta M, Fontanesi J. Dose effect in adjuvant radiation therapy for the treatment of resected keloids. Int J Radiat Oncol Biol Phys 2018; 102 (01) 149-154
  • 42 Flickinger JC. A radiobiological analysis of multicenter data for postoperative keloid radiotherapy. Int J Radiat Oncol Biol Phys 2011; 79 (04) 1164-1170
  • 43 Sakamoto T, Oya N, Shibuya K, Nagata Y, Hiraoka M. Dose-response relationship and dose optimization in radiotherapy of postoperative keloids. Radiother Oncol 2009; 91 (02) 271-276
  • 44 Speranza G, Sultanem K, Muanza T. Descriptive study of patients receiving excision and radiotherapy for keloids. Int J Radiat Oncol Biol Phys 2008; 71 (05) 1465-1469
  • 45 Ogawa R, Yoshitatsu S, Yoshida K, Miyashita T. Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis. Plast Reconstr Surg 2009; 124 (04) 1196-1201