Michael Padway & Associates Facial Scarring Lawyers
Serving Washington, D.C.

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The effect of facial scarring is more than skin deep

Scarring: Scars result any time the deeper layers of skin are cut or torn. A scar is visible if it is higher or lower than the surrounding skin, a different color, or “goes against the grain” (natural lines) of the face. Scar tissue is a normal result of the healing process. Whenever the skin has been broken, whether by an injury, infection, or surgery, there will always be scarring, for it is nature’s way of binding a wound together.

Throughout history, facial scarring has been a source of low self-esteem for men, women and children. Scars form as part of the body's healing process whenever multiple layers of skin are injured, but these scars can negatively affect a patient's self-esteem, as well as their business and social life. Often it is very difficult to evaluate the emotional impact of such injuries. This is especially true with children who are unable to verbalize their feelings about the scars, or in males who are taught to minimize their concern about their appearance. Facial scarring does not have to be an inhibiting part of daily life: with today’s technology, scars can be significantly minimized or even erased.

Types of Scars

The three most common types of scars are:

Hypertrophic scar - An excessive amount of scar tissue in an incision or wound characterizes this type of scar. The scar itself appears reddened in color, firm and rises above the surrounding skin.

Keloid scar - This type of scar exhibits the same characteristics as the hypertrophic scar, but it continues to grow and enlarge with time. Areas of the face most likely to develop keloid scars are the earlobes, jaw line and neck.

Infectious scar - The most common type of facial scarring comes from acne and/or chicken pox infections.

The Effects of Facial Scarring

It's often difficult to predict what the final appearance of a scar will be, since scars tend to look their worst during the early stages of healing. At first, tiny new blood vessels generally form around an injury to help speed the healing process. This causes the new scar to look red and noticeable. Next, collagen fibers begin to be laid down, giving the scar a raised or lumpy appearance. After about six weeks, the scar begins to shrink and soften-a process that may continue for a year or more.

Some facial scars, however, are not improved sufficiently with time. Severe burn scars, for example, tend to have a puckered appearance. Acne may leave deep pits in the skin. Some scars, rather than shrinking, grow abnormally, forming hypertrophic scars. Keloids, a type of hypertrophic scar that results from an overproduction of collagen, continue growing beyond the margins of the original wound. Even a small scar may draw unwanted attention if it cuts across the face's natural creases and contours, and any scar that is unusually large, uneven, or differently colored may be nearly impossible to camouflage. Some scars actually interfere with the normal function of facial features. A scar that contracts as it heals may restrict the movement of muscles and tendons or pull the lip or eyelid into an unnatural position.

Facial Scarring Treatments

Most people with recent scarring want immediate repair, but often a scar must be allowed to “mature” prior to surgery. Maturation is a gradual change in the appearance that all scars go through until they have stabilized and change no further. Initially a scar looks reddened or occasionally raised. Gradually the firmness and red color resolve and should disappear leaving a softer scar that is more level and somewhat lighter in color than the surrounding skin. This process can take anywhere from 6 to 18 months. In some situations, waiting may be the best and only treatment necessary.

Children and young adults are the most common victims of injury. Unfortunately, their skin tends to heal with more scarring as an accompaniment to their ability to heal more rapidly. Although these scars tend to fade with time, it still makes the treatment program more difficult. It also makes it much more important to wait before initiating treatment since a scar that looks poor a month or so after injury may continue to greatly improve in appearance for many months. Ultimately, it may be so unnoticeable as to not require treatment.

Below we’ve identified some of the common treatment options for injured people who wish to minimize scarring:

Chemical Peels

Chemical peels can be performed on the face, neck, chest, hands and even arms and legs. Most chemical peels are performed as outpatient procedures. Based on your skin type and the desired results, your physician may recommend a superficial, medium or deep chemical peel. Your physician will select the proper chemical or mix of chemicals (glycolic acid, Jessner, TCA or trichloroacetic acid or carbolic acid) and apply the solution to various areas of skin. Once applied, the chemicals produce a separation and peeling of the outer layers of the skin. This stimulates the production of new skin from beneath.

Microdermabrasion/Dermabrasion

Microdermabrasion can be likened to a "superficial skin polishing" using microcrystals vacuumed through a delicate hand piece. In as little as twenty minutes, this gentle abrasive technique efficiently produces satisfying results. Treatments are progressive and are applied through a course of weekly sessions. Dermabrasion is a surgical planing technique which can be used to smooth down raised or uneven scars. Most commonly used for acne scarring, it is frequently helpful in the treatment of other injury scars.

Soft tissue augmentation

This procedure uses natural and synthetic fillers such as ArtecallTM, Autologen®, CymetraTM, DermalogenTM, HylaformTM, RestylaneTM and ZydermTM and ZyplastTM collagen. Utilizing the appropriate filler for you, your doctor will inject it under the treated area. Results are immediate. The duration of the improvement depends on the size and location of the scar treated as well as on the material used.

Laser resurfacing

Laser resurfacing with CO2 lasers, Erbium lasers, dual mode lasers, and Vascular lasers gives your physician precise control as the procedure gently vaporizes the damaged or acne-scarred skin to reveal the smooth, fresh skin underneath. Scars are removed in a precise, rapid, bloodless fashion achieving excellent results. Laser scar removal can be performed with local anesthesia if limited areas are treated, while full face resurfacing is usually performed with the administration of intravenous sedation by an anesthesiologist.

Pressure and Massage It is important to remember that sometimes conservative treatment is the best form of therapy. Repeated massage using cocoa butter or vitamin E can greatly improve the appearance of scars. In some cases, special pressure dressing may also be of use.

Cortisone Drugs Various types of cortisone drugs may be used either as injections, topical preparations, or in the form of special tapes. These may well improve the scar to a point where surgery is not required.

Collagen Implantation Collagen implantation involves the injection of a collagen material into the scar. It can be helpful in the treatment of depressed scars. In some cases, it can flatten the scars and make them almost imperceptible. Collagen does not result in permanent correction and treatment must be repeated after several months.

Silicone Pressure Therapy In many cases, a silicone dressing can be applied to a raised scar and help to soften or thin out the scar. The mechanism of this effect is unknown at the present time, but it has proven useful in many cases. It is very safe and simple to use. The special silicone sheet is cut to size and applied to the scar. It should be kept in place for 12 to 24 hours a day, depending on tolerance. Effects are not immediate, but results are usually seen within several weeks.

Facial Surgery

Facial scarring may be very disturbing emotionally, especially if the scars are difficult to camouflage with makeup. The appearance of unsightly or disfiguring scars may be improved by well-planned and carefully executed surgery.

The goal of surgical treatment of scars is to make a new scar which will be less noticeable than the present scar: an exchange of a bad scar for a better scar. The amount of improvement depends on many factors including the scar’s size, shape, location, general skin condition, and patient’s age. Each patient’s scarring requires careful study to determine if and when surgery is indicated. Patients tend to be impatient about the results of scar revision surgery. They are often already upset by the injury itself and find it difficult to understand that adequate and complete treatment may take many months or even several years. Often, scar revision surgery must be staged over a period of months to years in order to obtain the best results.

Excisional surgery

Excision is the surgical technique whereby the surgeon removes excess scar tissue and carefully sutures the wound together to create an even, narrow scar. It may be necessary to simultaneously try to reposition the scar so that it will fall within the natural skin lines or creases. If that is not possible, an elegant technique termed geometric broken line closure (GBLC) can be used. In this type of scar revision, the straight unnatural line of a visible scar can be broken into small geometric patterns that are difficult for the eye to follow, causing it to blend better with the surrounding skin. Dermabrasion to smooth any residual surface irregularities may then be recommended to enhance the final result.
Re-excision In many cases, simple excision and re-closure of the wound will greatly improve the result. We may be able to close the wound without the tension that was present at the time of the initial repair. Furthermore, what was originally a jagged cut may now be changed into a clean surgical incision.

Serial Excision In many cases, wide or extensive scarring cannot be adequately treated with one operation. A planned, staged approach may be required in which several operations are utilized to lead to the best possible result. In some situations, a device called a tissue expander can be used to hasten this type of reconstruction.

Zig-Zag-Plasty The zig-zag-plasty is a technique of excising a scar and replacing the line with a geometric broken line. This type of wound tends to heal with less tension, and replaces a straight line scar with a broken line scar which tends to be less apparent to the eye. This is one of the most common and successful techniques of dealing with facial scars.

With all of these procedures at your disposal, your treatment can be tailored to achieve your expectations.

Click Here for a list of online resources on facial scarring