advancements have always made an impact on the way we live, and
new advancements in medical technology are changing the way we look.
Laser treatments, vitamin based topical creams and special acid
peels have provided new methods for the Facial Plastic Surgeon and
the Dermatologist to erase some of the wrinkles we earn with age
and to help facial scars to begin to disappear.
Vitamin A creams like Retin-A and Renova help the skin to increase
the production of new surface cells and shed old dead cells more
rapidly. They may cause a reddened, irritated appearance to the
skin in the area of application after a day or two but the long
term result usually shows a marked reduction in wrinkles and a tighter,
younger appearance to the skin. Chemical Peels have been used for
many years and were often used by cosmetologists in salons before
the dangers and medical risks were understood. Now salons can offer
certain chemical peels but many require the expertise and supervision
of the physician.
New laser delivery systems allow the laser to touch each area in
the targeted zone for a brief instant and then move on. Certain
wavelengths of the laser light can be used in this way to peel off
the outer layers of dead skin cells and tighten the supporting tissues.
Depending on the intensity of the laser beam used, the effects may
allow surface peeling, temporary discoloration, and even a thermal
burn much like severe sunburn. These side effects may be temporary
while the lasting effects may offer smoother, tighter, younger-looking
Laser resurfacing has also proven useful in the treatment of facial
scars from accidents and injuries. Dermabrasion and scar revision
surgery are often required as well. The process of considering surgical
intervention requires an understanding of the development of scars.
Wound healing after a facial injury is a process that continues
for as much as a year or more after the initial injury. The early
phase in the first few weeks is dramatic and the initial swelling
and inflammation and redness around the wounds tend to subside as
the initial scarring takes place. The body builds tissue bridges
to connect torn edges and this is the area we can see as scarring.
The extent of the initial injury and the techniques used in the
early repair are the most important factors in obtaining a good
Over the many months that follow, the scarring is limited to the
small area of the wound and usually the tissues around the wound
slowly have much of the inflammatory material responsible for swelling
and scarring begin to fade away and disappear. The process may take
may months and in some facial injuries around the mouth and nose
we may see changes that are visible as much as two years beyond
initial injury that were not visible at the 5 - 6 week mark. Some
scars may benefit from local injection of steroid medicines to help
the scar shrink. In some cases, the topical application of Vitamin
E in cream or gel form and the application of steroid creams may
help to control scarring and may change the appearance of the healed
After a few weeks and again after 6 months or so, the new scar should
be re-examined to determine if the natural process is allowing it
to fade and be less noticeable. Laser resurfacing and dermabrasion
both create significant redness that may take months to fade. Camouflage
techniques can be very helpful, during these early months, to minimize
any disfigurement caused by scarring. Specialized make-up can cover
changes in coloration such as the redness after laser resurfacing.
Other types of makeup can be effectively used to completely obscure
scars on the face. Men are often encouraged to grow beard or moustache
hair to easily hide facial scars.
It is difficult
to predict, during the early phase of healing, just what procedure
may be needed and exactly when it may be needed in order to achieve
a pleasing final result. It is fair to say that many patients who
have facial injuries may require more than two procedures and will
often deal with the disfigurement of facial scarring for many years.
The psychology of facial scarring is variable and depends very much
on the magnitude of the injuries and the individual's stability
at the time of the evaluation. Certainly the disfigurement of facial
scarring creates an unusual strain that may be variable at different
periods in life. The psychological impact of facial scarring on
the young lady who is about to attend her prom or debutante ball
may be significantly greater than the impact on a 9 year old boy
with scarring from a bicycle accident.
A final pleasing aesthetic result may require multiple procedures
over several years. Although we expect that each procedure would
be less involved and less difficult than the previous ones, that
is not always the case. Outpatient surgery usually requires anesthesia
care also and skilled nursing assistance at a surgical facility.
The total cost of each procedure truly depends on the extent and
complexity of the specific operations selected. In some cases a
sequence of scar revisions and finally a dermabrasion or the application
of chemical peels or laser resurfacing may follow initial repair.
aesthetic result is always the goal and requires continued realistic
discussion between the patient, the family, and the facial plastic
surgeon. Insurance concerns often are involved in planning necessary
procedures. Early settlement with any involved party in an accident
may overlook important details of timing regarding the treatment
of facial scarring. Consultation with your insurance agent or your
attorney may be advisable in order to avoid misunderstanding at
a later time.
Dr. Love is
board certified by the American Board of Otorhinolaryngology-Head
and Neck Surgery and has subspecialty training in Facial Plastics
and Reconstructive Surgery. If you have questions about facial scarring
or about new techniques in facial plastic surgery, contact Dr. Love
and his staff at the Otorhinolaryngology Associates, (334) 281-6327.