Facial Scar Revision
Q: Dr. Eppley, I am interested in a facial scar revision. I have a long grooved scar on my left cheek from a two layer Moh’s operation performed three years ago. I have had several consultations from Plastic Surgeons and now am confused. The plastic surgeons said the original doctor did not evert the edges during closure therefore this is why it looks like it does now. The last plastic surgeon I consulted stated he would place deep sutures and not evert and do zero top stitching, placing just a fine stitch running over and over and than taken out in a week to prevent stitch marks. When I asked if he would evert the skin edges he stated no. Is not eversion the only way to give the best possible outcome with a atrophic scar apart from tension on the inner layers? How do you do it .. The first, Vertical mattress no dissolvable sutures and evert….the next zero eversion and deep sutures. I though eversion was the way to go? Thank you for your time and consideration.
A: When it comes to facial scar revision the various techniques can be confusing. One has to look at the original problem, understand it and then devise a strategy which will improve the outcome. You have classic inverted scar, not because the right wound closure technique was not done, but because this was a wound closed over an area of tissue excision under some degree of tension. That combination is doomed to result in a wider inverted scar no matter how it was closed. Skin under tension closed over an area of deeper tissue deficiency is bound to sink in as it heals over time.
Your scar revision now is different. The wound edges will not be under such tension and there be no deeper area of tissue deficiency since nothing is being removed. Therefore, release of the skin edges and the deeper tissues with reapproximation of tissue layers will solve the inversion issues. There really is not need to do specific skin edge eversion. Providing deeper tissue support or buildup is the key. How the skin is closed is really irrelevant.
Dr. Barry Eppley