How Is Facial Scar Revision Different In Children Than In Teenagers And Adults?

Q: Dr. Eppley, our son is in need of some revision of scars about his face and lips. he is only 4 years old. I have some questions about the procedure if you wouldn’t mind answering them for me.

  1. Would it be necessary for you to remove any stitching afterwards? And if so, how long would it be before they would be removed.?
  2. One concern I have is that he is so young that he might damage or pick at any stitches if he had the operation now.
  3. Is the operation done under a local?  He may also be a little too young to sit still for a long time. If the operation is under local how long would the procedure take?
  4. Do you perform the procedure?

A: In answer to your questions of facial scar revision in children:

  1. I never use stitches that have to be removed in children under the age of around 8 years old. Children are understandably fearful and uncooperative when you approach their face with instruments, as you might imagine. Therefore, I use very tiny dissolveable sutures that go away on their own. For lip scar revision, there are no restrictions afterward in regards to eating and oral hygiene practices.
  2. I have never children picking or manipulating their stitches to be a problem. I have done many hundreds of cleft lip and nose repairs in children, for example, and have never seen that to be an issue.  The only issue with children, particularly boys, is their tendency to get inadvertent trauma such as falls and collisions while playing.
  3. I would never perform facial surgery on a child under the age of about 10 unless they were asleep. Just like stitches that they won’t let you take out, they most assuredly are not going to allow the process to get them in.
  4. There is only me to perform the procedure. I have no assistants or trainees. And even if I did, they would still not be performing the surgery. That is what people pay for me to do.

Dr. Barry Eppley

Indianapolis, Indiana