Q: Dr. Eppley, I am interested in a facial scar revision. My facial scar is three years old and is the result of a sharp tool attack. It was thinner after the attack but has grown considerably larger with time. It also appears more indented now. What are my scar revision options to make it less noticeable? I have attached several pictures which shows the scar as it cross the cheek and goes below my eye.
A: You have a very classic scar pattern that occurs when a long scar horizontally crosses the cheek area. Since it runs perpendicular to the relaxed skin tension lines (RSTL) of the face in that area, it is very prone to widening over time no matter how well closed it was initially. This creates scar widening and an indentation along its course as the weight of the facial tissue pulls down on it over time. Your long facial scar can be improved but its appearance can not be completely eliminated. It needs to be excised along its length and then put back together in a broken line closure pattern. Such interdigitations prevent the recurrent scar widening that you now have. While in some cases of facial scar revision it would be followed months later by light laser resurfacing or dermabrasion, your darker skin pigmentation would preclude that final touch-up after your scar revision.
Dr. Barry Eppley