Facial Scarring

FEATURE | Facial Scarring | Symptoms and Treatment of Accidental Facial Scarring

Facial scarring is perhaps the worst form of skin scarring one can sustain. The face is the most visible part of the body so facial scarring would be easily noticeable. When a person sustains a laceration on the face, a plastic or facial surgeon should repair the laceration under special techniques to avoid facial scarring that is unacceptable. Get to know how one may prevent facial scarring, or how one may treat scars before they get worse.

Guide: Facial Scarring Accident Symptoms and Treatments

In this guide:

Causes of Facial Scarring

When the integrity of the facial skin is endangered, the skin scars easily. It is up to the skills of the surgeon or another type of doctor, to return skin to its normal integrity with a scar that is the least noticeable. Facial scarring can happen under certain circumstances. These include:

  • Severe lacerations from a motor vehicle accident, altercation, fall, or sporting accident. Some lacerations are more difficult to repair than others and there should be special care to avoid severe scarring easily.
  • A thermal burn to the face can yield extensive scarring. Thermal burns can come from occupational facial injuries, car fires, home fires, and even from barbecue grills. Second and third-degree burns have the potential for scarring. First degree burns generally heal without scarring.
  • Chemical burns, such as with acids and bases, can cause severe second and third degree burns to the face. With full thickness burns, skin grafting can help heal the burn faster and to minimize chemical burn scar.
  • Acne can scar the face severely with pockmarks that are indented into the skin from deep abscesses from severe acne conditions.
Types of Facial Scarring
  • Keloid Scars. These scars tend to be hereditary in nature and are the result of a healing process becoming overly aggressive. The scars are bumpy and extend past the boundaries of the original laceration or burn. If they get big enough, they can negatively affect a person’s facial mobility. Doctors can try to remove the keloid scar surgically, can use steroid injections, or apply silicone sheets to the keloid on the face in order to flatten it. If the keloid is small, it can be treated with cryotherapy or laser therapy. If you are prone to keloid scars, you can use silicone gel pads to keep the keloid from forming. Keloids are more prominent and prevalent in people of African-American origin or other people with dark pigmentation.
  • Contracture Scars. These occur when the skin has been burned in a sheet-like fashion. As the skin heals, it contracts the surface so that the skin becomes tight and is unable to facilitate movement. The contracture can affect muscles and nerves as well.
  • Hypertrophic scars. These scars are similar to keloid scars with the exception that they do not go beyond the borders of the original wound. The scar is raised above the level of the skin. It can be treated by injecting the scar with corticosteroids or by using silicone sheets to make the scar flatter.
  • Acne scars. There are several kinds of acne scars. The worst are those that pit the skin as they are very obvious and difficult to treat. Worst acne scars can look like waves or can be more angular in appearance. The best treatment for acne scars is the prevention of acne in the first place.
Symptoms of Facial Scarring

Severe facial scarring can include the muscle and nerves beneath the skin, resulting in pain or numbness and a limitation in the mobility of the affected part of the face.

Facial scars are also disfiguring in appearance and can lead the victim to avoidant behavior, depression and suicidal tendencies. No one wants to look disfigured and it is easy to hide from others so as to avoid the stigma of having a large facial scar. The same is true of acne scars, which unfortunately often affect fragile teens who are prone to avoidance, depression and suicidal ideation over their appearance.

Risks for Facial Scarring

As mentioned, those with a lot of pigment in their skin have a higher incidence of keloid scar and for scars that are a different color than their normal skin. People with acne are at higher risk of scars, particularly those who suffer from cystic acne.

People who have lacerations that are not surgically corrected properly can have bad scars. This is especially true of burst lacerations, in which multiple lacerations come out of a central point, or irregular lacerations. Lacerations that go against the grain of the skin can contract and form a puckered facial scar.

People most likely to get facial marks are those who play rough sports, those who box for sport or for a living, and those who participate in high-risk behaviors such as driving too fast or getting into fist fights with others.

Diagnosing Facial Scarring

Facial marks are easy to diagnose because they are easy to see. What isn’t easy to see is the extent of the scar. Does the face scar involve skin and soft tissue only or has the scar extended into the underlying muscle and nerves?

In order to determine the extent of the scar, the doctor needs to evaluate the muscles of facial expression and the sensation of the face to see if they might be involved in the scar. For example, if the scar moves greatly along with a muscle contraction, then the scar might be attached to some degree to the muscle beneath it. If there is pain or numbness in an area near but not directly on the scar, a nerve may be entrapped within the scar.

In diagnosing a facial scar, the doctor pays close attention to the natural lines of the skin. In the face, the lines go in different directions but can be determined using gentle traction on the skin. If the traction is along the lines of the skin, it will not separate as much as it will between lines of the skin.

Prevention of Facial Scars

Prevention of Facial Scars | Facial Scarring | Symptoms and Treatment of Accidental Facial Scarring

There are ways to prevent scarring on the face or minimize the appearance of scars following an injury or following surgery to the face. Talk to your doctor about what you can do to improve the appearance of facial scars or try the following techniques to help your face scar heal better and with a better cosmetic appearance. These techniques will help in the healing process so as to minimize any complications.

  • First, massage cocoa butter or cocoa butter lotion into the scar on the face (a cheek scar, for example) on a daily basis. Cocoa butter also treats stretch marks. It has the ability to cause scars on the face to fade by promoting cell regeneration.
  • Put vitamin E oil or cream on the scar every day. Vitamin E has antioxidant properties and is antibacterial. It helps your wound heal and takes care of any inflammation of the scar tissue on the face. You should also consider taking a vitamin E supplement orally to get an internal antioxidant effect.
  • Find a skin moisturizer that contains alpha hydroxy acids and apply it to the area of the scar on a daily basis. Alpha hydroxy acids promote scar fading and are healthy for your skin. It can speed up the process of healing your wound by helping collagen production go faster. You need collagen for the formation of strong scar tissue on the face.
Treatment of Facial Scars

How do you get rid of scar tissue on the face? Or, how to fade scars on face? Consider these scar treatment and surgery methods to get rid of any face scar tissue:

  1. Over-the-counter creams, gels, or ointments are available by prescription. The creams contain antihistamines to reduce inflammation and corticosteroid to flatten thick scars. Antihistamines also reduce the nasty itching of facial scars so you don’t damage the skin on and around the scar. A few common ointments include aloe vera and coconut oil.
  2. Corticosteroid injections are especially good for keloid on the face or hypertrophic scars. They thin the skin in the area of the injection so the scar shrinks down to a more normal size and shape.
  3. Collagen injections or injections with another type of filler may fix pitted or sunken scars. Unfortunately, depending on the filler, they last only several months to a few years before reinjecting the area.
  4. Remove Scar - One option for scar revision is to have scar removal and create a new incision. Not always will the new, revised scar be linear. The doctor uses the lines of the face to determine what the new scar will look like.
  5. Dermabrasion is possible to reduce scars on the face. Doctors abrade the upper layers of the skin with a wire burr or fraise. This is a special wire brush that allows new skin to grow over the abraded area in order to soften the surface of the skin. It also gets rid of irregularities of the scar.
    Some people can have large burned areas that yield a sheet-like scar that is hypertrophic and that involves muscles, tendons, and joints. A Z-plasty surgery improves the appearance and function of this type of scar. The scar becomes thinner and follows the natural curves of the skin lines so it is less noticeable.
  6. Skin grafting takes a thin piece of skin from another body area and covers the scarred area, especially when the wound will not close or when it forms thin skin that will not heal properly. The appearance is not always perfect but the area is definitely more functional. It is best to wait at least a year before having your scar surgery this way as the scar across face can change over time and it might not be necessary to do a skin graft procedure.
  7. Tissue expansion can be used when you need more skin to fully close the wound in an optimal fashion. The procedure uses a silicone balloon that is inserted beneath the tissue and is gradually expanded to the size necessary to get enough skin to close the wound properly.
Revision of Facial Scarring

Sometimes there is no improvement with creams and injectables. In this case, a plastic surgeon may perform a facial scar revision under local anesthesia or general anesthesia.

You should consider waiting for your scar revision surgery at least 60-90 days after the initial injury. This is because face scars lighten and shrink over time. In fact, some specialists believe you should wait at least a year for a scar revision because the scar on face changes a great deal during that time. Talk to the plastic surgeon about what would be the best waiting time before undergoing a revision surgery.

Doctors perform scar revision in the following types of scars on face:

  • You have a keloid scar on face.
  • You have a hypertrophic scar.
  • There has been a wound dehiscence—a splitting apart of the incision.
  • The scar across the face is at a bad angle when compared to facial tension lines.
  • The scar distorts the features of the face or interferes with movement.

There are risks for scar revision that include:

  • Anesthesia risks
  • Bleeding complications
  • Infection of the wound
  • Recurrence of the scar
  • Recurrent keloid formation
  • Wound dehiscence
Physical Complications of Facial Scarring

One of the big problems of scars like keloid scars is that, once you remove them, they tend to grow back. The same thing goes with hypertrophic scars. The tendency to form these kinds of scars is inborn so it may not be possible to simply remove and revise the scar.

There can also be a wound dehiscence. This is a separation of the wound before it has had a chance to heal scars on face and can occur if there is a great deal of scratching or any tension on the wound. A wound dehiscence can result in an unsightly, wide and ugly wound.

Other Effects of Facial Scarring

Facial scars also have severe emotional consequences. They aren't wounds that can be hidden by clothing and so a person can become extremely self-conscious about their facial scar—sometimes to the point of severe depression and suicidal.

Handling severe facial scarring psychologically is a very difficult issue.  Generally speaking, it’s best to allow people to look in the mirror in their own timetable. Severe facial injuries are a difficult blow to anyone’s self-esteem.  They should have someone they feel comfortable with when first looking at the scarring. Do not feel hurt if it is not you. Some people feel more comfortable to be with a nurse or someone else who doesn’t know them when first viewing the scarring.

Watch this video from BBC Three featuring the story of a car accident survivor who's dealing with facial scarring:

Types of Facial Scarring Claims

A variety of accidents can cause injuries to the face, including:

  • Car Accidents: A serious auto accident can cause catastrophic injuries which can result in permanent scarring. This can be caused by the contact with the windshield, dashboard or steering wheel. Surgery is often required for treatment of serious injuries, which may also leave a scar.
  • Bicycle Accidents: Traffic collisions are significantly more dangerous for cyclists due to their lack of physical protection. This can increase the risk of bodily injuries such as facial lacerations and scars from the impact with a motor vehicle or skidding on a paved surface.
  • Auto Products Liability: Rapid airbag deployment in a traffic collision can cause abrasions or burn injuries. Since the face is first to come into contact with the airbag, it is particularly vulnerable to getting injured or burned. Conversely, explosions and fires may occur in a car wreck. These can result in severe burning in the skin of the face. When defective vehicle parts or equipment are responsible for a crash, the auto manufacturer may be held liable for subsequent damages.
  • Dog Bite Injuries: A dog may bite or attack someone in the leg, arm or face. This may result in stitches or scarring. It may be difficult to determine whether a facial scar will heal or require further treatment. In some cases, a consultation from a scar revision specialist may be necessary to evaluate the extent of the scarring. Typically, plastic surgeons conduct an evaluation after six months to monitor the healing process of the scar.
  • Motorcycle Accidents: Those who have been injured in a motorcycle accident may be left with scars or other forms of disfigurement. These may serve as a constant reminder of their collision, further leading to significant mental anguish.
  • Pedestrian Accidents: Pedestrians may experience a number of facial injuries in a collision with a vehicle. These may range from jaw fractures and dental damage to eye trauma and facial scarring. The risk of disfigurement is even higher when road rash is involved.
  • Slip and Fall Accidents: People can slip and fall in commercial locations such as superstores, grocery stores, and retail stores. Other times, individuals can trip along poorly aligned sidewalk edges or stairs that are not built to code and/or are in poor condition. Any slip and fall accident can result in a traumatic injury such as facial trauma. Since there are many legal issues to look at in these types of cases, it is best to consult with an experienced injury lawyer.
  • Truck Accidents: Injuries in a truck accident are known for being among the most life-altering and debilitating of any collision. The overwhelming size, weight, and momentum of commercial trucks can increase the likelihood of serious injuries for those riding in passenger vehicles. Recovering after a trucking accident can be a long and frustrating process, particularly when severe facial scarring and disfigurement are involved. Those who have suffered facial trauma often deal with the recurrence of anxiety and pain every time they take a look at themselves in a mirror.
Factors in a Facial Injury Claim

Many factors are considered when determining the value of a facial injury claim. These include:

  • The age, gender, and marital status of the injured party
  • The size, color, and visibility of the disfigurement
  • The cosmetic effect of the injury
  • The psychological impact of the scarring
Recoverable Damages in a Facial Disfigurement Case

Damages in a personal injury claim for a facial disfigurement is typically determined on a case by case basis. However, the most common types of damages recovered in these cases include:

  • Medical Expenses: Plastic surgery or reconstructive surgery is often required to treat a facial scar or disfigurement. Since these types of medical procedures are not usually covered by health insurance, this can result in high out-of-pocket expenses. It is useful to retain an injury attorney in a facial scarring case. A lawyer can send an injured party to a reputable plastic surgeon in town to obtain the cost of future surgery needed and facilitate financing for that cosmetic treatment if necessary.
  • Wage Loss: A scar in a visible location such as the face can affect a person’s self-identity and earning potential in the workplace. This is common in cases of those who work as salespersons, models, and performers. Since many painful and expensive cosmetic surgeries may be necessary to improve the appearance of a scar, the injured party may need to take time off from work to recover. When this happens, lost wages including any bonuses, commissions and other earnings may be recovered.
  • Future Loss of Earnings: Sociological studies have shown that people who are disfigured make less over the course of their career compared to those without a disfigurement. When a facial scar causes a permanent and detrimental effect to one’s ability to earn wages, he or she may recover the value of the wage reduction. This is calculated by the amount of income one is expected to lose in the future due to the disfigurement.
  • Disfigurement: The amount of damages for a disfigurement varies upon several factors. These include the severity and location of the scar and the age and gender of the individual. For instance, if a person has a scar on his or her face, they may be compensated more in damages than they would if the scar was on a coverable area of the body such as the ankle. Compensation for a disfigurement also takes into account the emotional harm caused by the unpleasant and unexpected alteration to the individual’s appearance.
  • Loss of Consortium: When a spouse suffers facial scarring, this may cause damage to the marriage. When this happens, the injured party and/or the spouse may seek compensation for the loss of affection, assistance, society, conjugal fellowship, and impairment or loss of sexual relations.
  • Pain and Suffering: A disfigurement can leave a person with a lasting deformity resulting in a loss of confidence and self-esteem. This can affect one’s motivation to care for themselves and work as well as their social life. The value of pain and suffering damages, including the emotional, mental and physical pain endured, varies from case to case.
Impact of Facial Scarring on Children

Accidents involving children are not uncommon. When facial injuries are involved, it can have long-lasting and devastating consequences for a child. Not only must he or she deal with the embarrassment and humiliation by other children while growing up, but severe scarring during adulthood can also adversely affect an individual’s earning capacity and have severe psychological effects. A child should live a normal childhood free from the emotional consequences that come with a prominent scar or facial disfigurement. An experienced personal injury attorney can help a family in these situations by building a strong case for compensation of damages including medical expenses, wage loss, and pain and suffering.

Watch this video from USDOTNHTSA discussing the story of a distracted driving accident survivor who is coping with facial trauma:

Is There Enough Insurance?

An experienced personal injury lawyer looks at whether there is any insurance to cover the extent of damages in every case. If a negligent party does not have insurance, then the likelihood of recovering damages is very little. The most common type of insurance to cover facial scarring from a dog bite injury is homeowner’s insurance or renter’s insurance. Automobile insurance may also apply if the dog attack occurs within close proximity of a vehicle. Conversely, car insurance may cover facial scarring sustained in a motor vehicle accident. When there is no insurance, an injured person may seek compensation from their own automobile insurance company if they have uninsured/underinsured motorist protection. If such coverage is not available, the injured party may seek damages from the responsible party. However, this is not possible in all cases unless the at-fault party has independent wealth.

Statute of Limitations

According to the statute of limitations for personal injury in California, claims must be filed two years from the date of the incident. This time limit may be tolled or extended in the case of a minor until he or she reaches 18 years of age. However, the statute may not be tolled in some cases. For this reason, it is best to discuss the details of your case with an experienced injury lawyer promptly.

How a Law Firm Can Help

Coming to terms with a facial scar or disfigurement can be a long and challenging recovery for the injured party and their family. Social challenges, loss of self-esteem and emotional trauma are difficult to overcome. This is especially true for minors who may be subject to cruelty or teasing from other children for the facial injury. If you or a family member have suffered facial scarring in an accident, you do not have to endure this experience alone. A personal injury lawyer experienced in handling facial disfigurement cases understands the psychological and physical impact of a facial scar and has the resources to ensure you receive the proper treatment. Moreover, an attorney can help recover compensation for physical and psychological effects associated with a facial injury.

Sacramento Personal Injury Lawyer

The amount of scarring seen after a wound or injury depends on the size of the wound, how deep the wound is, the location of the wound and the amount of tension put upon the wound at the time of healing. If you or a loved one has suffered facial scarring as a result of someone else’s negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916.921.6400 to set up a FREE consultation.

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Editor's Note: This article has been updated for accuracy and relevancy. 

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