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 facial scarring before it gets 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 home fires, car fires, occupational facial injuries, 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.
  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:

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. 

JC

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