The Use of Botulinum Toxin-A as an Adjunctive Treatment for Facial Atrophic and Hypertrophic Scars After Surgical Correction.

Background: Facial wounds, especially the ones lying perpendicular to the Lines of Langer, heal poorly. Several methods have been attempted to rectify this, but most of them do not target the underlying pathological process of scarring. Botulinum Toxin-A (BTA) has been successfully used for atrophic and hypertrophic scars. Materials and Methods: This is a prospective study, where 30 patients who were operated for facial scar revision were divided into two equal groups: The first group was injected with BTA, but the second group was not. They were followed up for three months, and the results were analyzed. Results: Manchester scar scale (MSS) was used to assess the scars. In all the cases, the MSS score reduced after surgical correction, which further reduced after the injection of BTA in the first group of patients. The results are statistically significant (P < 0.01). Conclusion: The BTA plays an important role in the treatment of scars after scar revision surgeries.

V-EMF treatment of facial scar: First results.

AIM OF STUDY: This is a retrospective study aimed at evaluating the effectiveness of the use of electromagnetic fields and negative pressure treatment (V-EMF) for facial scars, from an aesthetic and functional point of view, and considering the variations in the levels of hydration. MATERIAL AND METHODS: 25 subjects with facial scarring were re-evaluated after being treated with the V-EMF method. The hydration levels of the scars before and after treatment were compared. The results were evaluated considering the satisfaction levels of the patients with the VAS, and of the medical specialists who performed the treatment, and of 3 independent dermatologists with the Likert scale. RESULTS: Mean hydration levels of scars went from 41.8 to 53.3, with mean hydration levels of healthy reference points equal to 54.6. The minimum patient satisfaction level was 2 in the VAS. The minimum level of satisfaction of specialists and dermatologists was equal to IV on the Likert scale for all patients, except for 1 subject in which it was III for the specialist who had treated him. Anti-aging and re-pigmentation effects were also noted as secondary results. CONCLUSIONS: From an aesthetic and functional point of view, and for the overall anti-aging effect of the treated area, V-EMF applied to facial scars has shown extremely promising results.

Computer-assisted intraoral approach in the management of infected comminuted mandibular fractures: Technical notes.

In the extraoral approach for mandibular fractures, facial scars and facial nerve injury are common complications. Herein, we introduce an improved surgical technique to reduce fragments of infected comminuted mandibular fractures with the assistance of computer software. Firstly, the model was reset by 3-dimensional (3D) printing, and then the titanium plate was reconstructed on the model. Finally, open reduction and internal fixation through intraoral approach. This method can effectively control infection, reduce facial scars and avoid the risk of facial nerve injury.

Effect of Compression Garment Combined with Orthosis on Facial Burn Scar / 中国康复理论与实践

Objective:To compare the effects of compression garment combined with orthosis for central face on facial burn scar to compression garment and 3D compression mask. Methods:From September, 2016 to June, 2019, 38 facial burn scar patients received compression therapy in Department of Burns and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University. According to their preference, they wore compression garment only (CG group, n = 15), compression garment and orthosis for central face (CO group, n = 17) and 3D compression mask (3D group, n = 6) for a year. The facial scar was assessed with Vancouver Scar Scale (VSS) before and after treatment, and the comfort and medical cost was investigated with questionnaire. Results:The VSS score decreased after treatment in all the groups (F = 18.49, P < 0.05), while the VSS score was higher in CG group than in CO group (1.717 points, 95%CI 0.925 to 2.482, P < 0.001) and 3D group (1.782 points, 95%CI 0.738 to 2.827, P < 0.001), the difference was less between CO group and 3D group (0.065 points, 95%CI -0.957 to 1.088, P = 1.000). The comfort rate was 60%, 52.9% and 66.7% for CG group, CO group and 3D group, respectively, with no significant difference (P > 0.05). The medical cost was the most for 3D group (12 000 to 16 000 Yuan), and similar for CG group (3000 to 4800 Yuan) and CO group (3300 to 5300 Yuan). Conclusion:Compression garment combined with orthosis for central face is more effective on facial burn scar, similar to 3D compression mask, but cheaper than 3D mask, which can be a choice for facial scar patients in developing areas.

Depressed forehead scar: a case report and review of literature.

Depressed forehead scars are not frequently reported in the literature in the West African sub-region. Although they are not commonly reported, few cases were managed and are to be documented. We had seen a case of depressed forehead scar which was due to post frontal avulsion injury of the forehead with an intact posterior table of the frontal bone. He complained of aesthetic and psychological problems of the scar on presentation. The scar revision was done with polymethylmethacrylate bone cement with simple wound closure based on patient's choice after counseling. The treatment outcome was satisfactory. We intend to highlight the use of polymethylmethacrylate bone cement and simple wound closure as an option in the revision of depressed forehead scars as well as add a report to the volume of literature from the sub-region.

Lasers, Microneedling, and Platelet-Rich Plasma for Skin Rejuvenation and Repair.

Skin resurfacing for the purpose of rejuvenation and repair continues to evolve with the development of noninvasive or minimally invasive surgical substitutes. Advances in laser therapy, microneedling, and platelet-rich plasma have reinvigorated research in wound repair and regenerative science. An overall positive clinical response toward the use of platelet-rich plasma as an adjuvant to fractional photothermolysis and percutaneous collagen induction is observed. Its effect on post-treatment adverse symptoms, erythema, edema, crusting, and clinical outcomes in rejuvenation are summarized in this article. The lack of identifiable complications and convenience of treatment provides a positive outlook for future use and investigations.

Posttraumatic Laser Treatment of Soft Tissue Injury.

Laser treatment for posttraumatic injury offers the clinician the unique opportunity for early intervention in mediating early scar formation, or for reducing the appearance of scars after maturation. In this review, the authors focus on the mechanisms by which lasers exert their therapeutic effects, highlighting several popular lasers and dosimetry used, and underscoring the power of combined surgical scar revision in managing posttraumatic facial scars.

Treatment of a traumatic atrophic depressed scar with hyaluronic acid fillers: a case report.

BACKGROUND: Hyaluronic acid filler has been documented in the treatment of atrophic depressed acne scars relatively frequently in the literature but rarely in chronic depressed traumatic atrophic facial scars. METHODS: This case report discusses the use of hyaluronic acid fillers in the correction of a post-traumatic facial atrophic scar on the right cheek. RESULTS: The right cheek scar was substantially corrected with one session of two different hyaluronic acids injected in a deep and superficial plane. CONCLUSION: Relatively accurate, simple and effective correction of this atrophic traumatic scar may suggest that fillers are a suitable alternative to surgery for such scars.

Unique Clinical Aspects of Nasal Scarring.

Various methods are available for refining scars of the external nose and optimal scar revision frequently requires the utilization of multiple techniques. Differing anatomy of nasal subunits and their underlying structural framework limit surgical options in nasal scar revision compared with other areas of the face. An understanding of a variety of laser technologies and their specific applications can vastly aid in fine, controlled scar revision. Achieving optimal scar reduction regularly requires multiple stages of intervention, close follow-up, and repeat procedures.

Repeated expanded bilateral deltopectoral flap for resurfacing severe facial-cervical scar / 中华医学美学美容杂志

Objective To investigate the application of the repeated expanded bilateral deltopectoral flap for resurfacing severe facial cervical scar, with review of relating articles to discuss issue of repeated expanding flap.Methods Nine patients suffered from hyperplastic facial and cervical scar.Two soft tissue expanders were implanted into the anterior chest region at both sides of sternum.The center of inner border of the expander was at the cross of second intercostal and parasternal line, and the lengthways axe of the expander was located at the ligature of the second intercostals and mammary areola.After two weeks when the expander was filled, expanded flap was transferred to cervical defect.The transferred flap was repeated expanded after half a year and transferred to resurface facial defect.Results In the first expansion stage, 600 or 800 ml expander were implanted in each side of sternum.In the second stage, 400 or 500 ml were used.The first stage of expanding process was smooth, and 2 of the expanding flaps were ruptured during the second expansion period.400-520 cm2 (average 440 cm2) additional expanded flap was acquired during two stages of expanding.Conclusions The repeated expanded bilateral deltopectoral flap gives us greater opportunity to repair severe facial-cervical scar.The best interval time of the two-stage expansion is over half a year.The speed of second expansion should be lower than that in the first stage, and protecting the expanding flap carefully from external force compression is needed during the second expasion.

Clinical efficacy of free expanded deltopectoral perforator flaps for aesthetic repair of large facial scars / 中华医学美学美容杂志

Objective To investigate the effect of expanded deltopectoral perforator flap as a free skin flap for distant transfer to aesthetically repair large facial scars via microsurgical technique.Methods 20 cases of large facial scars were treated with free expanded deltopectoral skin flaps via microsurgical technique.At the first stage,24 large volume expanders were inserted into the subcutaneous pockets in the deltopectoral zone.4 to 6 months later,the second stage operation was performed when the flaps were expanded fully and facial scars removed;deltopectoral perforator flaps harvested choosing the second or the third thoracic artery perforating branches as the pedicle;the surface of the wound was covered with the flaps.Results All of the 24 flaps survived completely and the wounds healed well after transplantation.The 6 months to 2 years' follow-up results showed that the color and texture of the flaps matched the recipient place well without swelling.The superficial and deep sensation recovered very fast.Conclusions It is safe,practical and effective that the delto-pectoral perforator flaps are used to repair large facial scars avoiding the shortcomings of traditional pedicle transfer such as more procedures,longer fixed time,or more wasted expanded skin.Free transfer of expanded delto-pectoral perforator flaps can achieve ideal function and aesthetic effects.

Soft tissue trauma and scar revision.

Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders.

Unexplained facial scar: child abuse or ehlers-danlos syndrome?

CONTEXT: Child abuse is a serious problem, and its physical manifestations can be mimicked by certain diseases and conditions. These conditions can include genetic, congenital and other disorders that may result in poor weight gain, bone fractures or skin lesions that look like bruises or burns. CASE REPORT: This paper reports the case of a seven-year-old girl with Ehlers-Danlos Syndrome (EDS), which was misdiagnosed as child abuse. This child was referred to us for treatment of an unexplained facial scar that was alleged to be the result of child abuse. CONCLUSION: When unusual skin presentations are observed, dermatologists should consider the possibility of child abuse to protect the child. Furthermore, they should be aware of the cutaneous abnormalities that mimic injuries associated with abuse to avoid the unnecessary reporting of child abuse.

Excessive expansion of cervical skin to repair lower hemifascial scar / 中华医学美学美容杂志

Objective To explore the reconstruction effects of lower hemifascial scar by cervical skin excessive volume expansion. Methods Single 100 ml or 150 ml standard volume tissue expander was implanted under the cervical skin in 50 patients with lower hemifascial scar. After the tissue expanders were injected with 4-5 times than the designed volume, the scar was resurfaced with the expanded flap. Results The excessively expanded cervical flaps of 50 patients all were successfully used to reconstruct the facial scar. The expanded flap was matched well with surrounding skin after 3-12 months following-up. No obvious contracture was observed. The district recontrueted by expended flaps have the normal expression aetivities. Conclusion Excessive expansion of cervical skin can promote the efficiency in the reconstruction of the lower hemifascial scar.

More Effective Facial Scar Revision in Asian

Facial scar is very stressful for patients and physicians, especially in the case of non-parallel to relaxed skin tension line (RSTL). In general, for long facial scar not parallel to RSTL, Z-plasty or W-plasty has been performed to change the direction of scar or divide it into multiple segmented scar. These methods would be suboptimal, however, in the instance of Asian skin prone to scar formation. So, we experienced good results for scar revision through scar excision and solid subcutaneous- dermal repair to minimize scar widening despite of leaving linear type of scar. From July 2004 to March 2007, our methods were undergone for facial scar longer than 3cm in 84 patients. All scars were excised along the scar margin and subcutaneous tissue and dermis were repaired using single layer of subcutaneous-dermal stitch with 4-0 or 5-0 PDS to elevate wound margin 3-4mm higher than adjacent skin surface. Skin was repaired with 6-0 Prolene. The rate of satisfaction was over 89%(75 of 84 patients), the mean scar widening was 0.61+/-0.20 mm, and secondary operations were made in 3 patients. The Asian skin has some characteristics such as thick skin, increased melanin, energetic proliferation of fibroblast, and vigorous collagen formation, etc. Because of characteristics of Asian skin mentioned above, the linear pattern repair, technically easier than Z-plasty or W-plasty, would be superior to them in terms of the results. The essentially important point for scar revision in linear pattern is very strong subcutaneous-dermal repair to make elevation of wound margin enough for tolerating the skin tension and preventing scar widening.

Treatment of Facial Scars with CO3 Laser

Numerous modalities have been used to treat facial scars. Although excellent results can be obtained by high-energy, pulsed carbon dioxide(CO2) laser, significant morbidity exists due to the considerable thermal damage to the skin. CO3 Laser combines the performance of a CO2 system with the safety and convenience of an Er:YAG laser. The CO3 effect is due to a wide range of pulse durations, up to 20 times longer than those delivered by conventional Er:YAG lasers. The result is a thermally tunable laser, with a zone of thermal effect up to 100micrometer in depth. With the CO3 laser, the user chooses the correct depth of thermal effect for maximum safety and efficacy. This study was performed to evaluate the effect of the long-pulsed Er:YAG CO3 laserbrasion in treatment of scars and propose that it can be a effective method to improve cosmetic results. The authors treated 47 cases (8 males and 39 females) including acne scar(n=8), annular atrophic scar(n=9), posttraumatic scar(n=19), postsurgical scar (n=11) with CO3 laser. Questionaire were completed for clinical assessment by the patients and clinicians. Excellent and good results were achieved in 87.3% of scars in clinician's assessments and in 78.8% of scars in patient's assessments. In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for facial scars.