Facial Scarring Lawyers
Scarring Attorneys Serving San Francisco, San Jose, Los Angeles, Oakland,
& Ontario, California
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The effect of facial scarring is more than skin deep
Scarring: Scars result any time
the deeper layers of skin are cut or torn. A scar is visible if it is
higher or lower than the surrounding skin, a different color, or “goes
against the grain” (natural lines) of the face. Scar tissue is a
normal result of the healing process. Whenever the skin has been broken,
whether by an injury, infection, or surgery, there will always be scarring,
for it is nature’s way of binding a wound together.
Throughout history, facial scarring has been a source of
low self-esteem for men, women and children. Scars form as part of the
body's healing process whenever multiple layers of skin are injured, but
these scars can negatively affect a patient's self-esteem, as well as
their business and social life. Often it is very difficult to evaluate
the emotional impact of such injuries. This is especially true with children
who are unable to verbalize their feelings about the scars, or in males
who are taught to minimize their concern about their appearance. Facial
scarring does not have to be an inhibiting part of daily life: with today’s
technology, scars can be significantly minimized or even erased.
Types of Scars
The three most common types of scars are:
Hypertrophic scar - An excessive amount of scar tissue
in an incision or wound characterizes this type of scar. The scar itself
appears reddened in color, firm and rises above the surrounding skin.
Keloid scar - This type of scar exhibits the same characteristics
as the hypertrophic scar, but it continues to grow and enlarge with
time. Areas of the face most likely to develop keloid scars are the
earlobes, jaw line and neck.
Infectious scar - The most common type of facial scarring
comes from acne and/or chicken pox infections.
The Effects of Facial Scarring
It's often difficult to predict what the final appearance
of a scar will be, since scars tend to look their worst during the early
stages of healing. At first, tiny new blood vessels generally form around
an injury to help speed the healing process. This causes the new scar
to look red and noticeable. Next, collagen fibers begin to be laid down,
giving the scar a raised or lumpy appearance. After about six weeks, the
scar begins to shrink and soften-a process that may continue for a year
Some facial scars, however, are not improved sufficiently
with time. Severe burn scars, for example, tend to have a puckered appearance.
Acne may leave deep pits in the skin. Some scars, rather than shrinking,
grow abnormally, forming hypertrophic scars. Keloids, a type of hypertrophic
scar that results from an overproduction of collagen, continue growing
beyond the margins of the original wound. Even a small scar may draw unwanted
attention if it cuts across the face's natural creases and contours, and
any scar that is unusually large, uneven, or differently colored may be
nearly impossible to camouflage. Some scars actually interfere with the
normal function of facial features. A scar that contracts as it heals
may restrict the movement of muscles and tendons or pull the lip or eyelid
into an unnatural position.
Facial Scarring Treatments
Most people with recent scarring want immediate repair,
but often a scar must be allowed to “mature” prior to surgery.
Maturation is a gradual change in the appearance that all scars go through
until they have stabilized and change no further. Initially a scar looks
reddened or occasionally raised. Gradually the firmness and red color
resolve and should disappear leaving a softer scar that is more level
and somewhat lighter in color than the surrounding skin. This process
can take anywhere from 6 to 18 months. In some situations, waiting may
be the best and only treatment necessary.
Children and young adults are the most common victims of
injury. Unfortunately, their skin tends to heal with more scarring as
an accompaniment to their ability to heal more rapidly. Although these
scars tend to fade with time, it still makes the treatment program more
difficult. It also makes it much more important to wait before initiating
treatment since a scar that looks poor a month or so after injury may
continue to greatly improve in appearance for many months. Ultimately,
it may be so unnoticeable as to not require treatment.
Below we’ve identified some of the common treatment options for
injured people who wish to minimize scarring:
Chemical peels can be performed on the face, neck, chest,
hands and even arms and legs. Most chemical peels are performed as outpatient
procedures. Based on your skin type and the desired results, your physician
may recommend a superficial, medium or deep chemical peel. Your physician
will select the proper chemical or mix of chemicals (glycolic acid,
Jessner, TCA or trichloroacetic acid or carbolic acid) and apply the
solution to various areas of skin. Once applied, the chemicals produce
a separation and peeling of the outer layers of the skin. This stimulates
the production of new skin from beneath.
Microdermabrasion can be likened to a "superficial
skin polishing" using microcrystals vacuumed through a delicate
hand piece. In as little as twenty minutes, this gentle abrasive technique
efficiently produces satisfying results. Treatments are progressive
and are applied through a course of weekly sessions. Dermabrasion is
a surgical planing technique which can be used to smooth down raised
or uneven scars. Most commonly used for acne scarring, it is frequently
helpful in the treatment of other injury scars.
Soft tissue augmentation
This procedure uses natural and synthetic fillers such
as ArtecallTM, Autologen®, CymetraTM, DermalogenTM, HylaformTM,
RestylaneTM and ZydermTM and ZyplastTM collagen. Utilizing the appropriate
filler for you, your doctor will inject it under the treated area. Results
are immediate. The duration of the improvement depends on the size and
location of the scar treated as well as on the material used.
Laser resurfacing with CO2 lasers, Erbium lasers, dual
mode lasers, and Vascular lasers gives your physician precise control
as the procedure gently vaporizes the damaged or acne-scarred skin to
reveal the smooth, fresh skin underneath. Scars are removed in a precise,
rapid, bloodless fashion achieving excellent results. Laser scar removal
can be performed with local anesthesia if limited areas are treated,
while full face resurfacing is usually performed with the administration
of intravenous sedation by an anesthesiologist.
Pressure and Massage It is important
to remember that sometimes conservative treatment is the best form of
therapy. Repeated massage using cocoa butter or vitamin E can greatly
improve the appearance of scars. In some cases, special pressure dressing
may also be of use.
Cortisone Drugs Various types
of cortisone drugs may be used either as injections, topical preparations,
or in the form of special tapes. These may well improve the scar to
a point where surgery is not required.
Collagen Implantation Collagen
implantation involves the injection of a collagen material into the
scar. It can be helpful in the treatment of depressed scars. In some
cases, it can flatten the scars and make them almost imperceptible.
Collagen does not result in permanent correction and treatment must
be repeated after several months.
Silicone Pressure Therapy In
many cases, a silicone dressing can be applied to a raised scar and
help to soften or thin out the scar. The mechanism of this effect is
unknown at the present time, but it has proven useful in many cases.
It is very safe and simple to use. The special silicone sheet is cut
to size and applied to the scar. It should be kept in place for 12 to
24 hours a day, depending on tolerance. Effects are not immediate, but
results are usually seen within several weeks.
Facial scarring may be very disturbing emotionally, especially
if the scars are difficult to camouflage with makeup. The appearance
of unsightly or disfiguring scars may be improved by well-planned and
carefully executed surgery.
The goal of surgical treatment of scars is to make a
new scar which will be less noticeable than the present scar: an exchange
of a bad scar for a better scar. The amount of improvement depends on
many factors including the scar’s size, shape, location, general
skin condition, and patient’s age. Each patient’s scarring
requires careful study to determine if and when surgery is indicated.
Patients tend to be impatient about the results of scar revision surgery.
They are often already upset by the injury itself and find it difficult
to understand that adequate and complete treatment may take many months
or even several years. Often, scar revision surgery must be staged over
a period of months to years in order to obtain the best results.
Excision is the surgical technique whereby the surgeon
removes excess scar tissue and carefully sutures the wound together
to create an even, narrow scar. It may be necessary to simultaneously
try to reposition the scar so that it will fall within the natural skin
lines or creases. If that is not possible, an elegant technique termed
geometric broken line closure (GBLC) can be used. In this type of scar
revision, the straight unnatural line of a visible scar can be broken
into small geometric patterns that are difficult for the eye to follow,
causing it to blend better with the surrounding skin. Dermabrasion to
smooth any residual surface irregularities may then be recommended to
enhance the final result.
Re-excision In many cases, simple excision and re-closure of the wound
will greatly improve the result. We may be able to close the wound without
the tension that was present at the time of the initial repair. Furthermore,
what was originally a jagged cut may now be changed into a clean surgical
Serial Excision In many cases,
wide or extensive scarring cannot be adequately treated with one operation.
A planned, staged approach may be required in which several operations
are utilized to lead to the best possible result. In some situations,
a device called a tissue expander can be used to hasten this type of
Zig-Zag-Plasty The zig-zag-plasty
is a technique of excising a scar and replacing the line with a geometric
broken line. This type of wound tends to heal with less tension, and
replaces a straight line scar with a broken line scar which tends to
be less apparent to the eye. This is one of the most common and successful
techniques of dealing with facial scars.
With all of these procedures at your disposal, your treatment
can be tailored to achieve your expectations.
for a list of online resources on facial scarring