Risk factors for the formation of facial scars include skin type, ethnicity, scar location, and certain medical conditions that contribute to poor or delayed healing. Risk of scar can be reduced with appropriate surgical planning, including proper placement and design of incisions, meticulous skin closure, aseptic technique, and wound care to improve healing. Common pathologic scars include hypertrophic scars and keloid scars, each of which has unique approaches to surgical revision and medical treatment due to their respective risks of recurrence. Topical scar therapies, medical therapies, and surgical revision techniques for improvement in final scar appearance are discussed.

BACKGROUND: Botulinum toxin type A (BTA) has a wide range of clinical applications, and its use in improving aesthetics is one of them. The aim of this study was to better assess the efficacy and safety of BTA in patients with facial scars.
CONCLUSIONS: We extracted the data of the visual analog scale (VAS) score, Vancouver scar scale (VSS) score, scar width, observer scar assessment scale (OSAS), patient scar assessment scale (PSAS), and/or drug-related adverse events. Five studies provided the data of VAS score, and the results showed that the VAS score in the BTA group was significantly higher than that in the control group. Three randomized controlled trials (RCTs) reported the VSS score. A statistically significant difference exists between the BTA group and the control group. Three RCTs reported the scar width after BTA treatment. A more favorable change was found in the BTA group with scar width even without statistical significance. Data about the OSAS and PSAS scores were available in two trials. There was no significant difference in OSAS and PSAS scores between the BTA group and the control group. Only three studies recorded three slight adverse events. There were no reports of severe complications. In conclusions, this study demonstrated that BTA has the potential to improve facial scars with an acceptable safety profile.

BACKGROUND: Facial resurfacing is a surgical and aesthetic challenge, as it requires soft, pliable, and stretchable donor skin with a good match of color, texture, and thickness and minimum donor scarring. Rhombic flap is a highly versatile flap that has the aforementioned properties. Careful flap planning and execution is vital for successful outcomes.
OBJECTIVE: The aim of this work was to study the geometry of the classic rhombic flaps; to evaluate their versatility and technical finesse as well as their application to resurface defects over various regions of the face.
METHODS: Overall, 42 patients with facial scars due to trauma, malignancies, small nevi, and mature scars of the face were studied and operated on. Of the four rhombic flaps that were possible, choosing the best option required careful attention to camouflage of scar and proximity to vital deformable anatomical structures. Geometrical planning of the flap was the essence of the entire surgical exercise.
RESULTS: Outcome of rhombic flaps were meticulously and critically analyzed. The study consisted of 36 females (85.71%) and only 6 males with a mean age of 23 years. Defects were created on 27 mature scars (64.29%) and 11 burn scars (26.19%). Defects over the cheek and lateral canthus of the eye were especially problematic. It is a safe flap with excellent results as far as visible scarring and traction deformities are concerned. Scars elsewhere on the face fared better than on the bony prominence.
CONCLUSIONS: Rhombic flaps offer an excellent alternative to resurface facial scars and defects in a selected subset of patients.

Ablative fractionated carbon dioxide (fCO2 ) laser may be a useful tool to improve noticeable scars after skin cancer surgery. Therefore we evaluated 40 patients who have been treated with fCO2 laser for facial scars after skin cancer surgery. This retrospective study is based on blinded evaluation of pre- and postoperative photographs. Patients (n = 40), laypersons (n = 5) and experts (n = 5) evaluated the esthetics and the Vancouver scar scale as primary endpoints. Secondary endpoints included patient satisfaction and treatment safety. Patients, laypersons and experts consistently assessed a significant improvement of scar quality and appearance after fCO2 laser treatment, which was paralleled by high patient satisfaction. In conclusion, ablative fCO2 laser is effective in improving noticeable postsurgical scars. Patients are highly satisfied with post-laser results.

This study aimed to evaluate the effectiveness and long-term outcomes of free and pedicled, expanded deltopectoral flaps with perforation of the internal thoracic artery to repair facial scars. This retrospective review was of 37 patients who presented between June 2013 and June 2019 with various types of facial scar. Ten patients received a free expanded deltopectoral flap and 27 a pedicled, expanded deltopectoral flap. During the stage-one operation, the expander was implanted into the deltopectoral area and fully expanded by normal saline injection. In stage two, the facial lesions were incised, and the free or pedicled flap transferred to reconstruct the defect. Flap necrosis did not occur in the 10 patients treated with free flaps. Two patients need to have the pedicle trimmed three months after surgery because it had become bloated. Distal necrosis occurred in five of 27 patients who received a pedicled, expanded deltopectoral flap. Healing by conservative treatment was noted in two cases and healing after skin grafting was documented in the other three. All 37 patients achieved satisfactory results. A pedicled, expanded deltopectoral flap appears to be a reliable and safe option for the treatment of facial scars.

Atrophia maculosa varioliformis cutis (AMVC) is a sporadic or inherited childhood disorder, signified by the occurrence of pitted scars, usually over the face. We report two cases of AMVC occurring in monozygotic twins.

UNASSIGNED: Severe facial hypertrophic scars are known to severely impact emotional well-being. Pressure therapy by means of transparent face masks has been used for almost 40 years, but evidence about the clinical effects remains sparse.
UNASSIGNED: To provide a summary on the efficacy of transparent face masks in the treatment of facial hypertrophic scars.
UNASSIGNED: A literature search was conducted in PubMed, MEDLINE, and Cochrane databases through 1 January 2018. Articles describing the clinical effects of facial pressure therapy for remodeling the face after trauma or surgery with a validated tool were included. This review included studies of participants treated with facial hypertrophic scars, both minors and adults.
UNASSIGNED: Three articles involving 33 patients were selected for inclusion. Two studies described statistically significant improvement in facial scars measured by durometer, ultrasound, and the Patient and Observer Scar Assessment Scale (POSAS).
UNASSIGNED: Facial pressure masks have been shown to deliver significant improvement in facial scars, measured by both subjective and objective tools. However, only three studies could be included in this literature review. Also, because of considerable limitations of the studies, it remains difficult to draw substantial conclusions about the efficacy of transparent face masks.
CONCLUSIONS: This literature review provides a summary of the current evidence on the subjectively and objectively measured clinical effects of transparent face masks in the treatment of facial scars, highlighting the need for further research on this topic.

Hypertrophic scar continues to be one of the leading reasons for surgical and non-surgical treatments after burn healing. Facial post-burn hypertrophic scars can cause severe functional and emotional disability, as they are usually difficult to conceal. Numerous nonsurgical and surgical therapies have been used for the treatment of hypertrophic scars. This study describes the combination of bipolar radiofrequency, intense pulsed light and cooling (given the collective term \'E-light\'), and reports the outcomes of its use in the treatment of post-burn facial hypertrophic scars in a series of sixty-five patients in the pediatric age group. There were no reports in the literature of the use of this modality (E-light) in the treatment of facial post-burn hypertrophic scars in pediatric patients. Results showed that the mean decrease in total VSS score for all patients was 5.8. Regarding the satisfaction of the parents of our patients, 66.15% rated the result excellent, 24.61% rated it good and 9.23% rated it fair. We received no poor ratings for the final result, with a significant reduction in total Vancouver scar scale after treatment (P-value = 0.000). The E-light therapy technique studied in this work is effective, safe and economical if compared to other treatment modalities that can be used in the management of facial post-burn hypertrophic scars.
Les cicatrices hypertrophiques restent une des demandes majeures de traitement, chirurgical ou non, après cicatrisation d’une brûlure. Lorsqu’elles se situent au niveau du visage, elles entraînent des séquelles fonctionnelles et esthétiques majeure en raison de la difficulté de les masquer. De nombreuses options, chirurgicales ou non, sont possibles. Cette étude décrit la combinaison de radiofréquence bipolaire, lumière pulsée intense et refroidissement (connue sous la dénomination de “E-lumière”) et ses résultats après utilisation pour traiter des cicatrices hypertrophiques du visage d’enfants cicatrisés de brûlures. On observe une réduction de 5,8 sur l’échelle de Vancouver (significative à p<0,0001). Les parents jugent le résultat excellent pour 66,15% d’entre eux, bon pour 24,61%, moyen pour 9,23%, aucun d’eux ne l’estimant mauvais. Le traitement par E-lumière est efficace, sûr et économique (comparativement à d’autres procédures) dans la traitement des cicatrices hypertrophiques après brûlure.

Treatment of facial scars is a multispecialty endeavor for optimal patient recovery. One new innovation helping in facial scar treatments are lasers. Fractional laser predictably (tunable) disrupts the barrier of the skin creating deep channels that allow the delivery of drug and cellular materials; this is called laser-assisted drug delivery (LAD). Without exception thus far, LAD has been found to enhance the local uptake of any drug or substance applied to the skin. These zones may be used postoperatively to deliver drugs and other substances to create an enhanced scar therapeutic response to drug or substance applied to the skin.

Posttraumatic soft-tissue injuries of the face are often the most lasting sequelae of facial trauma. The disfigurement of posttraumatic scarring lies in both their physical deformity and psychosocial ramifications. This review outlines a variety of techniques to improve facial scars and limit their lasting effects.