An Algorithm for Prevention of Unsightly Facial Scars Considering the Newest Research Insights

Abstract

Background: Unsightly scars after facial surgery might be a worry for patients and surgeons alike. To prevent unfavorable scars after facial operations, it is inevitable for the surgeon to adhere to different principles and to follow an algorithm: patient assessment, incision planning, surgical technique, suture material, and postoperative scar management. A defined knowledge about the pathophysiology of wound healing is required. The aim of this report is to serve as a teaching purpose and to verify the well-known empirical practices in scar prevention with the corresponding explanatory research. Based on these findings, the suggestion of an appropriate algorithm for the best scar management will be elaborated. Methods: This article elucidates the basics of unsightly scar prevention and the concomitant scientific proofs in detail by reviewing the literature and newest research published in PubMed. Results: The preoperative, intraoperative, and postoperative guidelines for the achievement of acceptable facial scars will be distinguished regarding the valid state of knowledge. Special attention is drawn to the “flat incision technique” as the first surgical step. Based on the newest research, an algorithm of the important preoperative, intraoperative, and postoperative features to achieve scar improvement is presented. Conclusions: To prevent unsightly facial scars, a well-defined algorithm must be followed. In summary, three well-established, empirically proven measures are documented now by the equivalent physiological scientific proof: (1) the flat incision technique, (2) the wound closure with maximal tension reduction, and (3) the postoperative scar management with further tension reduction and more moisturizing of the scar.

Effect of simvastatin on brain-derived neurotrophic factor (BDNF)/TrkB pathway in hippocampus of autism rat model

“…Hippocampal structural changes that regulate perception of emotion are associated with ASD-like behavior [12]. Moreover, alterations in neurochemistry due to impairment of metabolic pathways of catecholamines were reported in ASD patients, and also in propionate-mediated autistic rats [13]. However, the exact mechanism involved is not yet clear.…”

Redefining Fasciocutaneous Microanatomy: An Illustrated Review of Current Concepts and Their Clinical Correlates

“…To enhance early perfusion from the surrounding skin, the design may incorporate beveled or de-epithelized wound margins. This design promotes the alignment of skin structures, facilitating inosculation between the remaining vessels of the deep dermal and subdermal plexi [45][46][47]132].…”

“…This principle is exploited in plexus-to-plexus apposition techniques, in which plexi from donor and recipient site tissues are approximated. Inosculation is also promoted by increasing the area of marginal plexus-to-plexus apposition, as accomplished in beveled-margin grafts and flaps [45][46][47]132]. This latter technique is particularly effective in composite grafts from retroauricular skin, as this skin receives predominantly marginal perfusion, and thus, possesses well-developed deep dermal and subdermal plexi [8].…”