Technological advancements have always made an impact on the way we live, and new advancements in medical technology are changing the way we look. Laser treatments, vitamin based topical creams and special acid peels have provided new methods for the Facial Plastic Surgeon and the Dermatologist to erase some of the wrinkles we earn with age and to help facial scars to begin to disappear.

Vitamin A creams like Retin-A and Renova help the skin to increase the production of new surface cells and shed old dead cells more rapidly. They may cause a reddened, irritated appearance to the skin in the area of application after a day or two but the long term result usually shows a marked reduction in wrinkles and a tighter, younger appearance to the skin. Chemical Peels have been used for many years and were often used by cosmetologists in salons before the dangers and medical risks were understood. Now salons can offer certain chemical peels but many require the expertise and supervision of the physician.

New laser delivery systems allow the laser to touch each area in the targeted zone for a brief instant and then move on. Certain wavelengths of the laser light can be used in this way to peel off the outer layers of dead skin cells and tighten the supporting tissues. Depending on the intensity of the laser beam used, the effects may allow surface peeling, temporary discoloration, and even a thermal burn much like severe sunburn. These side effects may be temporary while the lasting effects may offer smoother, tighter, younger-looking skin.

Laser resurfacing has also proven useful in the treatment of facial scars from accidents and injuries. Dermabrasion and scar revision surgery are often required as well. The process of considering surgical intervention requires an understanding of the development of scars.

Wound healing after a facial injury is a process that continues for as much as a year or more after the initial injury. The early phase in the first few weeks is dramatic and the initial swelling and inflammation and redness around the wounds tend to subside as the initial scarring takes place. The body builds tissue bridges to connect torn edges and this is the area we can see as scarring. The extent of the initial injury and the techniques used in the early repair are the most important factors in obtaining a good final result.

Over the many months that follow, the scarring is limited to the small area of the wound and usually the tissues around the wound slowly have much of the inflammatory material responsible for swelling and scarring begin to fade away and disappear. The process may take may months and in some facial injuries around the mouth and nose we may see changes that are visible as much as two years beyond initial injury that were not visible at the 5 - 6 week mark. Some scars may benefit from local injection of steroid medicines to help the scar shrink. In some cases, the topical application of Vitamin E in cream or gel form and the application of steroid creams may help to control scarring and may change the appearance of the healed wound.

After a few weeks and again after 6 months or so, the new scar should be re-examined to determine if the natural process is allowing it to fade and be less noticeable. Laser resurfacing and dermabrasion both create significant redness that may take months to fade. Camouflage techniques can be very helpful, during these early months, to minimize any disfigurement caused by scarring. Specialized make-up can cover changes in coloration such as the redness after laser resurfacing. Other types of makeup can be effectively used to completely obscure scars on the face. Men are often encouraged to grow beard or moustache hair to easily hide facial scars.

It is difficult to predict, during the early phase of healing, just what procedure may be needed and exactly when it may be needed in order to achieve a pleasing final result. It is fair to say that many patients who have facial injuries may require more than two procedures and will often deal with the disfigurement of facial scarring for many years. The psychology of facial scarring is variable and depends very much on the magnitude of the injuries and the individual's stability at the time of the evaluation. Certainly the disfigurement of facial scarring creates an unusual strain that may be variable at different periods in life. The psychological impact of facial scarring on the young lady who is about to attend her prom or debutante ball may be significantly greater than the impact on a 9 year old boy with scarring from a bicycle accident.

A final pleasing aesthetic result may require multiple procedures over several years. Although we expect that each procedure would be less involved and less difficult than the previous ones, that is not always the case. Outpatient surgery usually requires anesthesia care also and skilled nursing assistance at a surgical facility. The total cost of each procedure truly depends on the extent and complexity of the specific operations selected. In some cases a sequence of scar revisions and finally a dermabrasion or the application of chemical peels or laser resurfacing may follow initial repair.

An acceptable aesthetic result is always the goal and requires continued realistic discussion between the patient, the family, and the facial plastic surgeon. Insurance concerns often are involved in planning necessary procedures. Early settlement with any involved party in an accident may overlook important details of timing regarding the treatment of facial scarring. Consultation with your insurance agent or your attorney may be advisable in order to avoid misunderstanding at a later time.

Dr. Love is board certified by the American Board of Otorhinolaryngology-Head and Neck Surgery and has subspecialty training in Facial Plastics and Reconstructive Surgery. If you have questions about facial scarring or about new techniques in facial plastic surgery, contact Dr. Love and his staff at the Otorhinolaryngology Associates, (334) 281-6327.