The authors present a comprehensive synopsis of late scar revision and other soft tissue deformities. They make the reasonable point that maxillo-facial surgery and its management of soft tissue injuries to the face is closely linked to cosmetic surgery. After describing the phases of wound healing they continue by detailing the management of scars. A useful summary of the different modalities is given including intralesional steroid injection, silicone gel use, laser therapy, dermabrasion and chemical peels, and of course surgery. There are examples shown of a modified W-plasty as well as a reference to subcision. The authors then go on to discuss management of volume deficiency. They discuss the importance of timing when allowing weeks until full granulation may yield acceptable initial results and also the benefits of pre-suturing and using biological coverage. Volume replacement is described utilising both autologous grafts and soft tissue fillers. This is a well constructed review article on a subject which should probably receive more attention in our press. Quite often we focus on the hard tissue aspects of our work, which by and large have become standardised in their treatment protocols. We may reassure ourselves when looking at the x-ray that we have achieved a good result only to find the patient unhappy because of the soft tissue outcome. Scar revision is frequently limited to surgical approach and we should consider the above-mentioned additions to our armamentarium. I suspect that in the future micro-needling may become a useful adjunct and we may be more wary of all non-autologous tissue fillers.
Scar revision synopsis
Reviewed by David Chin Shong
Late revision or correction of facial trauma related soft tissue deformities.
CONTRIBUTOR
David Chin Shong
University of South Manchester NHS Foundation Trust, Manchester, UK
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