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Formation and Revision of the Cicatrix. Herve’ LeBoeuf, MD Karen Calhoun, MD. Tension Lines. Langer’s lines Relaxed Skin Tension Lines Unique to each patient Frequently perpendicular to muscle Different from “wrinkle lines” Identified by pinching the skin

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formation and revision of the cicatrix

Formation and Revision of theCicatrix

Herve’ LeBoeuf, MD

Karen Calhoun, MD

tension lines
Tension Lines
  • Langer’s lines
  • Relaxed Skin Tension Lines

Unique to each patient

Frequently perpendicular to muscle

Different from “wrinkle lines”

Identified by pinching the skin

  • Straith, Kraissl, Bulacio
wound healing
Wound Healing
  • Neovascularization
  • Inflammation
  • Epithelialization
  • Granulation
  • Contraction
  • Remodeling
preoperative management
Preoperative Management
  • Debridement & Irrigation
  • Instrumentation
  • Anesthesia
  • Incision planning
  • Patient consultation
intraoperative precautions
Intraoperative Precautions
  • Incision placement
  • Undermine where necessary
  • Meticulous hemostasis
  • Dead space obliteration
  • **Dermal closure**
  • Suture type & placement
  • Anti-tension taping of wound
postoperative wound care
Postoperative wound care
  • Topical emollients for moisture
  • Frequent cleaning with H2O2
  • Early dermabrasion of irregular wounds
  • Avoidance of sun, water
  • Steroid creams, retinoids, etc.
goals of scar revision
Goals of scar revision
  • Flat scar, level with surrounding skin
  • Good color match with local tissue
  • Narrow
  • Parallel to the patient’s RSTL
  • Absence of straight, unbroken lines
scars that may benefit
Scars that may benefit...
  • Those interrupting a facial aesthetic unit
  • Webbed or pin cushion scars
  • Hypertrophied or widened scars
  • Those adjacent to a favorable site
  • Long scars perpendicular to RSTL
  • Aesthetically or functionally distorting
excisional techniques
Excisional techniques
  • Fusiform excision with or without

M-plasty

Rotational flaps

Tissue expanders

  • Repositioning of scars
  • Partial serial excision of larger scars
altering scar polarity
Altering scar polarity
  • Classic Z-plasty
  • Multiple “running” Z-plasties
  • W-plasty
  • Geometric Broken Line Closure
  • Early dermabrasion with the irregular

closures and hypertrophied scars

nonsurgical revisions
Nonsurgical revisions
  • Steroids -- Injectables and creams
  • Estriol and tretinoin with iontophoresis
  • Silicone gel sheeting and tocopherol
  • Ultrapulsed CO2 laser resurfacing
  • Injectable fillers: Zyderm, Zyplast, Fibrel, autologous fat, Autologen, Silicone, etc.
  • Cosmetics