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 J. Regan Thomas, M.D., F.A.C.S. |
Although several factors that are beyond the surgeon's control can affect the final appearance of the scar, including the mechanism of injury, position of the wound, health status of the patient, patient skin type and tendency to form hypertrophic scars or keloids, employing irregularization techniques can effectively camouflage a once cosmetically unacceptable scar.
TROMPE D'OEIL "Irregularization techniques like W-plasty and GBLC work by making it harder for the eye to follow that irregular, unpredictable scar line, as opposed to a straight line that tends to be more noticeable," explains J. Regan Thomas, M.D., F.A.C.S., professor and head of the Department of Otolaryngology-Head and Neck Surgery, Illinois Eye and Ear Infirmary, University of Illinois at Chicago. In effect, he explains, the techniques create an optical illusion that make it more difficult for the eye to identify the scar.
One of these techniques, a running W-plasty, creates a zig-zag or W-like configuration that runs along the scar, with each component of the "W" being 5 mm to 7 mm long. Dr. Thomas notes that these dimensions seem to be around the right size that can fool the eye and make a scar successfully blend in with its surrounding healthy tissues. The W-plasty or GBLC are most useful when the surgeon is simply trying to break a scar into irregular patterns or figures.According to Dr. Thomas, the running W-plasty technique requires a narrow scar and a scar that is even (i.e., flat, not raised) with the surrounding tissue for the most successful camouflage effect. The GBLC technique can even further irregularize a scar, making it less predictable and preventing the eye from perceiving any unevenness in the skin contour.
 Facial scar before (left) and after revision (right) employing the geometric broken line closure (GBLC) technique. (Photo credit: J. Regan Thomas, M.D., F.A.C.S.) |
CHANGE OF DIRECTION According to Dr. Thomas, the Z-plasty can also irregularize the scar and is used in specific situations in which the surgeon is trying to lengthen a contracted scar or change its direction. "This is especially useful if the scar runs perpendicular to the relaxed or resting normal skin tension lines," Dr. Thomas explains, as in this situation, a Z-plasty allows one to change the direction of the scar. However, if scar camouflage is all that one requires, a W-plasty or a GBLC is probably more effective because it is not necessary to transpose and move tissue around as is done with the Z-plasty technique. "The Z-plasty can also achieve a transposing of additional soft tissue and this can be lengthened and can correct a contracture," he adds.
