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Camo closures - Unsightly scars camouflaged with revision techniques

Article-Camo closures - Unsightly scars camouflaged with revision techniques

Key iconKey Points

  • According to experts, cosmetic surgeons have several options to optimize nonaesthetic scars
  • Various scar revision techniques, or irregularization techniques, which can successfully trick the eye by camouflaging a once unsightly scar, are discussed

J. Regan Thomas, M.D., F.A.C.S.
CHICAGO — A patient with an unsightly scar can suffer much psychological distress as a result of social stigmatisms and cosmetic imperfection. But experts tell Cosmetic Surgery Times that an experienced plastic surgeon has many options to optimize, if not eliminate, these nonaesthetic scars. The use of various scar revision techniques such as running W-plasty or geometric broken line closure (GBLC), Z-plasty and M-plasty, also known as irregularization techniques, can successfully trick the eye by camouflaging a once unsightly scar.

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.)
According to Dr. Thomas, however, the technique is not performed as regularly as the W-plasty because some of the tension lines created with GBLC fall outside of the direction of the resting skin tension lines. In contrast, with the W-plasty there are tension lines to which the components are all relatively parallel. "The choice of the technique ... used to effectively hide a scar is really a matter of clinical judgment," Dr. Thomas says.

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.

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