LAM FACIAL PLASTICS

I was attacked two years ago and slashed in the face. As a result I have an ugly scar that really bothers me and brings up very bad memories. A few months after the injury I went to a plastic surgeon and continued to see him. He waited for the scar to fully heal and soften, and now he has scheduled a z-plasty.

While he has already told me that the scar will never be invisible, he said he can improve it. I try to cover it with my makeup/hair but I would like it to be a lot less visible. I wanted to get an opinion from anonymous strangers on their honest opinion of whether a z-plasty will improve this type of scar. I know it will look worse initially for a while. I have attached a picture of the initial injury and how the scar looked later. It looks similar now but deep/white. It is a scar that I can feel when I touch my forehead.

Thanks for any opinions.

i personally think a z-plasty is a mistake. i only use z-plasties to lengthen contracted scars because it WILL lengthen a scar. a z-plasty can be used to reorient a scar but even though this scar does not fall along a relaxed skin tension line there is very little reason to change its direction. what i would plan to do for you would be botox 2 weeks before so that the wound heals well and does not stretch back followed by a meticulous geometric broken line repair (GBLR) closed in 3 layers. why a gblr over a z-plasty?
1. a gblr is the bentley of all closures. it allows the wound to be truly irregularized so that the incision is much harder to see (look at my forehead and other scars i have done with gblr. the regular pattern of a z-plasty does not hold a candle to the tiny trapezoids, triangles, and squares that make one's eye have a much harder time to read it.
2. a z-plasty unfavorably lengthens a wound and i rarely perform it. i only use it for contracted areas like the upper lip or lower lip when scars are contracted. it is far from a gold standard in my opinion but it is far easier to perform than a gblr.
best,
sml

Thank you for such a quick response. I'll admit it makes me a little bit nervous. I chose my doctor because he was ranked one of the top plastic surgeons in Manhattan and I therefore trusted his opinion. He discussed with me a variety of types of surgeries, and even combinations of different treatment, and in the end, I thought it sounded like he thought z-platy was the best choice. My scar has whitened and improved in look since the time of that photo, but is still glaringly there and obvious. I would hate to come out of this making it look worse in the end. Thank you for your response.

no worries. sorry to cause alarm. my goal is to explain what i do and what i don't and why for your benefit and that of others. i am sure you are in good hands.
best,
sml

I really appreciate it. You are extremely helpful. Thank you.

my pleasure. glad to be of help.
s.

Dear sunshine406,

Having seen the picture, I personally would not try to alter it through more surgery. What seems horrific to you, is not at all unattractive to me. I definitely notice it, but it does not strike me as unattractive. Moreover, scars do fade over time. Two years is not a long time. I'll tell you some things that you can do to help, but first I'll tell you my wife's z-plasty experience.

Before we were married she had tongue cancer surgery, with removal of about 1/3 of her tongue, the lymph system on the right side of neck and breast, a tracheotomy because of a missed bleeder that nearly choked her to death and the additional emergency surgery. She has the additional complication of extensive keloid development. She had z-plasty to relieve the tension, which caused even more adhesions to form. Over time these adhesions became worse and have caused considerable problems throughout.

She has learned to break up the adhesions through massage and vigorous rubbing. But she waited years before doing so. Her surgeries & z-plasty were over 20 years ago and she battles the complications daily. If she had been told to massage the scar tissue early on, perhaps this would not be the case. The muscle tension that these cause lead to terrible headaches and even tensions in other parts of her body. This morning I gently massaged her neck and trachea until the tensions dissipated.

I also have had many scars from various injuries. Men tend to have more scars. But my parents knew the value of massaging scar tissue and taught that value to me. Use of cocoa butter, virgin coconut oil, olive oil, or even aloe is also helpful.

I have a scar on my knee from falling on a freshly sharpened lawn mower blade, that was quite visible and now is hard even to find. I have other scars that also have become much less visible.

My personal opinion is that the scar that you show in the photo is not unattractive and is not worth the agony of more surgery. My wife's scars were very obvious when I met her. Several years into our marriage, even after her z-plasty, her scar was observed by a little girl whom she was holding, and she observed, "You have bubble gum on your neck." We laughed, because it did look like a big band of bubble gum running much of the length of her neck.

Today, after much rubbing and the normal course of healing, her scar is hardly noticeable.

I suspect that if you begin gently rubbing your scar, especially with application of one of the oils, that your scar will fade to where you do not mind it anymore.

I am very saddened by the report of your attack and the painful reminder that the scar causes you. But I suggest that rather than looking at the scar as a cause of painful memory, that you rather use it as a reminder of God's goodness and as a cause of giving thanks. Over time you will have to look more and more closely to find it, and then you can give thanks for that, too.

hi,
thanks for the long story. i am sorry to hear of your wife's situation. normally, i do not permit advice sharing, and in this case i still do not. however, i will let the comment to stand with these caveats:
1. massage may help with a contracted scar but it can worsen non-contracted scars. this situation is a non contracted scar so it has no bearing on what you have written.
2. the face tends to heal tremendously better than the neck, chest, and other areas and is impossible to have a keloid on the face so your wife's scar and this person's scar have zero similarity.
3. the photo that i see looks like i could improve it but not using a z-plasty that would unduly lengthen the scar and not be the best method of scar camouflage in my opinion. i believe despite a longer recovery the risks would not be excessive. also, i believe that it is bad enough that could warrant surgery if the person desires and understands the risks. too often we extrapolate from our personal situation and warn everyone else not to do something even though the situation is completely different. i appreciate the comments but truly they do not directly apply in this situation, at least from what i see.
best,
s.

Thank you.

you are welcome.

I apologize for such a delayed response but I just came across this forum.

I had a horrific dog bite at age 6, I am now 26 and after countless surgeries (scar tissue removal etc.) I opted for a z-plasty 2 years ago and I could not be happier with the results. My scar took up basically my whole cheek (basically from corner of eye to corner of mouth and almost back to earlobe) and although I have lived with it all of my life and everyone claimed 'it wasn't a big deal' or they 'didn't even notice it' I did.. and I did not like what it reminded me of nor how it made my feel.

I had a z-plasty in August of 2009 and as previously stated I am extremely happy with my results. Did it alter the scar? Absolutely. Is it invisible? Not at all. Is it another healing process? Yes, and it is rather annoying to deal with new scars and stitches etc. but the ability that doctors have created to trick the natural eye and altering a blunt line straight scar to a zig zag shape is more helpful than I can explain. It is much easier to cover up and it also thinned out my scar as well. I am more than happy to share pictures if you'd like but once again.. I would highly recommend it. You never know what you can do or how it can change until you do it.

Hi,

I appreciate the comments. However, as you know this form is really intended for asking me questions rather than just comments. Hope you're doing well.