eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Scar Revision: Multimedia

Author: Howard S Kotler, MD, Clinical Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Jun 30, 2009

Multimedia

Scar revision. Four main facial lines that deline...Media file 1: Scar revision. Four main facial lines that delineate the prevailing direction of relaxed skin tension lines (RSTLs).
Scar revision. Four main facial lines that deline...

Scar revision. Four main facial lines that delineate the prevailing direction of relaxed skin tension lines (RSTLs).

Scar revision. Classic Z-plasty composed of two 6...Media file 2: Scar revision. Classic Z-plasty composed of two 60° angles.
Scar revision. Classic Z-plasty composed of two 6...

Scar revision. Classic Z-plasty composed of two 60° angles.

Scar revision. Transposition of flaps in Z-plasty.Media file 3: Scar revision. Transposition of flaps in Z-plasty.
Scar revision. Transposition of flaps in Z-plasty.

Scar revision. Transposition of flaps in Z-plasty.

Scar revision. Completion of 60° Z-plasty. N...Media file 4: Scar revision. Completion of 60° Z-plasty. Note lengthening of the scar and how the central limb now lies nearly perpendicular to original orientation in Image 3.
Scar revision. Completion of 60° Z-plasty. N...

Scar revision. Completion of 60° Z-plasty. Note lengthening of the scar and how the central limb now lies nearly perpendicular to original orientation in Image 3.

Scar revision. Elastic model demonstrating Z-plas...Media file 5: Scar revision. Elastic model demonstrating Z-plasty before flap transposition.
Scar revision. Elastic model demonstrating Z-plas...

Scar revision. Elastic model demonstrating Z-plasty before flap transposition.

Scar revision. Transposition of flaps in 60°...Media file 6: Scar revision. Transposition of flaps in 60° Z-plasty. Note beginning of lateral tissue distortion as the central limb lengthens.
Scar revision. Transposition of flaps in 60°...

Scar revision. Transposition of flaps in 60° Z-plasty. Note beginning of lateral tissue distortion as the central limb lengthens.

Scar revision. Final closure of elastic model in ...Media file 7: Scar revision. Final closure of elastic model in 60° Z-plasty. Note directional change of the central limb and extreme lateral tissue distortion.
Scar revision. Final closure of elastic model in ...

Scar revision. Final closure of elastic model in 60° Z-plasty. Note directional change of the central limb and extreme lateral tissue distortion.

Scar revision. Relationship between angle and cen...Media file 8: Scar revision. Relationship between angle and central limb lengthening in Z-plasty. Note how the larger angle corresponds to a greater increase in length.
Scar revision. Relationship between angle and cen...

Scar revision. Relationship between angle and central limb lengthening in Z-plasty. Note how the larger angle corresponds to a greater increase in length.

Scar revision. Properly oriented Z-plasty for a s...Media file 9: Scar revision. Properly oriented Z-plasty for a scar traversing the cheek-lip groove with lateral limbs directed nearly parallel to relaxed skin tension lines (RSTLs).
Scar revision. Properly oriented Z-plasty for a s...

Scar revision. Properly oriented Z-plasty for a scar traversing the cheek-lip groove with lateral limbs directed nearly parallel to relaxed skin tension lines (RSTLs).

Scar revision. Improperly oriented Z-plasty with ...Media file 10: Scar revision. Improperly oriented Z-plasty with lateral limbs directed perpendicular to relaxed skin tension lines (RSTLs). Note how inferior the lateral limb lies perpendicular to RSTLs of the white lip.
Scar revision. Improperly oriented Z-plasty with ...

Scar revision. Improperly oriented Z-plasty with lateral limbs directed perpendicular to relaxed skin tension lines (RSTLs). Note how inferior the lateral limb lies perpendicular to RSTLs of the white lip.

Scar revision. Compound 4-flap 45° Z-plasty.Media file 11: Scar revision. Compound 4-flap 45° Z-plasty.
Scar revision. Compound 4-flap 45° Z-plasty.

Scar revision. Compound 4-flap 45° Z-plasty.

Scar revision. Completion of compound 4-flap 45&#...Media file 12: Scar revision. Completion of compound 4-flap 45° Z-plasty. Note significant tissue distortion at ends of wound.
Scar revision. Completion of compound 4-flap 45&#...

Scar revision. Completion of compound 4-flap 45° Z-plasty. Note significant tissue distortion at ends of wound.

Scar revision. Serial Z-plasty applied to ovoid d...Media file 13: Scar revision. Serial Z-plasty applied to ovoid defect.
Scar revision. Serial Z-plasty applied to ovoid d...

Scar revision. Serial Z-plasty applied to ovoid defect.

Scar revision. Serial Z-plasty applied to ovoid d...Media file 14: Scar revision. Serial Z-plasty applied to ovoid defect.
Scar revision. Serial Z-plasty applied to ovoid d...

Scar revision. Serial Z-plasty applied to ovoid defect.

Scar revision. Serial Z-plasty applied to ovoid d...Media file 15: Scar revision. Serial Z-plasty applied to ovoid defect.
Scar revision. Serial Z-plasty applied to ovoid d...

Scar revision. Serial Z-plasty applied to ovoid defect.

Scar revision. Size and number differential betwe...Media file 16: Scar revision. Size and number differential between W-plasty triangles to ensure corresponding fit between inner and outer wound curvature.
Scar revision. Size and number differential betwe...

Scar revision. Size and number differential between W-plasty triangles to ensure corresponding fit between inner and outer wound curvature.

Scar revision. Modification of customary isoscele...Media file 17: Scar revision. Modification of customary isosceles right triangular configuration to approximate more closely the prevailing relaxed skin tension line (RSTL). Lines with arrowheads indicate the direction of RSTL.
Scar revision. Modification of customary isoscele...

Scar revision. Modification of customary isosceles right triangular configuration to approximate more closely the prevailing relaxed skin tension line (RSTL). Lines with arrowheads indicate the direction of RSTL.

Scar revision. W-plasty is drawn carefully.Media file 18: Scar revision. W-plasty is drawn carefully.
Scar revision. W-plasty is drawn carefully.

Scar revision. W-plasty is drawn carefully.

Scar revision. W-plasty is excised while maintain...Media file 19: Scar revision. W-plasty is excised while maintaining the blade perpendicular to the skin's surface.
Scar revision. W-plasty is excised while maintain...

Scar revision. W-plasty is excised while maintaining the blade perpendicular to the skin's surface.

Scar revision. A completed W-plasty. Note lack of...Media file 20: Scar revision. A completed W-plasty. Note lack of lateral tissue deformation.
Scar revision. A completed W-plasty. Note lack of...

Scar revision. A completed W-plasty. Note lack of lateral tissue deformation.

Scar revision. Excision following design of geome...Media file 21: Scar revision. Excision following design of geometric broken line.
Scar revision. Excision following design of geome...

Scar revision. Excision following design of geometric broken line.

Scar revision. Closure of geometric broken line r...Media file 22: Scar revision. Closure of geometric broken line revision technique.
Scar revision. Closure of geometric broken line r...

Scar revision. Closure of geometric broken line revision technique.

Scar revision. Geometric broken line closure (GBL...Media file 23: Scar revision. Geometric broken line closure (GBLC) on a curved wound, oriented differentially to relaxed skin tension line (RSTL). Note height differences of geometric figures at ends and middle of wound and relative increase of triangular shapes to rectangles.
Scar revision. Geometric broken line closure (GBL...

Scar revision. Geometric broken line closure (GBLC) on a curved wound, oriented differentially to relaxed skin tension line (RSTL). Note height differences of geometric figures at ends and middle of wound and relative increase of triangular shapes to rectangles.

Scar revision. Central scar with bilateral M-plas...Media file 24: Scar revision. Central scar with bilateral M-plasty.
Scar revision. Central scar with bilateral M-plas...

Scar revision. Central scar with bilateral M-plasty.

Scar revision. A wound following excision of cent...Media file 25: Scar revision. A wound following excision of central scar. Note how M-plasty design conserves otherwise discarded healthy surrounding tissue.
Scar revision. A wound following excision of cent...

Scar revision. A wound following excision of central scar. Note how M-plasty design conserves otherwise discarded healthy surrounding tissue.

Scar revision. M-plasty final closure.Media file 26: Scar revision. M-plasty final closure.
Scar revision. M-plasty final closure.

Scar revision. M-plasty final closure.

Scar revision. Diagrammatic representation of M-p...Media file 27: Scar revision. Diagrammatic representation of M-plasty closure with advancement of the tip into the defect by horizontal mattress suture technique.
Scar revision. Diagrammatic representation of M-p...

Scar revision. Diagrammatic representation of M-plasty closure with advancement of the tip into the defect by horizontal mattress suture technique.

Scar revision. An alternative method of closing a...Media file 28: Scar revision. An alternative method of closing angulated flap by horizontal half-buried mattress suture. The flap tip may be advanced differentially into the wound apex to achieve a moderate degree of eversion and decreased tension.
Scar revision. An alternative method of closing a...

Scar revision. An alternative method of closing angulated flap by horizontal half-buried mattress suture. The flap tip may be advanced differentially into the wound apex to achieve a moderate degree of eversion and decreased tension.

Scar revision. Incision parallel to direction of ...Media file 29: Scar revision. Incision parallel to direction of hair follicle reduces likelihood of alopecia.
Scar revision. Incision parallel to direction of ...

Scar revision. Incision parallel to direction of hair follicle reduces likelihood of alopecia.

Design of W-plasty in cheek scar revision.Media file 30: Design of W-plasty in cheek scar revision.
Design of W-plasty in cheek scar revision.

Design of W-plasty in cheek scar revision.

Scar revision. W-plasty in scar parallel to orbic...Media file 31: Scar revision. W-plasty in scar parallel to orbicularis oris.
Scar revision. W-plasty in scar parallel to orbic...

Scar revision. W-plasty in scar parallel to orbicularis oris.

Scar revision. Utility of curvilinear W-plasty in...Media file 32: Scar revision. Utility of curvilinear W-plasty in forehead scar revision. Note intentional angulation of triangular sides to lie within relaxed skin tension lines (RSTLs).
Scar revision. Utility of curvilinear W-plasty in...

Scar revision. Utility of curvilinear W-plasty in forehead scar revision. Note intentional angulation of triangular sides to lie within relaxed skin tension lines (RSTLs).

Scar revision. Planning for W-plasty through eyeb...Media file 33: Scar revision. Planning for W-plasty through eyebrow.
Scar revision. Planning for W-plasty through eyeb...

Scar revision. Planning for W-plasty through eyebrow.

Scar revision. Completed W-plasty for scar traver...Media file 34: Scar revision. Completed W-plasty for scar traversing the eyebrow.
Scar revision. Completed W-plasty for scar traver...

Scar revision. Completed W-plasty for scar traversing the eyebrow.

More on Scar Revision

Overview: Scar Revision
Treatment: Scar Revision
Follow-up: Scar Revision
Multimedia: Scar Revision
References
Further Reading

References

  1. Frodel JL Jr. Dealing with the difficult trauma and reconstructive surgery patient. Facial Plast Surg Clin North Am. May 2008;16(2):225-31, vii-viii. [Medline].

  2. Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and z-plasty for facial burn scars: the alternative to excision. Ann Plast Surg. May 2008;60(5):480-6. [Medline].

  3. Martins A, Trindade F, Leite L. Facial scars after a road accident--combined treatment with pulsed dye laser and Q-switched Nd:YAG laser. J Cosmet Dermatol. Sep 2008;7(3):227-9. [Medline].

  4. Skouge JW. Subcutaneous island pedicle flap with Z-plasty: a cosmetic enhancement. Dermatol Surg. Dec 2007;33(12):1529-32. [Medline].

  5. Stiefel D, Schiestl C, Meuli M. Integra Artificial Skin((R)) for burn scar revision in adolescents and children. Burns. May 26 2009;[Medline].

  6. Borges AF. Principles of scar camouflage. Facial Plast Surg. Spring 1984;1(3):181-90. [Medline].

  7. Borges AF. Prognosis of scarring in wounds. In: Borges AF. Elective Incisions and Scar Revisions. Little Brown & Co;1973.

  8. Borges AF. Relaxed skin tension lines. In: Borges AF. Elective Incisions and Scar Revisions. Little Brown & Co;1973.

  9. Borges AF. Z-Plastic scar revision. In: Borges AF. Elective Incisions and Scar Revisions. Little Brown & Co;1973.

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  13. Goslen JB. Physiology of wound healing and scar formation. In: Thomas JR, Holt GR, eds. Facial Scars: Incision, Revision and Camouflage. Mosby-Year Book;1989.

  14. Goslen JB. Wound healing for the dermatologic surgeon. J Dermatol Surg Oncol. Sep 1988;14(9):959-72. [Medline].

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  22. Schmidt A, Gassmueller J, Hughes-Formella B, Bielfeldt S. Treating hypertrophic scars for 12 or 24 hours with a self-adhesive hydroactive polyurethane dressing. J Wound Care. May 2001;10(5):149-53. [Medline].

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Keywords

scar revision, cosmetic wound revision, scar repair, cosmetic skin repair, Z-plasty, classic Z-plasty, multiple Z-plasty, serial Z-plasty, W-plasty, running W-plasty, zig-zag plasty, M-plasty, geometric broken line closure, GBLC

Contributor Information and Disclosures

Author

Howard S Kotler, MD, Clinical Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago
Howard S Kotler, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Physician Executives, American Medical Association, American Medical Informatics Association, Chicago Medical Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Keith A LaFerriere, MD, Clinical Professor, Fellowship Director, Department Otolaryngology-Head and Neck Surgery, University of Missouri at Columbia
Keith A LaFerriere, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Missouri State Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

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