Scar Camouflage Research Articles

Paradigms in periorbital scar management

Periocular scarring following surgery or trauma is of great aesthetic and functional concern and is difficult to predict. In today’s era, with increasing scientific knowledge and technological advances, both physicians and their patients are highly concerned with minimizing scar appearance as a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. Although various non-surgical and surgical treatment strategies are available it is still difficult to improve excessive scarring. Thus, the importance of thorough knowledge of eyelid anatomy and heal­ing mechanisms along with appreciation of wound closure techniques like placing the sutures at natural cosmetic subunit junctions and along relaxed skin tension lines (RSTLs) in order to achieve scar camouflage and to ensure decreased tension on the wound cannot be more emphasised. Periorbital area should be tackled by the oculoplasty surgeons in view of their distinct anatomy and close proximity to the eye.Scars are commonly treated with a combination of non-surgical techniques, including watchful waiting, scar massage, pressure therapy, silicone gel sheeting, topical or intralesional injections, cryotherapy, laser therapy or radiotherapy. Surgical approaches include pincushioning debulking, direct scar excision, broken line closure techniques, scar lengthening procedures (Z plasty, V-Y/Y-V advancement) and scar excision with lid reconstruction. Mastery of this content is essential for consistent operative success. For good cosmetic and functional outcomes, scar revision techniques should be thoughtfully tailored to the individual and scar subtype.

Cutaneous Adverse Reactions Associated with Tattoos and Permanent Makeup Pigments.

Tattooing is the procedure of implanting permanent pigment granules and additives into the dermal layer of the skin, serving various purposes such as decoration, medical identification, or accidental markings. There has been a significant rise in the popularity of decorative tattooing as a form of body art among both teenagers and young adults. Thus, the incidence of tattoos is increasing, with expanding applications such as permanent makeup, scar camouflage, nipple-areola, lips, and eyebrows tattooing, and utilization in oncological radiotherapy such as colon marking. However, there have been reported a broad range of adverse reactions linked to tattooing, encompassing allergic reactions, superficial and deep cutaneous infections, autoimmune disorders induced by the Koebner phenomenon, cutaneous tumors, and others. These reactions exhibit different onset times for symptoms, ranging from immediate manifestations after tattoo application to symptoms emerging several years later. Given the limited information on a tattoo's side effects, this review aims to elucidate the clinical spectrum of cutaneous complications of tattoos in different patients. The analysis will investigate both allergic and nonallergic clinical presentations of tattoo-related side effects, microscopic findings from skin biopsies, and therapeutic outcomes. This exploration is essential to improve our understanding of tattoo-related cutaneous complications and associated differential diagnoses and highlight the significance of patient awareness regarding potential risks before getting a tattoo.

Modified vertical lid split orbitotomy: a case series and literature review

ABSTRACT Purpose To describe the modified vertical lid split (VLS) technique for anterior orbitotomy and report surgical outcomes in patients with intraconal lesion removal using this surgical technique. Method Retrospective review of medical records and orbital images. Results A total of four (female = 3) patients with intraconal orbital lesions underwent modified VLS orbitotomy from January 1, 2019 to June 30, 2021 in Hong Kong East Cluster. The average age was 49.3 years old (range: 35–65). Complete excision of intraconal orbital lesion was performed in all four cases. All cases were cavernous haemangioma histologically. All patients were satisfied with their cosmesis postoperatively and most had satisfactory postoperative extraocular movement. Conclusion Modified VLS approach is simple and provides good intraoperative surgical exposure for intraconal lesions, giving the additional advantage of better scar camouflage.

Exploring tattoo artists’ understanding of decorative non-medical professional tattooing as a method of scar camouflage and decoration

ABSTRACT Research surrounding the use of decorative tattooing by non-medical professional tattooists as a form of scar camouflage or decoration is limited. This study provides critical and deepening insights into tattoo artists’ experiences of tattooing scars, to help inform a more in-depth understanding of its uses from a health and wellbeing perspective. Specifically, it aimed to explore qualitatively, the different methods and techniques used by non-medical tattoo professionals to cover up or decorate scars, which can have a psychological impact on those affected. Six tattoo artists from legitimate UK based studios were identified through snowballing and purposive sampling methods. Data collection involved semi-structured telephone interviews. The data was then transcribed, and thematic analysis was then performed. Five themes were identified: Personal Opinion of Scar Camouflage Tattooing, Tattooing Methods, Scars and Tattooing Risks, Positive Impact, and Understanding of Customer Experience. These themes were then broken down into more specific sub-themes. The discussion considers these findings in relation to theory and existing literature, for example, around understanding of role, and makes recommendations for future study in this field.

Revisiting Rhombic Flaps for Aesthetic Facial Resurfacing: Addressing a Surgical Conundrum.

Background:Facial resurfacing is a surgical and aesthetic challenge, as it requires soft, pliable, and stretchable donor skin with a good match of color, texture, and thickness and minimum donor scarring. Rhombic flap is a highly versatile flap that has the aforementioned properties. Careful flap planning and execution is vital for successful outcomes.Aims:The aim of this work was to study the geometry of the classic rhombic flaps; to evaluate their versatility and technical finesse as well as their application to resurface defects over various regions of the face.Materials and Methods:Overall, 42 patients with facial scars due to trauma, malignancies, small nevi, and mature scars of the face were studied and operated on. Of the four rhombic flaps that were possible, choosing the best option required careful attention to camouflage of scar and proximity to vital deformable anatomical structures. Geometrical planning of the flap was the essence of the entire surgical exercise.Results:Outcome of rhombic flaps were meticulously and critically analyzed. The study consisted of 36 females (85.71%) and only 6 males with a mean age of 23 years. Defects were created on 27 mature scars (64.29%) and 11 burn scars (26.19%). Defects over the cheek and lateral canthus of the eye were especially problematic. It is a safe flap with excellent results as far as visible scarring and traction deformities are concerned. Scars elsewhere on the face fared better than on the bony prominence.Conclusion and Significance:Rhombic flaps offer an excellent alternative to resurface facial scars and defects in a selected subset of patients.

Extensive Scarring Alopecia Treated Through a Single Dense-Packing Follicular Unit Extraction Megasession.

Follicular unit extraction (FUE) is becoming more popular in hair restoration. However, its potential for treating extensive scarring alopecia is unknown. Patients with scarring alopecia larger than 100 cm2 were enrolled from 2015 to 2018. After assessing scar quality regarding vascularity, pliability, and thickness, dense-packing megasession (DPM)-FUE was performed on high-quality recipient sites. Patients were followed up at 1 week and 12 months postoperatively to evaluate complications, survival rates of grafts, and patient satisfactions. Cases of nonscarring alopecia were reviewed as controls. Fifty-two scarring alopecia and 55 nonscarring alopecia patients were enrolled. The mean scar area was 120 cm2, and the procedure required an average of 8 operative hours, with no difference between groups (p > .05). Graft amount and postoperative complications were similar as well (p > .05). The survival rate in scarring alopecia was lower than that in the control but was still 85% (p < .05). Follow-up photographs showed effective scar camouflage after DPM-FUE. Most patients were very satisfied with the final results (p > .05). DPM-FUE is a safe and effective treatment for extensive scarring alopecia.

Uso da micropigmentação como método de camuflagem para cicatriz de estrias

Striae are linear cutaneous atrophies derived from a cicatricial process, they are formed when the tissue tension causes a lesion of the dermal connective, causing a tear of the meshes, generating the loss of elasticity and compression causing an injury. Micropigmentation, or also known as dermopigmentation, dermography, dermatography, or tattooing is a technique that consists of a minimally invasive procedure, used to implant pigment in the subepidermal layer, to correct small abnormalities or for aesthetic purposes. The objective of this case study was to verify the efficacy of the camouflage of scars by micropigmentation. After application of the micropigmentation session, it was verified an improvement in the appearance of the striae in the volunteer who followed the guidelines correctly.Key-words: striae, tattoing, esthetics equipment.

Abstract: Camouflage of Scarring Alopecia By Using Follicular Unit Transplantation

INTRODUCTION: Scarring alopecia usually results from trauma, burn and previous surgery in the aesthetic units of head and neck.1,2,3,4Various treatment options that anti-scar ointments, laser treatments and scar revisions surgeries have been used for treatment of these scars. However, it is difficult to destroy the existing scar with these treatment methods; it is not possible to treat alopecia. In this study, we present our result about the camouflage of the scarring alopecia with follicular unit transplantation in the head and neck area. METHODS: Between 2015 and 2016 years, 27 patients who were treated for scaring alopecia after 13 trauma (4 scalp, 2 sideburn, 3 eyebrows and 4 beard) and 14 cleft lip repair(6 unilateral, 8 bilateral) were included in the study. Firstly the recipient areas were assessed for scar width and maturity, the number of needed donor grafts, the angle and direction of the existing hair around scar. The occipital and post auricular scalp area were selected as donor sides for scalp, sideburn and eyebrow scars. If there were adequate follicular unit in the submental beard region, it was selected as donor side for moustache and beard scar; if were not, scalp was selected again. Two teams that extraction and implantation worked together for shortening the duration of ischemia. Çeviri hatasýAll patients were discharged on the same day with analgesics and antibiotics. The patient was called for control at the 2nd week, 1st, 3rd, 6th, 12th months and digital photographs were taken. Graft survival and patient satisfaction were assessed with Photoshop program and the patient satisfaction scale (1: not satisfied, 0: neutral, 1: moderate,2: good, 3: very satisfied) at postoperative 1 year. RESULTS: There were no major complications in the early postoperative period, transient edema due to tumescence infiltration and pain responding to simple analgesia. In the late period, one epidermal inclusion cyst developed, treated with excision. Mean survival rate of grafts was 86%. 20 patients were very-well satisfied (3), 7 were good (2). CONCLUSION: The scarring alopecia is a challenging problem to deal with affects the social and psychological condition of the patient in the aesthetic units.2,3 Focal unit extraction technique(FUE) hair and beard transplantation is an easy, low cost, minimally invasive and alternative treatment with high success and satisfaction rate in scar camouflage.2,4 Reference Citations: 1. Umar S. Use of beard hair as a donor source to camouflage the linear scars of follicular unit hair transplant. J Plast Reconstr Aesthet Surg. 2012 Sep;65(9):1279–80. 2. Barr L, Barrera A. Use of hair grafting in scar camouflage. Facial Plast Surg Clin North Am. 2011 Aug;19(3):559–68. 3. Epstein J. Facial hair restoration: hair transplantation to eyebrows, beard, sideburns, and eyelashes. Facial Plast Surg Clin North Am. 2013 Aug;21(3):457–67. 4. Barrera A. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp. Plast Reconstr Surg. 2003 Sep;112(3):883–90.

The role of neck wrinkles for cosmetic effect during carotid artery endarterectomy.

Minimally invasive procedures in carotid endarterectomy are currently preferred. Smaller skin incisions (transverse or longitudinal) and the mapping of carotid artery bifurcation with Doppler ultrasound are promoted. There is a lack of papers about cosmetic effects and patients' preferences. The aim of this study was to qualify natural skin wrinkles as potential anatomical markers of carotid artery bifurcation and scar camouflage. 50 patients underwent carotid endarterectomy in 2013-2014 in the Vascular Surgery Department of the Pomeranian Medical University in Szczecin. The positions of wrinkles were compared with the anatomical location of carotid artery bifurcation with the use of Doppler - Duplex Ultrasound. Patients' preferences and cosmetic effect were also assessed. 50% of patients declared the cosmetic effect important. Nevertheless, every patient preferred a transverse incision along a wrinkle line. The wound scar was invisible in 76% of cases 3-6 months after surgery. Wrinkles were close, within 1 centimeter, to carotid artery bifurcation in 80% of cases. It was mainly 4-5 cm from the angle of the mandible. Surgical access along wrinkles located 3, 4, 5, 6, 7 cm from the gonial angle was technically easy in 55%, 77%, 79%, 45%, and 21% of cases, respectively. Using ultrasound before surgery allows the planning of the optimal incision in 98% of cases. Transverse incision hidden in the wrinkles of the neck gives a good cosmetic effect and allows carotid endarterectomy in every case when carotid artery bifurcation is marked prior to surgery.

The Wave Flap

Reconstruction of defects straddling the alar groove presents the dual challenges of resurfacing the nasal sidewall and alar subunits while simultaneously recreating the alar groove. The wave flap (WF) is a modified, medially based, nasal sidewall rotation flap that uses locally recruited tissue from the nasal sidewall to facilitate color and texture match and permit camouflage of scars. To detail a surgical repair for defects in the horizontally oriented middle third of the alar groove. This retrospective case series describes a technique for repair of defects involving the alar groove. Using postoperative photographs, outcomes were assessed by blinded noninvestigator dermatologist raters using the Observer Scar Assessment Scale. Between February 2012 and June 2013, 10 patients were reconstructed using a WF design. Subjective assessment of scar vascularity, pigment, pliability, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 11.1 (out of 50). No complications were noted. The WF provides an excellent reconstructive option for Mohs defects of the middle third of the alar groove by recruiting local tissue and permitting maximum scar camouflage. A well-designed and executed WF provides cosmetically exceptional results for defects of the alar groove.

Micropigmentation: Camouflaging Scalp Alopecia and Scars in Korean Patients

The aim of this study was to identify the usefulness of micropigmentation as a technique for alopecia and scalp scar camouflage in Korean patients. Micropigmentation was performed in 43 Korean patients from November 2011 to October 2012. There were 23 female patients with female pattern hair loss (FPHL), 14 male patients with male pattern baldness, and 6 patients with scalp scars. The results for one patient with FPHL Ludwig stage I were satisfactory according to the physician's assessment, but the patient was dissatisfied because she did not notice any remarkable changes after the procedure. The results for the other 42 patients were highly satisfactory and there were no adverse effects or complications. Micropigmentation appears to be a good method for camouflaging hair loss and scalp scars. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Motivations and Benefits of Medical Alert Tattoos in Patients with Diabetes

Tattooing has increased in popularity over the past 2 decades (1). The motivations that drive individuals to acquire tattoos are plentiful, including embellishment, self-identity, and social affiliation (2). Tattoos are also used for medical purposes (3,4), including corneal tattooing, scar camouflage, or radiotherapy.

A new purpose for tattoos: Medical alert tattoos

Tattooing has gained a tremendous popularity for the past twenty years. The motivations that drive an individual to acquire a tattoo are plentiful. Tattooing has also found its way in the field of medicine (corneal tattooing, gastrointestinal tattooing during endoscopy, permanent make-up tattooing, scar camouflage or radiotherapy field marking...). An emerging application of tattooing is for the purpose of medical identification for conditions requiring special attention during emergency situations, such as patients with diabetes who may be found unconscious due to hypoglycaemia or with allergy to specific medication. This new phenomenon, (practiced by patients on their own without medical consultation) can be found on the Internet. We review here this practice, which is seemingly underreported in the medical literature with its advantages and potential drawbacks.

Upper Blepharoplasty Approach to Frontozygomatic Dermoid Cysts

Dermoid cysts are common periorbital lesions in children. Traditional surgical approaches have included incisions over the mass; above, below, or through the brow; and parallel to the superior orbital rim and the Lynch incision, as well as lateral canthotomy. We aimed to present experience of Alder Hey Children's Hospital on frontozygomatic dermoid removal through a blepharoplasty incision. In this article, we also aimed to review the current literature, describe the operative technique clearly, and offer reasonable explanations for the operative choices made based on our experience of the clinical anatomy and pathology. Thirty-four children were operated on (19 girls and 15 boys), aged 1 to 11 years, between 2005 and 2008. The lesions were left sided in 14 patients and right sided in 20 patients. Preoperative computed tomographic/magnetic resonance imaging scan was generally not used, except in cases where the cyst was more than 1 cm away from the brow margin. All cysts were completely excised. At surgery, all cysts were adherent to the periosteum, and 3 were subperiosteal. None extended through the bone into the orbit. The average operating time was 30 minutes. The average follow-up duration was 1 year. The only complications were early mechanical ptosis in 3 children, which completely resolved; the majority had an uneventful postoperative course. There were no recurrences, and in all patients, scar camouflage was described as excellent. This interesting and extremely effective technique provides excellent scar camouflage with no lid or ocular dysfunction.

Ergotrid Flap

Defects of the upper lateral lip can prove difficult for surgical repair, as even minute distortion of adjacent tissue may compromise aesthetic and functional results. Options for reconstruction include primary closure, healing by secondary intention, and local flap transfer. In this article, the authors introduce and review their experience with the ergotrid flap for reconstruction of defects of the upper lateral lip. Twenty patients with the aforementioned defect underwent reconstruction with the ergotrid flap with adequate postoperative follow-up and photographs. All 20 patients underwent successful reconstruction with ideal tissue match. There were no cases complicated by distortion of the nasal base or vermilion border. All patients reported satisfaction with their results and scar camouflage. The ergotrid flap serves as a viable option in defects of the lateral upper lip. Therapeutic, IV.

Lip Reconstruction With Local M-Shaped Composite Flap

The primary management of lip malignancies is radiotherapy or complete surgical resection. Surgical resection brings a full-thickness defect of lip tissues, and management of the resulting lip defect needs a surgical technique that maximizes functional and cosmetic outcomes. The use of local tissue flaps forms the basic concept of lip reconstruction. There are many techniques reported using the remaining lip and local adjacent tissues. Almost all of these techniques emphasize the innervated sphincter function after lip reconstruction. Authors present their experience in lip reconstruction by an M-shaped local composite flap. An M-shaped flap presents an incision line lying on the labiomental sulcus of the lower lip; on this line, 2 half-thickness Burrow triangles are created. The Burrow triangle allows tissue transposition to close the postsurgical defect. A similar surgical technique is presented also for the upper lip. Functional sphincteric recovery is assured by the integrity of the orbicularis oris muscle because of minimal alteration in the orientation of the muscle and the reconstruction muscular anatomic plane; moreover, such flap preserves the integrity of the corner of the mouth, preserves the sensibility of the lip, and has minimal aesthetic impact due to the camouflage of scar on the labiomental sulcus.

O.006 Hair transplantation – a method for camouflage of scalp scars

Le Fort III distraction osteogenesis with a rigid external distraction device is a powerful procedure to correct both exorbitism and impaired airways in faciocraniosynostosis. The aim of this study was to investigate treatment effect, perioperative parameters and volumetric outcomes after Le Fort III distraction osteogenesis in patients with Crouzon syndrome in a retrospective study design and to explore potential strengths and weaknesses of this procedure.From June 2013 to February 2015, a total of nine children with Crouzon syndrome underwent Le Fort III distraction osteogenesis with a rigid external distraction device (RED device, KLS Martin, Tuttlingen, Germany). Along with perioperative parameters, sleep study reports, traditional cephalometric analysis, three-dimensional imaging and photographs were evaluated for severity of disease and therapeutic effect and structural and functional changes of the upper airway preoperatively, after device removal and one year postoperatively.Surgery for Le Fort III distraction was performed at a median age of 12.5 years (SD 2.5 months) with an average weight of 43.0 kg (SD 12.9 kg). Mean estimated blood loss was 535.7 ml (SD 128.1 ml), not requiring any red blood cell transfusions. Mean duration of surgery was 240 min (SD 30.6min), average hospital stay eight days (SD 0.5 days) with a planned median ICU stay of 1.7 days (SD 0.4 days) for all patients.There were a total of five minor complications. Exorbitism and Angle class III malocclusions were corrected in all patients. No patient showed velopharyngeal problems postoperatively. The average amount of distraction was 18.4 mm (14–26 mm). Average length of the distraction period was 18.3 days (SD 0.4 days), with a total distraction plus consolidation time of three months (SD 0.25 months). In two patients, vector correction was performed during distraction. A counterclockwise movement despite vector correction, clinically resulting in an open bite, was observed in one of these two patients. Eight of the nine patients showed a frontal overbite at the end of the distraction period.Cephalometric analysis revealed a significant increase of Sella-Nasion-Point A angle (SNA) from 76.0° (+/− 2.9; T1) to 86.0° (+/− 3.4; T2) (p = 0.006) and growth-related point A-Nasion-point B angle (ANB) from −4.8° (+/−3.7) to 5.7° (+/−4.8) (p = 0.001) from preoperatively to device removal and stable results one year postoperatively.Upper airway structure and respiratory function were improved clinically after the Le Fort III DO treatment in all cases with an average posterior airway space increase from 3199 mm3 (+/− 229.6 mm3) to 8917,7 ml (+/−415.1 mm3) (T1 to T2).Surgical outcome was judged good to excellent both by patients and families and the craniofacial team.Le Fort III DO with a rigid external distraction device in patients with Crouzon syndrome is a powerful and reliable surgical procedure that reliably produces a more significant change of appearance than most other single procedures routinely performed by craniofacial surgeons. It effectively treated sleep apnea in the affected patients. In our collective, the maxilla remained stable after advancement without any relapse, but there was no subsequent anterior growth on one year follow-up. Careful vector planning was able to avoid frontal open bite in eight patients. Complication rates were acceptably low and patients’ functional and esthetic outcome was high.

Decorative tattooing for scar camouflage: patient innovation

Dermatography has been used in medicine both for aesthetic purposes as permanent make-up or for coverage of scars, defects and skin colour abnormalities. These procedures demand skill and usually more than one session to achieve the desired result. We present an innovative idea from some of our plastic surgery patients to camouflage their scars using decorative tattooing done by non-medical professional tattooists. Long abdominal scars were covered with symmetrical tattoo designs rendering the scars inconspicuous even on close inspection. As tattooing is less of a social taboo nowadays and, indeed, quite acceptable among many of the younger generations, this method could be presented as an option to camouflage scars of the trunk and the limbs that are unacceptable or undesirable, especially in patients who already have tattoos on other parts of their bodies.

Aesthetic Considerations in Scalp Reconstruction

This article reviews common methods of reconstructive surgery in patients with wounds that involve the scalp, including primary wound repair, healing by secondary intention, and the use of skin grafts, local tissue flaps, regional myocutaneous flaps, and microvascular free flaps. Special attention is paid toward consideration of aspects of the reconstruction that affect the aesthetic outcome, including preservation of the hairline and hair follicle orientation, scar camouflage, avoidance of alopecia, and secondary restoration of alopecia.

Aesthetic subunits of the breast.

Surgery for breast cancer has traditionally addressed the breast as if it were a geometric circle with associated quadrants. Cosmetic reconstruction should not follow geometric patterns but should emphasize perceived contour and normal clothing lines. Similar to nasal reconstruction, a subunit principle in breast reconstruction planning may significantly improve the appearance of the result. To better identify the most aesthetic subunits for breast reconstruction, 10 years of autogenous reconstruction in 264 patients was reviewed. Various patterns of breast subunits were identified. The more favorable subunits of the breast in terms of postoperative appearance and camouflage of scars included the nipple, areola, and expanded areola subunits. For larger skin defects, the best subunits were the inferolateral, lower half, and a total breast subunits. Dividing the breast into reconstructive subunits that are to be replaced as a whole rather than as a patch gives superior results. Photographed examples of aesthetic subunits illustrate the placement of scars along natural lines that maximize the advantages of camouflage afforded by clothing.