Depressed Scars Research Articles

The Long-Term Host Response to Liquid Silicone Injected during Soft Tissue Augmentation Procedures: A Microscopic Appraisal

Silicone has a long history of use as a soft tissue filler. As a contribution to the clarification of the role and fate of this material when used as a filler in soft tissue augmentation techniques, 35 skin biopsies were examined by light microscopy. These biopsies were obtained from target areas where liquid silicone had been injected in 25 patients between 1 and 23 years prior, for the correction of depressed scars on the face. The microscopic study revealed in 100% of the cases the continued presence, in significant amounts, of the silicone previously injected into the target areas, where it failed to elicit any significant adverse reaction. Owing to its high permanence and to its inertness, reflected by the lack of any adverse reaction to its presence in the target site, silicone should be regarded as a valuable filler, at least for the correction of small depressed facial scars.

The Long-Term Host Response to Liquid Silicone Injected during Soft Tissue Augmentation Procedures

BACKGROUND Silicone has a long history of use as a soft tissue filler. Materials and Methods As a contribution to the clarification of the role and fate of this material when used as a filler in soft tissue augmentation techniques, 35 skin biopsies were examined by light microscopy. These biopsies were obtained from target areas where liquid silicone had been injected in 25 patients between 1 and 23 years prior, for the correction of depressed scars on the face. RESULTS The microscopic study revealed in 100% of the cases the continued presence, in significant amounts, of the silicone previously injected into the target areas, where it failed to elicit any significant adverse reaction. CONCLUSION Owing to its high permanence and to its inertness, reflected by the lack of any adverse reaction to its presence in the target site, silicone should be regarded as a valuable filler, at least for the correction of small depressed facial scars.

435: The Use of Gynecologic Laparoscopic Scissors to Release Large Depressed Scars During Abdominal Liposuction

435: The Use of Gynecologic Laparoscopic Scissors to Release Large Depressed Scars During Abdominal Liposuction

Syndrome de l’hamartome comédonien

Nevus comedonicus is a rare disease and diagnosis is made chiefly on clinical grounds. It may occur in isolation, or in rare cases, it may be combined with other congenital malformations to constitute nevus comedonicus syndrome. We report a case of this disease herein. A young woman aged 20 years presented with cribriform plaques since birth resulting from the juxtaposition of depressed pigmented scars and comedonic lesions. These lesions were found on the entire face, the left hemithorax and the left upper limb, with well delineated distribution stopping at the median line. The patient's history revealed congenital cataract of the left eye operated at the age of 10 years. Clinical diagnosis of nevus comedonicus was confirmed by histological examination of the skin. Laboratory screening for other associated malformations revealed no abnormalities. Oral retinoids were proposed but the patient refused all treatments. Nevus comedonicus is one of the rarest forms of cutaneous nevus. This case is original as regards the extent and topography of the nevus covering the left side of the patient's body and its association with congenital cataract potentially indicating nevus comedonicus syndrome. This syndrome is extremely rare and belongs to a large group of epidermal nevus syndromes characterised by association of nevus and extracutaneous malformations, particularly ocular, skeletal and neurological.

Simple Epicanthoplasty with Minimal Scar

Asian eyelids are characterized by the presence of an epicanthal fold and the absence of a supratarsal fold. Because many Asians desire wide, open, large eyes, elimination of the medial epicanthal fold along with double-eyelid operation frequently are performed for cosmetic improvement. Medial epicanthoplasty enhances the aesthetic result by lengthening the palpebral fissure horizontally, thus producing larger-looking, open eyes. This study describes the author's method for correcting the medial epicanthal fold. Simple epicanthoplasty with minimal scar, the author's method, was performed to correct the epicanthal folds of 52 patients from December 2001 to August 2005 at the Catholic University of Korea Kangnam St. Mary's Hospital. This technique yielded excellent results in terms of inconspicuous scar and long-lasting open medial canthal area during a 3-year follow-up period. Of the 52 patients, 2 showed a depressed scar on the lower eyelid, which was corrected satisfactorily. Many procedures have been introduced to correct the epicanthal fold, but scarring or undercorrection remains as a dilemma for surgeons to overcome. Simple epicanthoplasty with minimal scar is a simple, easy-to-follow, and effective method that can be applied to various cases of medial epicanthal fold.

Hypotensive Splenic Infarction: A Case Report

Splenic infarction occurs when parenchymal ischemia of the spleen is evoked by an occlusion of the arterial or venous circulation. The most common causes include infiltrative hematological disease and thromboembolic conditions, but a hypotensive splenic infarction may be a rare cause of splenic infarction. A 62-year-old female patient presented with a hypotensive splenic infarction after massive bleeding. CT showed geographic low-density lesions in the central part of the spleen on the tissue equilibrium phase of dynamic CT. Usually, a depressed scar occurs in the course of healing of a splenic infarction. However, in this case recovery of blood flow and regeneration of the infarcted spleen was seen during the follow-up CT scans. We report a case of hypotensive splenic infarction with a review of the literature.

Surgical Pearl: Running horizontal mattress suture with intermittent simple loops

Wound eversion is critical in creating a superior surgical scar because the everted wound edges eventually flatten to yield a smooth surface and a thin scar. Opposing wound edges without eversion may produce a visibly depressed scar. Closure of the skin with two layers of sutures (ie, dermal and percutaneous sutures) is usually needed to achieve the appropriate eversion. Although the majority of the workload for attaining the desired outcome is shouldered by the buried dermal sutures, meticulous placement of the percutaneous suture will enhance the eversion and approximation of the wound edges.

Tetracycline/doxycycline-induced cutaneous depressed pigmentation

Pigmentary disorders are recognized adverse effects of tetracyclines. Unlike minocycline, which occasionally causes black pigmentation of a variety of tissues, tetracycline itself or doxycycline is rarely attributed to the pigmentation of skin. Herein, we report the first case report of blue-black discoloration developed within depressed acne scars following tetracycline/doxycycline therapy for acne.

Reconstruction of a natural-appearing umbilicus using an island flap: case report

A case of successful reconstruction of the umbilicus using a depressed scar in an 11-year-old girl with a large and rigid scar spreading around the centre of the abdominal wall is presented. The anatomical umbilicus was replaced by a large scar after a previous surgery for umbilical cord hernia. The difficulty of the conventional method compelled us to use a distant scar dimple as an island flap. In addition, the three-dimensional morphology of the umbilicus could be reproduced by rolling a spindle island flap into a cone. Postoperatively, the reconstructed umbilicus has remained deep and aesthetically well shaped.

Chronic Leg Ulcer Caused by Mycobacterium immunogenum

Rare tropical skin diseases are seen more frequently in Western countries because of the increased popularity of visiting tropical regions. A 55-year-old white man developed a painless leg ulcer after traveling in Guatemala and Belize. A mycobacterium was cultured from a biopsy specimen and was identified as Mycobacterium immunogenum by 16S recombinant deoxyribonucleic acid sequence analysis. The leg ulcer healed after 6 months of compression therapy and hydrocolloids; a hypopigmented depressed scar remained.

Idiopathic Disseminated Comedones in a Child

An 11-year-old girl had an uncountable number of hyperkeratotic comedo-like lesions on her shoulders, arms, buttocks, and thighs, present for 5 years. Depressed scars, cysts, and small purulent nodules were observed in involved areas. Her 6-year-old brother does not have similar lesions. Other members of her family were not available for examination. Light microscopy showed dilated elongated infundibula filled with corneocytes and arranged in a lamellated pattern. A peri-infundibular inflammatory infiltrate was present.

Le « reversed dermis flap » bientôt détrôné comme lambeau de comblement ?

In his paper entitled “The reversed dermis flap” published in 1978, Pakiam explained the advantages of de-epithelialising local flaps and applying them dermis-side down. We present a ten-year series of 107-reversed dermis flaps used to raise depressed scars. There have been no significant complications in this series except two cases of infection and six cases of postoperative haematoma. All patients were satisfied with the cosmetic outcome. We do not use this flap as much as we used to since Coleman demonstrated how efficient lipostructure ® could be especially when applied to thin depressed scars. The reversed dermis flap remains invaluable in cases of widespread scars or when lipostructure ® is dangerous or impossible.

The Use of Restylane in Cosmetic Facial Surgery

The injection of filler substances is one of the most common procedures in cosmetic surgery. In 2003, the number of nonsurgical procedures increased 22% from 2002. 1 American Society for Aesthetic Plastic Surgery. Available at: http://www.surgery.org/press/statistics-2003.php. Accessed March 28, 2004 Google Scholar The last 5 years have brought about an extreme interest in minimally invasive rejuvenation techniques. The ease and popularity of Botox (Allergan Inc, Irvine, CA) has popularized and expanded the use of rejuvenative injections. 2 Niamtu J. Botulinum Toxin A A review of 1,085 oral and maxillofacial patient treatments. J Oral Maxillofac Surg. 2003; 61: 317 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar , 3 Niamtu J. The use of botulinum toxin in cosmetic facial surgery. Oral Maxillofac Surg Clin North Am. 2000; 12: 596 Google Scholar , 4 Niamtu J. Aesthetic uses of botulinum toxin A. Oral Maxillofac Surg. 1999; 57: 1228 Abstract Full Text PDF Scopus (40) Google Scholar This, coupled with the introduction of multiple new products, has increased the number of treatment options for cosmetic patients. Multiple substances are available to inject into facial wrinkles, folds, lips, traumatic defects, and depressed scars, and to augment facial form (Table 1). Table 1SOME OF THE NEWER FILLER SUBSTANCES CURRENTLY IN USE AROUND THE WORLD Product Source Manufacturer Restylane Non-human hyaluronic acid Medicis Inc, Scottsdale, AZ Restylane Fine Line Non-human hyaluronic acid Medicis Inc Perlane Non-human hyaluronic acid Medicis Inc Cosmoplast Human-derived collagen Inamed Inc, Santa Barbara, CA Cosmoderm Human-derived collagen Inamed Inc Radiesse Hydroxyappetite BioForm Medical Inc, San Mateo, CA Hyalform Hyaluronic acid Inamed Inc Artecol PMMA beads in hyaluronic acid Artes Medical Inc, San Diego, CA Artefil PMMA beads in bovine collagen Artes Medical Inc Silikon Liquid injectable silicone Alcon Labs Inc, Ft. Worth TX Sculptra Polylactic acid Aventis Pharm Inc, Bridgewater, NJ Isolagen Cultured autologous fibroblasts Isolagen Inc, Huston, TX Autologen Autolougous collagen Collagenesis Inc, Beverly, MA Joseph Niamtu. Restylane in Cosmetic Facial Surgery. J Oral Maxillofac Surg 2006. Open table in a new tab Joseph Niamtu. Restylane in Cosmetic Facial Surgery. J Oral Maxillofac Surg 2006.

Treatment of Acne Scars with Liquid Silicone Injections

This article addresses the use of liquid injectable silicone as both an immediate and long-lasting treatment for broad-based, depressed acne scars. The only filler substance that maintains precision and permanence in improving and/or correcting these types of acne scar defects is medical-grade liquid silicone. We describe five patients with a history of acne scarring who showed improvements from injections of liquid silicone at the initial treatment session and lasting over a 10-, 15-, and 30-year follow-up period. Monthly liquid silicone injections using a technique known as the microdroplet, multiple-injection approach. This article documents the safety, effectiveness, and precision of silicone in addition to highlighting the fact that its permanence is what distinguishes it from other filler materials. As a precise and permanent filling substance used for soft tissue augmentation, liquid injectable silicone can improve and/or eliminate depressed, broad-based acne scars through a technique known as the microdroplet, multiple-injection

Laser Resurfacing of Smallpox Scars

At the beginning of the twentieth century, smallpox affected every continent and country in the world, but over the first half of the twentieth century this disease was eliminated in most countries, including Korea, thanks to the World Health Organization's eradication program. Most survivors of smallpox have facial scars with a distinct cobblestone appearance. Though most smallpox scar patients want smooth skin, it is difficult to achieve good results with dermabrasion or chemical peeling. Recently, with advances in laser technology, laser resurfacing has become more effective and safer than conventional methods because of its depth control precision. Between September of 1996 and August of 2001, 76 patients with significant smallpox scars were treated with a high-powered carbon dioxide laser at Korea University's Anam Medical Center. Different resurfacing methods, such as even-depth resurfacing, the shoulder technique, and the laser punch-out method, were applied according to the depth and pattern of the scars. The authors found that 54 patients (71 percent) had excellent or good results. The sharply demarcated margins of the smallpox scars faded out, and the depth and width of the depressed scars improved in most patients. Only seven patients sustained hypertrophic scarring after laser resurfacing, but this was resolved by intradermal triamcinolone injections. Prolonged erythema occurred in six patients (7.9 percent) and hyperpigmentation occurred in 15 (19.7 percent), but the erythema disappeared spontaneously and the hyperpigmentation could be readily managed with postoperative skin care. Laser resurfacing was found to be a useful treatment method for smallpox scarring.

Congenital Erosive and Vesicular Dermatitis with Reticulated Scarring

Congenital erosive and vesicular dermatitis healing with reticulated scarring is a rare entity presenting in the early childhood. It is manifest as crusted erosions and vesicles that heal relatively rapidly forming unique reticulated scars. Cohen first reported this entity in 1985 and since then, only ten patients have been reported. We herein report an additional case of this extremely unusual disorder. A 23 month‐old girl who was noted to have “rashes” and sores over her body at birth. Her twin sister was unaffected. She was born preterm at 35 weeks gestation but her developmental milestones have been within normal range. On exam she had depressed and somewhat macerated erosions and erythema primarily on her trunk, axillae, and ears. No vesicles or bullae were present. The skin biopsy showed neutrophilic and eosinophilic infiltrates with abundant crusting. Cultures were negative for infectious agents and direct immunofluorescent studies were also negative. Over the next two years she periodically developed erosions which healed quickly. However, the depressed reticulated scars have persisted and are more sensitive to sun exposure. This scarring disorder may be associated with mild ongoing blistering and must be distinguished from other congenital blistering disorders and immunobullous diseases. The pathophysiology remains unclear.

Leave the Fat, Skip the Bolster: Thinking outside the Box in Lower Third Nasal Reconstruction

Defects of the lower third of the nose often present especially challenging reconstructive dilemmas. The surrounding skin to match is often thick, sebaceous, and sun damaged, none of which characterizes the historically ideal periauricular donor skin for grafting. The surrounding nasal skin is quite stiff, precluding very small local flaps. To avoid the "misplaced patch" appearance of most classic full-thickness grafts to this area or the depressed scar of an elliptical excision, many surgeons turn to larger local or regional flaps. These provide not only skin color and texture match but also the necessary several millimeters of subcutaneous fat necessary for proper tip aesthetics. Many defects of the lower third are small, making many surgeons reluctant to employ these larger flaps with their long scars and potential to twist or distort delicate tip or ala anatomy. The author has sought a means to transport skin and subcutaneous fat for lower third nasal defects outside of flaps. On the basis of the superiority of nasolabial fold scars and a vast positive experience in the literature utilizing skin and fat composite grafts with no bolsters, the author applied these techniques to 33 lower third nasal defects in 29 patients. Of 33 grafts varying in size from 4 mm circular to 17 mm x 16 mm and retaining 1 to 5 mm of fat, no grafts were lost. Four grafts developed a 30 percent area or less of central necrosis resulting in localized depression. Three of these four grafts were in active smokers and the fourth graft was in a former smoker. Aside from these four grafts and one with considerable excess fat early in the series, contour was good to excellent. Hypopigmentation is still common but improves with time. Easily performed composite grafts effectively carry the necessary fat for aesthetic reconstruction and do not risk long scars on the nose and twisting of the tip and ala that can result from flaps. Revisions are infrequent and extremely simple when indicated.

Surgical Pearl: Bolster dressing for second-intention healing of Mohs micrographic surgical sites

B olster dressings have previously been described as a dressing for both splitand fullthickness skin grafts. Second intention has been shown to be an efficacious and cosmetically acceptable means of reconstruction, and can be the preferred method in some cases. Healing and cosmesis can be excellent, especially for small lesions and defects in concavities. Locations amenable to secondary-intention healing include the conchal bowl, posterior auricle, temple, forehead, and antihelix. In addition, candidates for secondaryintention healing include patients with coagulation disorders or on anticoagulant medications, and the elderly who may not tolerate extensive procedural repairs. Rates of infection with secondary-intention healing are as low as 0.2% with antibiotic ointment on the dressing. Complications during secondary healing can include hemorrhage, infection, retraction, telangiectasia, depressed scarring, and delayed healing. In addition, patients often have difficulty managing extended periods of exudates as the wound heals. We have had excellent results with application of tie-over bolster dressings for secondary-intention healing sites. There are 2 potential advantages to this technique: reduction of postoperative bleeding and exudate; and reduced manipulation by patients. The illustrative case is secondary-intention healing of the conchal bowl.

Split sternocleidomastoid muscle repositioning for correction of depressed post-tracheostomy scar and tracheal tug.

One important complication of tracheostomy procedure is the depressed scar left after the airway is removed. The problem is more challenging for the surgeon if tracheal tug accompanies. Six male patients with unaesthetic, depressed tracheostomy scars due to late removal of tracheostomy tubes after maxillofacial high-velocity gunshot injuries were treated. The patients' age ranged from 20 to 23 years, with an average age of 21 years. The mean tracheostomy tube removal time was 18 days (range, 9 to 34 days) postoperatively. The mean scar dimension was 13.4 mm x 14.4 mm x 4 mm (width, length, and depth, respectively). All patients showed tracheal tug and complained of swallowing discomfort. Under local anesthesia, split sternocleidomastoid muscle flaps were used bilaterally following excision of the skin scars and covered by adjacent skin flaps. The mean follow-up was 18 months. Cosmetic and functional results were satisfactory for all patients. Dysphagia disappeared in all patients following surgery. This technique is useful and easy to perform for reconstruction of complex post-tracheostomy scars.

Overlapping double platysma flaps for the correction of post-tracheostomy scars

Many surgical procedures have been described for the correction of the depressed, fixed post-tracheostomy scar, which produces a “tracheal tug” during swallowing. The purpose of this article is to review the common techniques and to present a new and simple surgical procedure for the correction of this deformity. During this procedure, the retracted scar is released from the trachea, left superior and right inferior based platysma muscle flaps are sutured in an overlapping fashion to provide thick and adequate soft tissue coverage over the tracheostomy site. This paper includes the presentation of two patients with a follow up of 6 and 12 months respectively, in which the tracheal tug and depressed scar were eliminated in a satisfactory manner.