Aesthetic characterization of cutaneous scars

The aesthetic characteristics of a scar are mostly subjective, since identical-looking scars can be absolutely satisfactory for one person and cause depression in another. On the other hand, this concept is objective, since it can be assessed using objective criteria. The latter primarily include how noticeable the scar is to others and to what extent it changes the perception of the contours of the face (body, limb). From this point of view, all scars can be conditionally divided into aesthetically acceptable and aesthetically unacceptable.

Aesthetically acceptable scars can be divided into hidden (inconspicuous) and barely noticeable. Hidden scars are located in such a way that they are practically invisible, especially to the unprofessional eye, and can only be detected upon detailed examination (within the scalp, in natural folds of the skin, behind the tragus of the auricle, on its back surface, etc.).

Inconspicuous scars differ from hidden ones in their minimal size (point and small normo- and atrophic scars) and their location (on the thighs and abdomen within the "swimming trunks" zone, on the foot, palmar surface of the hand and in other anatomical zones).

The term "barely noticeable" is largely arbitrary and may indicate not only that the scar is barely noticeable to others, but also that the patient himself pays little attention to it. Ultimately, it is the patient's position that largely determines whether or not to include a scar in the category of aesthetically acceptable.

Aesthetically unacceptable scars. The inclusion of a scar in the category of aesthetically unacceptable can be both objective and subjective.

Thus, scars of significant length and width, hypertrophic and keloid types, located on open areas of the body and especially on the face are objectively "unaesthetic". At the same time, even hidden scars may not suit patients with increased requirements.

That is why detailed information to the patient about the nature of future scars plays an extremely important role in the work of a plastic surgeon.

In this regard, a preoperative examination of the patient plays an important role, asking whether he or she has had any previous surgeries or injuries. The presence of normo- or atrophic scars in the patient indicates a normal reaction of the patient's tissues to the injury. Hypertrophic and especially keloid scars may be a good reason to refuse cosmetic surgery.

If the patient has not been operated on during his life and there are no scars on his body at all, then their nature in the future should be predicted very carefully. In this case, the patient should be warned (including in writing) that the formation of hypertrophic and even keloid scars is theoretically possible, although in practice it is extremely rare. Direct, although not absolute evidence of a normergic tissue reaction to trauma can be the absence of keloid scars in pierced earlobes.

The next step in informing potential patients is a brief description of the scars that typically form after a particular operation.

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