IMPORTANCEThe process of Z-plasty scar revision breaks up a linear scar into multiple parts with the purpose of camouflage and improvement of the cosmetic appearance of surgical scars. Although this postulation guides the practices of many reconstructive surgeons, few studies support improved aesthetic outcomes.OBJECTIVE To compare the perceived cosmetic appearance of linear scars vs zigzag scars by the general public.
DESIGN, SETTING, AND PARTICIPANTSA computer-generated image of a mature scar was designed in linear and zigzag configurations and overlaid on the faces of standardized headshots of 4 white individuals. Twelve sets of images of linear vs zigzag scars were arranged in side-by-side comparisons in an Internet-based national survey. Respondents rated each scar on the 10-point Patient and Observer Scar Assessment Scale, where a lower score indicated likeness with normal skin and a higher score, the worst scar imaginable.
MAIN OUTCOMES AND MEASURESAesthetic rating of scars by the survey respondents. RESULTS Eight hundred seventy-six participants responded to the survey (24.5% response rate); of these, 810 completed the survey (379 men [46.1%] and 443 women [53.9%]; 148 [18.0%] were 18 to 29 years, 171 [20.8%] were 30 to 44 years, 290 [35.3%] were 45 to 60 years, and 213 [25.9%] were older than 60 years). Significantly lower scores and better perceived cosmetic outcomes were found for linear scars compared with zigzag scars in every assessed group of images on the Patient and Observer Scar Assessment Scale (mean [SD] scores, 2.9 [1.6] vs 4.5 [2.2], respectively; P < .001).
CONCLUSIONS AND RELEVANCEThe lay public has a significantly better perception of the appearance of linear scars compared with zigzag scars in 3 facial locations (temple, cheek, and forehead) of white patients in various age groups.LEVEL OF EVIDENCE NA. sweepstakes entries. Routine benchmark surveys are administered to ascertain that respondents are representative of the US population as a whole. Image sequence and question order were randomized to minimize order bias.Patient and Observer Scar Assessment Scale ratings were statistically significantly lower for linear scars than zigzag scars for every assessment ( Table 2). The primary outcome-the difference between mean scores of linear and zigzag scars for all models-was also highly significant (mean [SD] scores, 2.9 [1.6] vs 4.5 [2.2], respectively; P < .001).
