Outcome of Beveled versus Vertical IncisionTechnique after Reconstructive or Aesthetic Facial Surgery

Abstract

Background: We suggest that the degree of scar improvement with a beveled incision technique with an angle of about 20 degrees to the skin can be translated for various reconstructions on the face and can be verified by a validated clinical assessment scale and histology. Methods: A total of 5 patients (2 men and 3 women) with a mean age of 68 years (range 54–84 years) undergoing elective surgeries on the face for tumor excision or cosmetic procedures were included. The beveled incision technique was compared with the conventional vertical incision (control group). Outcome measures were major and minor complications, pain and scar quality using the Patient and Observer Scar Assessment Scale, and histomorphologic scar assessment. Results: After a mean follow-up of 7.6 months (range 6–13 months), all patients healed uneventfully without pain, hypertrophic scars, or infection. We found a better overall Patient and Observer Scar Assessment Scale score in the beveled incision technique group (15 ± 3.4) compared with the conventional vertical incision group (18.4 ± 7.8, P = 0.7). Histomorphologic analyses showed after 6 months less scar zone, less inflammatory reaction, fewer macrophages, less foreign body reaction, and more hair follicles in the beveled incision technique group compared with the vertical incision group. Conclusion: We showed that the beveled incision technique using a 20-degree angle in elective surgeries on the face yields a cosmetic pleasant result for both the patient and the surgeon, which also goes in line with our histomorphologic analyses.

An Algorithm for Prevention of Unsightly Facial Scars Considering the Newest Research Insights

“…4). 23 If one considers the physiology of the wound healing and the role of the dermal layers within it, one recognizes the big advantage for wound healing by increasing the dermal wound layers. The three-dimensional structure of the dermis acts as a template for regulation of the properties of reparative cells.…”