Perceptions of Aesthetic Outcome of Linear vs Multiple Z-Plasty Scars in a National Survey

Abstract

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).

Continuous tension reduction technique in facial scar management: A comparison of W‐plasty and straight‐line closure on aesthetic effects in Asian patients

“…Some studies have found that the W‐plasty technique is significantly better than SL resection, and other studies have shown that there is no statistical difference between the two methods of skin closure. 4 , 8 , 9 In our previous study, we confirmed that the technique of CTR with a tension offloading device could effectively decrease the tension across the surgical incision and significantly reduce the keloid recurrence rate and achieve therapeutic efficacy. 13 In the research presented here, we first introduce the concept of CTR into traditional W‐plasty, aiming to overcome the drawbacks of using W‐plasty technology alone.…”

“…W-plasty has achieved good clinical results, especially in patients with scars not aligned to an RSTL on curved surfaces, because many small segments of the Wplasty do run parallel with RSTLs and broken-line scars are easily accepted by the human eye. 7,8 Previous studies have shown that the W-plasty technique demonstrates a better mean scar appearance compared with straight-line (SL) closure. 9 W-plasty redirects the forces of contracture, converting the lines of distraction from perpendicular to oblique and relieving the bowstringing effect of linear scars.…”

“…The W‐plasty procedure, which means to apply a series of small triangular advancement flaps on both sides of the scar, has been widely used in facial scar revision. W‐plasty has achieved good clinical results, especially in patients with scars not aligned to an RSTL on curved surfaces, because many small segments of the W‐plasty do run parallel with RSTLs and broken‐line scars are easily accepted by the human eye 7,8 . Previous studies have shown that the W‐plasty technique demonstrates a better mean scar appearance compared with straight‐line (SL) closure 9 …”

Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers

“…Patients with facial skin cancers returning for follow-up after MMS were asked to rate their postoperative scar appearance at their 1-to-2-week and 3-month visits using the Patient and Observer Scar Assessment Scale (POSAS). 9,10 The POSAS has multiple components, but for this study, only the "overall opinion" scale was used. Scoring was performed on a scale of 1 to 10, where 1 is synonymous with "like normal skin" and 10 to the "worst scar imaginable," such that higher scores represent a worse perception of scar appearance.…”

Scar Revisions

“…12,48,49,53 Ratnarathorn et al reported that the participants of their study preferred the appearance of linear scars to irregular scars created by Z-plasty. 57…”