A cut on the face heals into a scar that is permanent. How that scar looks is decided largely in the first repair: whether the edges were aligned, whether tension was taken by the deep layers, and whether landmarks like the lip border were matched exactly.
Facial wound repair is the careful closure of a cut on the face using plastic surgical technique: cleaning and removing any foreign material, closing in layers so the skin is under no tension, matching landmarks such as the lip border precisely, and using fine sutures removed early. It is best done within 24 hours. A well repaired facial wound usually needs no revision.
Every full thickness cut leaves a scar. Nothing makes it disappear. What determines whether it is a faint line or an obvious mark is largely technical, and most of it happens at the first repair.
Three things matter most. Tension is the first: a scar pulled apart by the tissue around it widens over the following months. Taking that tension with buried deep sutures, so the skin edges merely meet rather than being dragged together, is the single biggest factor.
The second is alignment. Facial landmarks are unforgiving. A one millimetre step in the vermilion border of the lip, where red meets skin, is visible across a room for life. The same applies to the eyebrow, the eyelid margin and the rim of the nostril. These are matched first, before anything else is closed.
The third is what is left in the wound. Grit, glass or road dirt not removed at the first wash becomes a permanent blue grey tattoo in the skin, and it is far harder to remove later than at the time.
Timing is flexible on the face. The blood supply is excellent, so wounds can often be closed up to 24 hours after injury, longer than would be safe elsewhere, and closure is usually preferable to leaving a facial wound open.
Almost any facial wound benefits from careful closure. A few need something more than stitches.
The wound is examined for depth, for nerve and duct injury and for foreign material. Facial movement and sensation are checked before local anaesthetic is given.
The wound is thoroughly irrigated and every fragment of grit or glass removed. This step prevents permanent traumatic tattooing.
Only clearly dead or crushed edges are trimmed. On the face, tissue is preserved wherever possible because blood supply is excellent.
Where the wound crosses the vermilion border, eyebrow or nostril rim, that point is aligned with the first stitch before anything else.
Deep tissue and dermis are closed with buried absorbable sutures so that all tension is taken below the skin.
Very fine sutures or tissue adhesive close the skin edges, to be removed at five to seven days.
Keep the wound clean and slightly moist with ointment. Sleep with the head elevated. Avoid facial expressions that stretch the wound where possible.
Sutures removed, early, to avoid stitch marks. Tapes may be applied to support the wound for a further week or two.
The scar becomes red and firm. This is normal and is the phase people find most alarming. Begin massage and silicone once fully healed.
The scar softens, flattens and fades. Final appearance is judged at around a year, and revision is considered only after that.
A well repaired facial wound usually heals to a fine line that becomes difficult to see after a year. It will never be invisible, and it goes through an ugly phase: scars are red, firm and at their most obvious between about four and twelve weeks, and that is normal rather than a sign of a poor result. Final appearance is judged at a year. Revision before then is usually premature, because most scars improve considerably on their own with sun protection and massage.
Small procedure, but a few things genuinely affect how the scar turns out.
Sun protection and scar massage are the two things patients control, and they matter.
Adhesive is excellent for small, clean, tension free cuts, particularly in children. It cannot take tension or align a layered wound, and used in the wrong wound it gives a worse result than proper suturing.
Almost all scars look worst between one and three months and improve substantially on their own. Revision before about a year usually means operating on a scar that was going to improve anyway.
On the face it just leaves permanent stitch marks. Strength is provided by the buried deep sutures; the skin stitches are only aligning the edges and come out at five to seven days.
Size is not the issue. Where the wound sits is. A small cut across the lip border needs more care than a larger one on the cheek.
Most facial scars that need revising were avoidable: closed under tension, landmarks not matched, or dirt left in. Getting the first repair right is far easier than correcting it a year later.
Repair of a traumatic facial wound is commonly covered by health insurance and by government schemes. Cost depends on the size and complexity of the wound and whether a general anaesthetic is needed, which is often the case in young children. A written estimate follows assessment, and emergency repair is not delayed for it.
Usually asked in the first hours, often by worried parents.
Ask your question →The sooner the better, and ideally within 24 hours. The face has an excellent blood supply, so a longer window is safe there than elsewhere on the body, but earlier closure gives a better result and a lower infection risk.
No. Any full thickness cut leaves a permanent scar. What good technique achieves is a fine, flat, pale line rather than a wide or stepped one. Most well repaired facial scars become hard to see after a year.
For a small, clean, tension free cut, adhesive is excellent and much less distressing. For a deeper wound, or one crossing the lip border or eyebrow, proper layered suturing gives a substantially better scar.
Almost certainly not. Scars are red, raised and at their most obvious between roughly one and three months. They then soften and fade over the following year. Judging the result early is the commonest reason people ask for unnecessary revision.
Yes, a great deal. Fine debris left in a facial wound becomes a permanent blue grey tattoo in the skin, and removing it later is far harder and leaves more scarring than cleaning it thoroughly at the first repair.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
