Laceration (Face)

Lacerations can occur on various body parts, ranging from minor to severe, depending on the wound’s size, depth, and location. Given their prominence, facial lacerations can have particularly strong emotional and psychosocial effects. In severe cases, facial lacerations can also result in significant functional complications, such as facial nerve damage (leading to partial or complete facial paralysis) or the impairment of delicate structures such as the eyelids, ears, salivary glands, or lips.

Treating facial lacerations is often complex, requiring the expertise of a skilled and artistically inclined plastic surgeon or facial plastic surgeon. If the facial nerve or smile mechanism is affected, consultation with a facial nerve expert specializing in facial reanimation is crucial. For complex eyelid lacerations, the specialized skills of an oculoplastic surgeon may be necessary to ensure optimal functional and aesthetic outcomes.

After laceration repair, the area can heal perfectly well, with minimal scarring, or result in visible scars that may be wide, depressed, discolored, “keloid”, or “hypertrophic.” The outcome largely depends on factors such as the wound’s severity, the repair technique used, post-operative scar management and the individual’s healing process.

Keloids are the result of wound healing “gone overboard,” which causes the scar to extend beyond the original wound and create raised, discolored areas that can be a cosmetic concern or even cause discomfort. Darker-skinned individuals are more likely to develop keloids due to genetic factors and increased melanin production, which can result in an overproduction of collagen during the skin’s healing process. Hypertrophic scars can look similar to keloids (raised and red). Still, there are key differences: hypertrophic scars remain within the limits of the original injury site and typically improve in appearance over time.

Ultimately, lacerations are best treated by meticulously closing them with fine, thin sutures using plastic surgical techniques. These techniques enable the surgeon to approximate jagged wounds precisely and reduce wound tension, resulting in the thinnest and most inconspicuous outcome.

Scarring is a natural part of the healing process, but certain scars can be more prominent and distressing than others. Minimizing scarring is key to effectively treating lacerations, especially on the face, given its crucial role in socializing and communication.

Even with the most meticulous closures, visible scarring can occur, especially in high-stress areas. After a cut, the skin edges often pull apart due to the skin’s natural elasticity, which increases wound tension. This stress on the wound is a primary reason why scars from lacerations may not heal well. To prevent visible scarring, keloids, and hypertrophic scars, it is crucial to close all lacerations and wounds promptly with a tension-free approach. The skin edges must be neatly aligned, and multiple layers of suturing may be necessary.

For toddlers and very young children, dissolvable sutures are preferable for skin closure to avoid the trauma associated with suture removal. Tissue adhesives such as Dermabond™, Histoacryl®, and SurgiSeal® can also be considered for small, clean, low-tension lacerations, offering a quick, painless resolution without the need for local anesthesia. Although tissue adhesives are good alternatives for younger children and select adults, there is a slightly higher chance of the wound separating than traditional sutures. External sutures and tissue adhesives should not be used together. (Sutures can disrupt the adhesive’s ability to form a secure bond, reducing its effectiveness and potentially leading to a reopening of the wound).

Utilizing silicone sheets or gels, pressure therapy, and avoiding unnecessary piercings are effective strategies for minimizing scars after laceration repair. If a keloid or hypertrophic scar does form, treatments such as corticosteroid injections, laser therapy, or surgical removal, followed by preventive care, can help manage and reduce their appearance.

Depressed scars are best treated with a combination of techniques such as dermal fillers, microneedling, laser therapy, or surgical subcision, tailored to the specific needs of the patient to improve skin texture and appearance.

Before you go

While most body lacerations are effectively repaired in urgent care or emergency room settings, facial lacerations often necessitate the specialized skills of a plastic surgeon, facial plastic surgeon, oral maxillofacial surgeon, or oculoplastic surgeon. These experts possess advanced training in facial anatomy and aesthetics, ensuring precise repair that minimizes scarring and preserves function and appearance. Their expertise is crucial for complex facial injuries involving delicate structures like the facial nerve, eyes, lips, or nose, where meticulous technique is essential for optimal healing and cosmetic outcomes.

The timing of laceration repair is also crucial for optimal healing. It should ideally be performed within a few hours after the injury to reduce the risk of infection and ensure better cosmetic results. Delayed repair, especially after 12 hours, can increase the likelihood of complications and may result in less favorable healing and scarring.

During the procedure

Most laceration repairs are performed under local anesthesia. Your surgeon will assess the wound, irrigate the area with saline to clean debris and reduce the risk of infection, and meticulously close it while repairing any underlying tissues that may have been impacted. If the facial muscles or nerves have been cut, they should also be repaired at the same time by a facial reanimation and nerve expert.

Compared to adults, children undergoing laceration repair often require more specialized anesthesia management, including the potential use of sedation or general anesthesia, to ensure they remain still and comfortable during the procedure. This approach helps minimize anxiety and pain, facilitating a smoother and more effective repair process.

Laceration Treatment (Face) Aftercare 

In the first week following laceration repair, you may be given antibiotic ointment to be applied several times a day and asked to gently clean the crusting around the incision with saline or diluted hydrogen peroxide daily. Sutures are typically removed in five to eight days. Lacerations repaired with tissue adhesives are left alone.

Freshly treated and healing skin is more vulnerable to the damaging effects of UV rays. Sun exposure can delay the healing process, lead to hyperpigmentation, and worsen the appearance of any ensuing scars. It is imperative to stay out of the sun entirely or wear high-quality sunscreen and protective clothing to safeguard your skin during this critical period.

Long-term follow-up may be required, especially in the first year. This may involve using silicone scar gels or sheets, laser therapy, dermabrasion, microneedling, or even scar revision to achieve the best possible outcome. Final healing after laceration repair may take up to one to two years.