Facial Lacerations and Scars: Why Small Injuries Deserve Specialist Attention

In facial injuries, even the smallest cut can make a lasting difference - especially when it crosses a cosmetically sensitive area like the eyebrow or cheek.

Case 1 - The Eyebrow Cut at Dinner

One evening, I received a call about an adult female who had been enjoying dinner with friends. In a moment of overexuberance, a friend who’d had a bit too much to drink accidentally knocked her over. She fell and struck the edge of a step - sustaining a deep cut across her eyebrow.

At first glance, it might have seemed minor. But the alignment of the eyebrow is important - any discrepancy becomes obvious immediately, especially in the hair-bearing area.

What Makes Eyebrow Lacerations Special

The eyebrow is not just a patch of hair; it’s an anatomically defined landmark of the face. Each strand grows in a certain direction, and the underlying muscles (like the frontalis and corrugator) are closely related to how our facial expressions move.

When a cut crosses this zone, a few things must be checked carefully:

• Nerve function - especially the supraorbital (V1) branch, to ensure normal sensation to the forehead

• Muscle integrity - as an unrepaired muscle injury can leave a subtle but visible depression

• Hair-bearing alignment - to minimise the risk of scar alopecia, where hair fails to regrow properly along the scar line

I assessed her and decided to wash out and repair the wound under loupe magnification, so as to be as precise as possible, with fine sutures to minimise scarring.

Because facial skin heals quickly, stitches were removed in 5 days - early enough to prevent train-track marks, yet late enough to ensure adequate strength. She’s now healing well, with her eyebrow line intact and sensation preserved.

Case 2 - When Old Wounds Leave a Mark

Another patient had a facial scar from a cut several years ago that was left untreated and allowed to heal on its own. Over time, this left a slightly sunken and depressed scar that bothered her.

She’d undergone subcision previously in an attempt to lift the depression. On review, it was clear that the problem wasn’t just tethering - it was the absence of proper wound edge alignment from the start, which therefore limited the results of the subcision.

Treatment would now require surgical scar revision, with various possibilities including re-excision of the old scar and closure, or designing local flaps (much like origami) to incorporate removing the old scar and cleverly blend in the new one with the surrounding tissues.

These two cases highlight how the quality of initial repair determines the long-term outcome - and how even years later, careful revision can still make a meaningful difference.

Why Timing and Technique Matter

Facial wounds heal fast - but that’s a double-edged sword. When aligned well, they can become almost invisible. When not, even a “small” laceration can leave a noticeable mark, distortion, or depression.

Early assessment by a plastic surgeon ensures:

• Precise anatomical repair

• Correct tension along natural skin lines

• Reduced risk of scar widening or alopecia

• Follow-up care to support scar maturation and recovery

Takeaway

Even simple facial cuts deserve thoughtful attention. While any doctor can close a wound, a plastic surgeon focuses on restoring form, function, and finesse - often making the difference between a visible scar and a barely perceptible line.

If you sustain a facial laceration - especially around the eyebrow, cheek, eyelid, or lip - seek prompt assessment by a plastic surgeon. A few extra minutes of care at the start can minimise the risk of poor or adverse scarring later on.

Written by Dr Ng Zhi Yang, Singapore Plastic Surgeon