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.

A Note on Wound Preparation

Before any laceration is closed, the wound edges must be debrided. This is not optional as the edges of any traumatic wound are, by definition, devitalised tissue. Suturing devitalised edges together risks delayed healing, wound dehiscence and poor scarring. Debridement to healthy, bleeding tissue before closure is a fundamental step in plastic surgical wound management, and one that is not always performed when facial lacerations are handled in non-specialist settings.

The cases below illustrate further principles that build on this foundation: how wound shape affects repair strategy, and how scar placement can be as important as closure technique itself.

Case 3 - Stellate Chin Laceration from a School Fall

A teenager sustained a stellate (star-shaped) laceration to the chin after slipping on a wet floor at school. Stellate wounds, where the skin tears in multiple directions from a single point of impact, are caused by compressive forces against an underlying bony prominence, in this case the chin.

Before any repair, clinical assessment was performed to rule out mandibular fractures and base of skull injury. Both were excluded on examination, and the wound was assessed for depth and contamination.

The stellate pattern itself is not amenable to direct closure as the irregular, multi-limbed geometry would result in puckering, poor edge apposition, and a worse scar. The wound edges were therefore debrided to convert the stellate pattern into a clean linear wound, which was then closed primarily with fine sutures under loupe magnification.

Assessment and repair were completed in a single visit via my Doctor Stitch service, with no need for separate triage and referral steps. For injuries like this, where the wound needs specialist attention but does not require hospital nor theatre admission, the same-day model avoids unnecessary delays.

Case 4 - Suprabrow Laceration from Assault

A patient presented with a laceration above the eyebrow following assault. The wound did not involve the hair-bearing area of the eyebrow itself, which changes the repair goal: rather than aligning the eyebrow architecture, the priority here was scar placement and concealment.

The lateral frontalis muscle was also involved and required repair in layers. For skin closure, a surgical brow lift approach was used, thereby positioning the scar at the natural junction between the eyebrow and normal skin, where it would be least conspicuous at rest and effectively hidden. The frontalis repair also ensured no residual depression or contour irregularity as the wound matured.

The mechanism of injury is also relevant clinically. In this case, the laceration was from a sharp object that had gone through the skin layers down to bone therefore, wound debridement was necessary to further reduce the risk of infection as well.

Case 5 - A Delayed Thigh Laceration and the Case for Same-Day Repair

A young woman sustained a deep laceration to the thigh from a ceramic fragment. She was seen by a GP initially and managed conservatively. At a dressing change two days later, the wound was unchanged, as expected, since a laceration of any depth will not close spontaneously without repair.

She contacted a public hospital plastics department, but an immediate assessment could not be arranged. By the time she was seen through my Doctor Stitch service, the wound had been open for five days.

At this point, closure was not simply a matter of suturing the edges together. Five days of exposure means dried out wound edges, bacterial colonisation, and devitalised tissue at the margins. Thorough debridement was performed first, and the wound was then closed primarily, a decision known as delayed primary closure, where a wound is intentionally or circumstantially closed after the initial injury window, provided the wound bed is adequately prepared.

She returned ten days later for suture removal, with the wound fully healed.

The principle this case illustrates is twofold: first, that a wound left open does not improve on its own, it simply waits and if it heals, with a very poor scar; and second, that delayed presentation does not preclude primary closure, provided the wound is properly assessed and prepared. My Doctor Stitch same-day model exists precisely for cases that fall between the urgency threshold of A&E and the waiting times of an outpatient referral.

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 seemingly simple 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 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