scar revision on face laceration

My mother (63yo female) was involved in a MVA 2 months ago. She suffered a blow to the head causing a basilar skull fracture, left temporal bone fracture, and a long laceration on the left side of her face on her frontal bone going all the way down to her left cheek bone. Her left eye was unharmed and the ER plastic surgeon was able to reconstruct her left eyelid, but she has some scarring and protuberance was formed in the orbital area. Also half her eyebrow is unmobile due to nerve damage. Anyway, we already talk to a plastic surgeon he told us he wanted to do an upper & lower eyelid lifting and that he would use a technique called the Z-incision revision scar, that would actually lenghtenght her scar by 20-40% leaving a z-incision scar 3x as long. Do you think a z-incision revision scar is the right technique for this type of laceration? do you believe she should have this plastic surgery done right away or should she wait 6 months to see how the laceration heels?, she is healing just fine right now, her scar is light pink and is slowly fading away.

[Howard Rosenberg, MD]

The procedure discussed with your mom was a scar revision with an associated z-plasty.  The z-plasty can change the direction of a scar and lengthen it.  Since she is only two months post-trauma, I would recommend that any consideration for revision wait at least six to nine more months to allow scar maturation and maximize the results of any scar revision.