The W Plastic Scar Revision

The W Plastic Scar Revision Technique described in Albert Borges’ treatise “Elective Incisions and Scar Revision” (1969) is a virtual masterclass on the above problems.

The siting of an incision is often predetermined by the problem needing to be addressed. While the simplest incision would be a curved or straight one closed primarily, the length of the incision often determines the outcome.

A short incision gives a satisfactory long-term result while a long one eventually ends up bowstringing, with a depression in the middle. The long scar, besides bowstringing, also catches light and hence is more obvious.

A good technique to repair these scars would be to revise the scar with the Borges technique of the W plastic repair in which the scar is excised in a zigzag pattern, breaking up the bowstring effect and by changing the direction of the scar.

The “W” effect results in an a dovetailing of multiple short scars which break up a long scar into multiple short lines to improve contour and appearance, as seen in figures 1 to 4 below.

Figure 1 - A depressed scar one year after excision of a lesion in the anterior third of the horizontal ramus of the mandible

Figure 1 – A depressed scar one year after excision of a lesion in the anterior third of the horizontal ramus of the mandible

Figure 2 - The outline of a W plastic scar excision (from a different patient)

Figure 2 – The outline of a W plastic scar excision (from a different patient)

Figure 3 - The W plastic scar revision before suture removal on the patient in figure 1

Figure 3 – The W plastic scar revision before suture removal on the patient in figure 1

Figure 4 - The patient in Figure 1, six months after W plastic scar revision

Figure 4 – The patient in Figure 1, six months after W plastic scar revision

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