Periocular scarring

Scar formation is an inevitable outcome of invasive periocular procedures; the best surgeons do not provide scar-less care, but rather understand the intricacies of appropriate scar camouflage. An expert surgeon, while well versed with the full-repertoire of revision techniques, understands that the most successful approach to revision is avoiding its necessity entirely. When suboptimal outcomes arise, thoughtful scar analysis should be employed prior to embarking on a revisionary procedure. There are several distinct categories of scar, including hypertrophic/keloidal, hypotrophic, inverted, red, and contracted scars; each requires a tailored approach to revision. With the exception of significant function-limiting scars, minimally invasive techniques-watchful waiting, scar massage, silicone gel sheeting, intralesional injection, light-based interventions, and dermabrasion-should be optimized prior to delayed surgical revision at 6-12 months. Surgical approaches to scar revision vary based on scar quality, location, and sequalae; revisionary options include: pincushioning debulking, direct scar incision, broken line closure, scar lengthening procedures (Z-plasty, V-Y/Y-V advancement), ectropion repair techniques, and the dreaded "do over. " Once mastered, these concepts will ultimately lead the surgeon to obtain improved cosmetic and functional results, even in the most challenging clinical scenarios.