Background
This patient sustained a forehead laceration (cut) caused by glass. When I first assessed her, four months after the injury, she had struggled to find specialist help for the problems associated with her scar.
Presenting problems
The scar and surrounding tissues were swollen, creating a prominent raised ridge across the forehead. The swelling, together with some scar adherence, was also pulling her eyebrow upwards, affecting facial symmetry.
Clinical assessment and findings
On examination, there was substantial localised oedema (swelling) around the scar. The tissue was very turgid, meaning it felt unusually firm and tense, with reduced mobility.
There was also some scar adherence to the underlying tissues, contributing to the altered forehead contour and elevated eyebrow position.
Scar management
Treatment involved four sessions combining manual scar mobilisation and LPG, a mechanical method of tissue mobilisation.
The focus was on reducing localised oedema, improving tissue mobility and softening the raised, firm area around the scar.
Outcomes
After four treatments, the raised area above the eyebrow had reduced considerably. The tissue was noticeably softer and more mobile, and the forehead contour was much flatter.
As the swelling reduced and scar mobility improved, the eyebrow moved towards a more symmetrical position.
The photographs show the changes achieved during this short course of scar rehabilitation, with no other treatments undertaken during this period.
Although these improvements were encouraging, further treatment was required, including input from other members of the specialist scar team, to achieve the best possible final outcome.
What can we learn from this case?
Swelling can contribute significantly to scar appearance and contour. Raised or firm scar tissue is not always caused by fibrosis alone. Localised oedema can contribute to tissue firmness and altered contour, and may respond to specialist scar rehabilitation.
Scar rehabilitation can influence surrounding structures. In this case, reducing swelling and improving scar mobility also helped restore a more symmetrical eyebrow position.
Different aspects of a scar may require different treatments. Manual mobilisation and LPG addressed the swelling and tissue mobility, but other interventions were needed to address the remaining scar characteristics.
Finding the right specialist input can make a difference. This patient had struggled to access scar-specific help. A specialist assessment can identify the different factors contributing to a problem and guide treatment, including when input from other members of the scar team is needed.