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Survey reveals public acceptability of facial linear scars compared with zigzag scars

Surveyed participants reported that they had a significantly better perception of the appearance of linear scars compared with zigzag scars in three separate facial locations, according to study results published in JAMA Facial Plastic Surgery.

Researchers used a computer-generated model of a mature scar in both linear and zigzag fashion, which was overlaid on photos of the faces of four volunteers: A white man and woman aged younger than 50 years and a white man and woman aged older than 50 years.

In a prospective, Internet-based survey, twelve sets of images of linear compared with zigzag scars were arranged in a side-by-side comparison. The dimensions of the linear scar were 1 mm in width and 2.5 cm in length, while the zigzag scar was 1 mm in width and 4.3 cm in length.

The scars were placed on the forehead, cheek and temple on the volunteers’ photos.

A 10-point Patient and Observer Scar Assessment Scale was used by survey respondents to rate each scar, with a lower score indicating normal skin and a higher score indicating, “the worst scar imaginable.”

The researchers collected data between May 1 and June 30, 2013, with analysis taking place July 31 to Sept. 1, 2013.

The survey had a response rate of 24.5% (876 participants), with 810 participants completing the survey (53.9% women). Among the survey respondents, 18% were aged 18 to 29 years, 20.8% were aged 30 to 44 years, 35.3% were aged 45 to 60 years and 25.9% were older than 60 years.

The linear scars received significantly lower rating scores on the Patient and Observer Scar Assessment Scale for every assessment, with a mean score of 2.9 vs. 4.5 for zigzag scars (P < .001).

“Our findings suggest that a linear scar on the temple, forehead or cheek is more aesthetically acceptable to the lay public than an appropriately sized zigzag scar on the same locations,” the researchers concluded. “Until randomized clinical data become available on this topic, surgeons should consider carefully whether the extra time and effort involved in performing Z-plasties provide additional cosmetic benefit outside the need for functional improvements, such as contracture, web revision or free-margin corrections.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.