Stellactomy- A novel technique for the management of facial scar

PROBLEM STATEMENT

Facial scars are esthetically unpleasant and can cause psychological distress to patients, resulting in poor body image, reduced self-esteem, loss of confidence, and at times, certain social stigma. Prevention of an unsightly scar is a primarily important requirement for any surgeon. Hence, the primary aim in the management of scars is to produce an invisible line.

Multiple surgical techniques have been described in the literature for such scars, including Z-Plasty, W-Plasty, geometric broken line closure, and V-Y Plasty.

In our surgical experience, we often encounter lesions wherein digital palpation overlooks the underlying fibrous component of the scar, which persists after attempting scar revision using the aforementioned techniques, thereby creating a linear scar. Hence, to avoid scarring and ensure complete removal of underlying fibrous tissue, we propose a star-shaped excision of the scar termed “STELLACTOMY” for the management of a nodular scar present on the right cheek of a 56-year-old male patient following old deep-seated nodulocystic acne. There were multiple fibrotic bands present underneath. The technique has opted to maximize the excision of the underlying nodular mass and parallelly achieve the desired cosmesis with minimal scarring.

Technique

A traditional surgical skin marking pen was used to map the minute irregularly irregular stellate incision design within the visible borders of the lesion, as shown [Figure 1].

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Figure 1:

Star-shaped skin marking of incision line – Stellactomy.

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A 15-no. surgical blade was used to incise the surface of the lesion, as shown in [Figure 2]. The dissection is then beveled outwardly with the central portion of the surface skin still attached to the bulk of the lesion. The flaps were then reflected to expose the underlying fibrous component, which had a nodular consistency.

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Figure 2:

The exposure of subcutaneous fat after removal of bulky fibrous tissue which was nodular in consistency.

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The exposed pathology was excised completely and was sent for pathologic evaluation. Meticulous hemostasis was then obtained.

The splayed flaps were then drawn centrally and held together with several subcuticular sutures and vertical mattress sutures using nonabsorbable 6-0 polyamide sutures to permanently collapse the cavity and achieve tensionless complete closure of the wound [Figure 3].

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Figure 3:

Flap approximation using cuticular sutures and vertical mattress sutures using 6-0 black polyamide sutures.

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Follow up

The patient was followed up for 8 weeks, and there was an almost scarless outcome with a self-reported satisfactory rate of 90% [Figure 4].

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Figure 4:

Uneventful healing at 8 weeks postoperatively.

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RECOMMENDED SOLUTION

Stellactomy presents a promising novel approach for managing nodular facial scars, offering both functional and aesthetic benefits. By addressing the underlying fibrous tissue and excising it through a star-shaped incision, this technique minimizes the risk of recurrent scarring while achieving a more natural aesthetic result. This method represents a significant advancement in scar management, particularly for lesions with persistent fibrous components, and could become an important addition to the surgeon’s armamentarium for scar revision procedures.