Pulls the eyelid
The lower eyelid moves away from the eye or turns out, the eye tears and dries, it is worse to close.
Ectropion
CONDITION / FACE
Cicatricial deformation of the face.
Cicatricial deformity of the face is a change in the shape of the face due to a scar after an injury, burn or operation: the scar tightens the eyelid or lip, retracts the contour or interferes with movement. It is treated in stages - scar care, laser, and, if necessary, surgery.
CONCEPTUAL VISUALIZATION- What it is
- A scar that is not just visible, but changes the shape of the face: pulls the eyelid, lip or corner of the mouth, pulls in the contour.
- Why does it appear?
- Injuries, cuts, burns, bites, wounds and operations on the face.
- When treated
- Most scars lighten and soften up to 2 years or longer; surgery is usually planned at a later stage.
- Who treats it
- Plastic surgeon; if necessary, together with a dermatologist, an ophthalmologist and a rehabilitation specialist.
01 / WHAT IS ITWhat is
What is
cicatricial deformity.
A scar is formed when damage to the skin reaches its deep layer - the reticular dermis. Scarring itself is a normal part of healing. But it can not only be noticeable on the face, but also change its shape.
Cicatricial deformity is said to occur when the scar tightens the skin and pulls nearby areas along with it: the eyelid moves away from the eye, the corner of the mouth drops or the mouth does not open wide, the wing of the nose tightens, a depression appears on the cheek or forehead. The face has many concave surfaces, so scars here are especially easy to tighten the skin.
Doctors distinguish between two different problems. If the scar is rough, but there is enough skin, treatment of the scar itself helps. If the skin is missing and the scar tightens the tissue, it must be relaxed or added to the skin - by surgery.
Facial scars also affect mood: in a review of 21 studies (2,394 participants), 26.1% of people with facial scars had anxiety, and 21.4% had depression.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
cicatricial deformity presents.
Symptoms depend on where the scar is and how much it tightens the skin. Often, it's not the appearance that bothers you, but the fact that the scar makes it difficult to close the eye, eat or speak.
Tightens the lip or mouth
The lip is everted or pulled up, the corner of the mouth is shifted, the mouth does not open wide.
MicrostomeIndented outline
At the site of the scar, there is a depression or a step, the face has become asymmetrical.
Stiffness
The skin around the scar pulls, it is painful or difficult to move - this is how scar contracture behaves, most often after a burn.
Post-burn contractures of the faceA thick scar
The scar is raised, dense, red, itchy. If it goes beyond the wound, it is a keloid.
Keloid scars on the facemood
A person avoids mirrors, photos and meetings. This is not a small matter: you should tell the doctor about it.
03 / REASONSWhy scar
Why scar
changes the shape of the face.
The cause depends on how much tissue is lost and whether there is enough local skin for correction.
Injuries and cuts
A wound on the face can heal with a wide or indented scar, which drags the neighboring areas with it.
Scars after injuries and cutsBurns
A burn can cause scarring of the skin. On the face with its concave surfaces, it especially often deforms the features.
Scars after facial burnsOperations
After removal of a tumor or other operations on the face, the scar sometimes tightens the eyelid, lip or wing of the nose.
Scars after operations on the faceWounds and bites
After wounds and bites, the wounds are lacerated, sometimes with tissue loss.
Consequences of animal bitesForehead
Forehead scars are a separate topic with its own methods of correction.
Cicatricial deformation of the forehead
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
An old scar that changes the shape of the face does not require emergency care: it is a planned situation. But if the injury or burn has just happened, help is needed immediately.
103 immediately if:
- bleeding from a wound that does not stop;
- blood beats in a stream;
- a deep or large wound on the face;
- a fragment or glass is stuck in the wound - do not remove it yourself;
- fresh facial burn;
- acid, other chemical or electric burn.
Do not delay a visit to the doctor:
On the same day: a scar or wound is swollen, painful, hot to the touch or pus flows from them; you have been bitten by a person or an animal. In the coming days: the old scar cracks, becomes wet, or a non-healing wound has appeared on it; the scar twists the eyelid, and the eye becomes dry or watery. Planned: the scar pulls, interferes with movements, changes the contour or just bothers you - make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to fix
- Conversation
When and why did the scar appear, how was the wound treated, what operations have already been performed; photo of the face before the injury, if available.
- Review
How mature is the scar, does it pull the eyelid, lip or wing of the nose, how does the eye close and the mouth open, is there enough skin nearby.
- Photo in standard angles
For planning and to compare changes over time.
- Examination as needed
CT scan — if the bones are damaged under the scar; examination by an ophthalmologist - if the eye is affected.
06 / TREATMENTHow we treat
How we treat
cicatricial deformity.
It is impossible to completely remove the scar: the goal is to make it thinner, softer, less noticeable and relieve tension. According to international recommendations, the best chance is given by a combination of several methods, selected for a specific person.
01
Without surgery
While the scar matures, and together with the operation.
- Silicone
- International guidelines consider silicone gels or plates to be the first choice for the prevention and treatment of thick scars.
- Compression
- Compression garments may be needed for large scars, especially after burns.
- Care
- Massage the scar with cream - only after complete healing; sun protection for at least a year and SPF 30 or higher.
- Laser
- An international consensus of 26 dermatologists and plastic surgeons from 13 countries called lasers the first-line therapy for scarring after trauma and contractures.
- Injections into the scar
- Depending on the type of scar, treatment may include steroid injections; they are prescribed by a doctor. A keloid often returns after excision itself, so it is treated in combination: after excision, injections into the scar or other methods prescribed by the doctor.
02
Surgery
When the scar tightens the tissues or remains rough.
- Z-plasty and local flaps
- The scar is dissected and adjacent tissues are rearranged in such a way as to relieve tension. Then the scar is rebuilt and softened over time, and together with the laser, it becomes less noticeable.
- Add skin
- If there is a lack of skin, it is not enough to rebuild the scar: the lack is covered with a skin graft or a flap.
- Expander
- A balloon is placed next to healthy skin and gradually filled to "grow" skin of the same color. In a review of 7,058 patients, 8.73% had head and neck complications; most often — perforation of the expander (3.0%) and hematoma (2.9%).
- Lipofilling
- Own fat is injected under the retracted scar. In a review of 23 studies (1,326 patients), scar quality improved in the opinion of both patients and physicians; with burn scars, more qualitative studies are needed.
03
Terms and sequence
- First, the function
- If the scar twists the eyelid, treatment is not delayed: with ectropion after a burn, early intervention gives a better result.
- Then - appearance
- Most scars lighten up to 2 years or longer; surgery to correct persistent scars is performed at a later stage and combined with other methods.
- Several stages
- With large scars, a good result usually requires the long-term work of several specialists, so treatment can last for months.
- support
- If the scar depresses the mood, talking to a psychotherapist also helps - you can tell the doctor about it.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Cicatricial deformities of the face are treated at Dr. Valikhnovskyi's Institute of Surgery in the "New Face" direction, and the effects of burns are treated in the "Reconstruction after burns" direction. Scar care, laser and dermatologist support - in the clinic.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Scar excision and Z-plasty — the scar is cut out or the tissues are rearranged with local flaps to relieve the tension and return the eyelid or lip to its place.
- Flaps from the face and neck — perforating flaps and flaps of adjacent areas close the defect with fabric, similar in color, without rough tension.
- Skin grafting — a full-layer graft when the skin is missing; it tightens less after healing.
- Expander — the balloon under the nearby healthy skin is gradually filled, and then the stretched skin is moved to the site of the scar.
- Free microsurgical flaps — for large and deep defects — tissues from other parts of the body with suturing of vessels under a microscope.
- Lipofilling — microfat and nanofat under the scar — for the volume and softness of the scar tissue.
- Fractional CO2 laser and IPL — for the surface, color and hardness of the scar, often together with the operation.
- Scar care — silicone, compression, control examinations by a dermatologist; with keloids after excision — injections into the scar.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
Publications by topic
How treatment works with us
- Photo onlineSend a photo of your face straight on and from the side, as well as in motion - when you open your mouth and close your eyes.
- ConsultationExamination of scars, assessment of tension and supply of skin nearby; if necessary - examination.
- PlanWhat to fix first - what interferes with the eye, mouth or movements - and what later, after the scars have matured.
- TreatmentLaser, injections, excision, flaps, expander or lipofilling — individually or in combination, often in several stages.
- RecoverySilicone, compression and reviews; the final appearance of the scar is assessed after months.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to remove the scar completely?
No. Any treatment leaves a scar. The goal is to make it thinner, softer, less noticeable and remove the tension that changes the shape of the face.
When can a scar be operated on?
Most scars take 2 years or longer to lighten and soften, so correction of persistent scars is usually planned later. If the scar twists the eyelid, treatment is not postponed.
Is it possible to do without a laser without surgery?
Laser is one of the main methods for scars after injuries. But if the scar tightens the tissues and the skin is missing, surgery is needed; laser is often combined with it.
What is an expander and what are the risks?
This is a balloon that is placed under healthy skin and gradually filled to obtain skin of the same color. In a review of 7,058 patients, 8.73% had head and neck complications.
Does lipofilling help?
Own fat under the scar improved its quality in a review of 23 studies. Whether it will suit you or not, the doctor will tell after the examination.
The old scar began to crack. Is it dangerous?
Show it to the doctor in the next few days. Skin cancer occasionally develops in old scars, most often after burns, and it is important not to miss it.
I avoid people because of the scar. Is this normal?
This is often the case: in a review of 21 studies, 26.1% of people with facial scars had anxiety. Tell the doctor about it - in addition to scar treatment, psychotherapy also helps.
Sources
17 sources · international guidelines, systematic reviews and the NHSshowCollapse
- Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatmentDermatologic Surgery, 2014pubmed.ncbi.nlm.nih.gov/25068544 ↗
- Updated scar management practical guidelines: non-invasive and invasive measuresJournal of Plastic, Reconstructive & Aesthetic Surgery, 2014doi:10.1016/j.bjps.2014.04.011 ↗
- Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus RecommendationsLasers in Surgery and Medicine, 2020doi:10.1002/lsm.23201 ↗
- The association of affective disorders and facial scarring: Systematic review and meta-analysisJournal of Affective Disorders, 2018doi:10.1016/j.jad.2018.06.013 ↗
- Paradigms in Complex Facial Scar ManagementSeminars in Plastic Surgery, 2020doi:10.1055/s-0040-1721768 ↗
- The Art of Local Tissue Rearrangements in Burn Reconstruction: Z-Plasty and MoreClinics in Plastic Surgery, 2024doi:10.1016/j.cps.2024.02.010 ↗
- Pediatric Facial Burn ReconstructionSeminars in Plastic Surgery, 2024doi:10.1055/s-0044-1786009 ↗
- Interventions for Functional and Cosmetic Outcomes Post Burn for Eyelid Ectropion — A Scoping ReviewEuropean Burn Journal, 2025doi:10.3390/ebj6030046 ↗
- Complications of tissue expansion in the head and neckHead & Neck, 2020doi:10.1002/hed.26017 ↗
- Effectiveness of Autologous Fat Grafting in the Treatment of Scars: A Systematic Review and Meta-AnalysisAesthetic Plastic Surgery, 2024doi:10.1007/s00266-024-04131-w ↗
- The Utility of Fat Grafting to Manage Burn Scars: A Systematic ReviewJournal of Burn Care & Research, 2025doi:10.1093/jbcr/iraf146 ↗
- Current Trends in Management of Marjolin's Ulcer: A Systematic ReviewJournal of Burn Care & Research, 2021doi:10.1093/jbcr/iraa128 ↗
- Ways to improve the results of treatment of patients with keloid scars on the faceClinical Anatomy and Operative Surgery, 2025doi:10.24061/1727-0847.24.2.2025.20 ↗
- Correction of cicatricial deformation of the frontal area: surgical methods and results of own researchHospital surgery, 2025doi:10.11603/2414-4533.2025.2.15396 ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- Burns and scaldsNHS, 2026nhs.uk/conditions/burns-and-scalds ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
The scar pulls
did you change your face?
Submit a photo of your face straight on, from the side, and in motion. The doctor will tell you what can be fixed and where to start.