CONDITION / SKIN AND SCARS

Scars from injuries to the face and neck.

Scar correction after facial or neck injury is needed when traces of shrapnel, rough sutures, indented areas, or scars that pull the neck or eyelid remain after gunshot, shrapnel, or mine-explosive injuries. They are treated in stages: laser, care, and surgeries.

Discuss your case How it is treated in the clinic ↓

CONCEPTUAL VISUALIZATION

OVERVIEW

What it is: Scars on the face and neck after gunshot, shrapnel, and mine-explosive injuries and the surgeries with which these wounds were treated.
Which are: Traces of small shrapnel, rough sutures, indented areas, dark spots on the skin, scars that pull the neck or eyelid.
When treated: Laser and care can be started early; surgeries—usually on mature scars, except for those that limit movement.
Who treats it: Plastic surgeon together with a dermatologist; if needed — psychologist.

01 / WHAT IS IT

What is special
scars after injuries.

Blast injuries are high-energy injuries: they can cause significant damage to soft tissues. At the Lviv Military Medical Center after 2022, wounds from large shell fragments are mostly treated; such fragments often tear out areas of facial bones along with the overlying soft tissues.

Therefore, the scars after injury are different from those after a regular cut. They can be numerous and of various depths: from traces of small shrapnel to large scars in areas of lost tissue. Added to these are scars from surgical wound treatment, staged operations, and on the neck — from airway surgeries, if they were performed.

Scars on the neck and other movable areas can become contractures — pulling the head, chin, or corner of the mouth. And explosive particles left in the skin give blue or black spots — traumatic tattooing.

Facial scars are also a psychological burden. In a review of 21 studies, a violent cause of a scar was one of the factors associated with anxiety and depression. Therefore, it is worth talking about your mood with a doctor just as you would about the scar itself.

This page is only about scars. Bone and tissue defects, facial expressions, and fragments are described on separate pages. This is general information. What will suit you specifically, the doctor will tell after an examination.

02 / SIGNS

What scars
remain after an injury.

Often, several types of scars combine in one person. They may itch, hurt, or interfere with movement — it is worth telling your doctor about this.

Shrapnel scars

Many small scars of varying depth scattered over the face and neck.

Thick stitches

Wide, raised, or uneven scars after surgical wound treatment and operations in a hospital.

Depressed areas

The scar has sunken where there is a lack of tissue under the skin; the contour of the face has changed.

Consequences of gunshot wounds to the face

Dark spots

Blue or black irregularly shaped spots — explosion particles remaining in the skin.

The scar pulls

The neck does not fully turn, the chin is pulled down, the eyelid or lip is pulled.

Cicatricial deformation of the face

Something under the scar

A hard spot can be felt under the scar, the area hurts or swells — possibly there is a fragment there.

Shrapnel in the face and neck

03 / REASONS

Why scars after injuries
are more complex.

It depends on how and with what the injury was caused, how many scars there are, how deep they are, and whether there is enough healthy skin around.

High energy

High-energy injuries can damage large areas of soft tissue — resulting in more scars.

Dirt and particles

Debris and particles from the explosion remain in the wound. Their removal is one of the main tasks in treating a fresh wound; what remains may cause a traumatic tattoo.

Multiple surgeries

For large injuries, reconstruction is planned in stages, and each stage leaves its own scars.

Movable areas

On the neck, near the mouth and eyelids, the scar tightens and can become a contracture.

Burn together with injury

If the injury was accompanied by a burn, the scars are treated taking it into account as well.

Scars after facial burns

04 / SEEK MEDICAL ADVICE

When to seek medical advice?

Mature scars after emergency treatment usually do not require immediate action: this is planned treatment. But while the wounds are still healing, some symptoms require immediate assistance.

103 immediately if:

the wound or scar continues to bleed;
the blood is bright red and spurts;
breathing is very frequent;
confusion, slurred speech;
the skin is blue, pale, or blotchy;
a rash that does not fade when pressed;
very high or very low temperature, the body feels hot or cold to the touch, or the person is shivering.

Do not delay a visit to the doctor:

Immediately, without delay: If you have thoughts of ending your life or harming yourself, do not stay alone with them — tell your loved ones and contact a 24-hour psychological support line or a doctor immediately; if there is an immediate threat — call 103. On the same day: The wound or scar is swollen, red, increasingly painful, hot to the touch, or oozing pus; you have a fever or feel unwell, but the signs on the 103 list are not present; the scar prevents you from fully closing your eye, and the eye is very red, painful, sensitive to light, or your vision has changed. In the coming days or weeks: Thoughts or memories of the injury won't go away, appear in dreams, or you avoid people or places — see a doctor or psychologist, even if months have passed since the injury. Planned: The scar pulls, interferes with turning your head, opening your mouth, or closing your eye, it itches, hurts, or you are concerned about its appearance — make an appointment for a consultation.

05 / DIAGNOSTICS

How they make
a scar treatment plan.

Conversation and documents
When and how it was injured, which surgeries have already been done; hospital discharge summaries, operation reports, CT scans.
Review
How many scars and what type, whether they are still maturing, whether they pull the neck, eyelid, or lip, how the face moves, whether there are particles in the skin.
Photo in standard angles
For planning stages and to compare scars over time.
Examination as needed
If something can be felt under the scar or it hurts — an examination prescribed by a doctor.

06 / TREATMENT

How we treat
scars after injuries.

It is not possible to completely remove scars, but they can be made thinner, softer, and less noticeable, and tension can be reduced. After injuries, this usually involves several stages combining laser, care, and surgeries.

While the scars mature

From wound healing.

Silicone: International guidelines consider silicone gel or sheets as the first choice for thick scars. In a meta-analysis of 6 randomized studies (375 patients), the gel made postoperative scars less pigmented, lower, and softer; gel and sheets acted comparably.
Compression: Compression garments may be required for large scars, especially if the injury was accompanied by a burn.
Sun protection: Cover scars from the sun for at least one year and apply SPF 30 or higher cream.
Early laser: Consensus among academic and military physicians allows early laser treatment to prevent contractures; this conclusion is mainly based on expert opinion. In a randomized study of 45 patients with traumatic facial scars, the authors recommend starting fractional CO2 laser approximately 2 weeks after suture removal.

Laser

The main method for many post-traumatic scars.

Fractional laser: Lasers — first-line therapy for scars and contractures after injuries: this conclusion was reached by an international group of 26 dermatologists and plastic surgeons from 13 countries.
Along with surgery: Persistent scars are corrected at a later stage with surgery and combined with additional methods — laser, silicone — to achieve a better result.
Particles in the skin: Traumatic tattooing is mostly treated with a special tattoo laser. But particles that can ignite from the laser are treated by other methods — therefore it is important to know exactly what caused the injury.

Operations

When the scar pulls, is coarse, or is depressed.

Excision and Z-plasty: The scar is excised, and tension is released by repositioning adjacent tissues (Z-plasty) — this relaxes the scar on the neck or near the mouth.
Skin grafts and flaps: If skin is lacking, the deficiency is covered with a skin graft or flap.
Expander: A balloon is placed under healthy skin nearby and gradually filled to obtain skin of the same color. In a review of 7,058 patients, complications on the head and neck occurred in 8.73%.
Lipofilling: Autologous fat is injected under depressed scars. According to a meta-analysis of 23 studies (1,326 patients) with scars from injuries and burns, the scars improved — this was assessed by both the patients themselves and the doctors.

Sequence

First, the function: Scars that limit the movement of the neck, mouth, or eyelid closure are usually treated earlier than others.
Then - appearance: The surgery helps mature scars when the timing is properly chosen; and scars can continue to lighten for 2 years or longer.
Psychological help: Psychotherapy helps with PTSD; symptoms can appear immediately or after months and even years following the injury.

07 / AT THE VALIKHNOVSKYI INSTITUTE

How
we treat it.

Scars after facial and neck injuries are treated at the Valikhnovskyi Surgery Institute in two directions — "Surgery of Gunshot Injuries" and "New Face." The clinic performs operations for Ukrainian Armed Forces servicemen with funding from charitable foundations.

CLINIC SERVICE Surgery of gunshot injuries Bullet, shrapnel, and landmine injuries — from a fresh wound to restoration of tissue, form, and function. View service

What we do for this condition

Scar excision and Z-plasty — when a scar tightens the skin and restricts movement; scars on the neck are excised and covered with local flaps.
Correction of postoperative scars — rough, deformed scars after operations in the hospital.
Flaps from the face and neck — perforator flaps and flaps from adjacent areas — tissue similar in color, without significant tension.
Skin grafting — a full-layer graft when the skin is missing; it tightens less after healing.
Expander — when there are many scars or they are large: a balloon is placed under the adjacent healthy skin, stretched for weeks, and then used to cover the scar area.
Lipofilling — own fat is injected into the scar area to soften it and even out depressed areas; the effect is evaluated individually.
Laser scar resurfacing — fractional CO2 laser for uneven surface, color, firmness, and itchiness of the scar, often together with surgery.
Debris removal — as indicated: if a fragment under the scar hurts or causes infection; the decision — after examination and CT.

Rostislav Valikhnovskyi

Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.

About the doctor ORCID

How treatment works with us

Photo onlineSend photos of the face and neck straight on and from the side, hospital discharge summaries, and CT, if available.
ConsultationExamination of scars, neck movements, mouth and eyelids; assessment of which scars are still maturing.
Plan of stagesWhat to do now — laser, care — and what after maturation; in what sequence.
TreatmentLaser, excision, flaps, skin graft, expander or lipofilling — separately or combined, in stages.
RecoverySilicone, compression as needed, sun protection, and follow-up checks between stages.

Discuss your case Call

08 / QUESTIONS AND ANSWERS

Common
questions

Short answers. What is right for you, the doctor will tell you during the consultation.

When can scars from injuries be treated surgically?

Usually — when the scars mature. Laser and care can be started earlier. Scars that restrict movement of the neck, mouth, or eyelid are usually treated first.

Can shrapnel marks be removed?

Completely — no, the scar does not disappear. But laser can make small scars smoother and less noticeable, and dark spots from explosion particles are treated separately.

How many procedures will be needed?

After severe injuries, treatment is usually staged: several laser sessions, sometimes one or more surgeries. The doctor explains the stage plan after the examination.

Will laser help old scars?

An international consensus of 26 specialists calls lasers a first-line therapy for scars and contractures after injuries. Whether a laser is suitable for you will be told by a doctor after an examination.

There is something hard and painful under the scar. What is it?

It could be a fragment. Show the area to a surgeon; if it is swollen, red, hot, or oozing pus — the same day.

I cannot get rid of memories of the injury. Whom should I contact?

A doctor or psychologist. Recurrent severe memories, dreams, and avoidance of people or places may be signs of PTSD, and psychotherapy helps.

Do you treat military personnel?

Yes. The clinic performs surgeries for servicemen of the Armed Forces of Ukraine funded by charitable foundations. Bring your military ID and hospital discharge papers to the consultation.

09 / SOURCES

Sources

18 sources · international consensuses, systematic reviews, experience of the war in Ukraine and the NHSshowCollapse

Management and reconstruction of blast wounds of the head and neckCurrent Opinion in Otolaryngology & Head and Neck Surgery, 2016doi:10.1097/MOO.0000000000000285 ↗
Mechanisms of Soft Tissue Injury and Repair from BallisticsFacial Plastic Surgery, 2021doi:10.1055/s-0041-1725130 ↗
Management of war-related facial wounds in Ukraine: the Lviv military hospital experienceBMJ Military Health, 2025doi:10.1136/military-2023-002527 ↗
Updated scar management practical guidelines: non-invasive and invasive measuresJournal of Plastic, Reconstructive & Aesthetic Surgery, 2014doi:10.1016/j.bjps.2014.04.011 ↗
Efficacy of topical silicone gel in scar management: A systematic review and meta-analysis of randomised controlled trialsInternational Wound Journal, 2020doi:10.1111/iwj.13337 ↗
Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus RecommendationsLasers in Surgery and Medicine, 2020doi:10.1002/lsm.23201 ↗
Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus reportJAMA Dermatology, 2014doi:10.1001/jamadermatol.2013.7761 ↗
Traumatic Scars: Evaluation of the Best Timing for Early Intervention With Fractional CO2 Laser Using Optical Coherence TomographyPhotodermatology, Photoimmunology & Photomedicine, 2026doi:10.1111/phpp.70071 ↗
Traumatic Tattoos: Prevention and TreatmentDermatologic Surgery, 2026doi:10.1097/DSS.0000000000005123 ↗
Surgery for scar revision and reduction: from primary closure to flap surgeryBurns & Trauma, 2019doi:10.1186/s41038-019-0144-5 ↗
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 association of affective disorders and facial scarring: Systematic review and meta-analysisJournal of Affective Disorders, 2018doi:10.1016/j.jad.2018.06.013 ↗
ScarsNHS, 2023nhs.uk/conditions/scars ↗
Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
PTSD (post-traumatic stress disorder)NHS, 2026nhs.uk/mental-health/conditions/ptsd-post-traumatic-stress-disorder ↗
EctropionNHS, 2025nhs.uk/conditions/ectropion ↗

The figures on the page are from these sources.

VALIKHNOVSKI SURGERY PARTNERS

Scars after injury
hinder life?

Send photos of your face and neck along with hospital discharge summaries. The doctor will tell you where to start and approximately how many stages will be needed.

Call Send an enquiry