A hairlip scar, more accurately termed a cleft lip scar, is a mark left on the lip and sometimes extending into the nose, resulting from the surgical repair of a congenital condition known as a cleft lip. This scar represents the body’s natural healing process following the closure of a birth defect where facial tissues did not properly fuse during development.
Formation of the Scar
A cleft lip scar forms after surgical correction of a cleft lip, a birth defect where the upper lip has an opening due to incomplete fusion of facial tissues. The surgery, often performed when a baby is 3 to 4 months old, brings together the separated tissues of the lip, including skin, muscle, and mucosa, to create a more natural lip line and restore function.
The body’s natural wound healing response begins immediately after surgical closure. This complex process involves phases like hemostasis, inflammation, proliferation, and remodeling. Initially, blood clots form, followed by immune cells clearing debris. New tissue, including collagen, is then produced to close the wound.
The final remodeling phase can continue for months or years as collagen fibers reorganize and strengthen. While surgery aims to minimize its appearance, scar tissue formation is an unavoidable part of this healing process, as the body replaces damaged tissue with fibrous connective tissue. This scar tissue results from a dysregulated wound-healing process with excessive collagen and extracellular matrix protein.
Appearance and Maturation of the Scar
A cleft lip scar appears as a line on the upper lip, often extending from the lip border towards the nostril, following the surgical incision. Its shape can vary depending on the initial cleft severity and the specific surgical technique used for repair. Initially, the scar is often pink or red, slightly raised, and may feel firm due to inflammation and collagen deposition.
Over time, the scar undergoes a maturation process, evolving in appearance. Within several months, its color generally fades, becoming less red and closer to the surrounding skin tone. The prominence of the scar also tends to decrease as initial swelling subsides and collagen fibers reorganize, often becoming flatter. However, scar tissue contains less elastin than normal skin, which can result in decreased elasticity.
Several factors influence the scar’s final appearance, including the severity of the original cleft, the surgical technique employed, and individual healing responses. Genetic predisposition, postoperative lip tension, and wound care practices, such as gentle massage, also contribute to the long-term aesthetic outcome.
Approaches to Scar Management and Improvement
Managing a cleft lip scar involves immediate postoperative care and various interventions over time. Following surgery, the treated area around the stitches will appear pink and slightly swollen. Post-operative care includes gentle cleansing of the suture line with a cotton bud and applying ointment. Arm splints may be used for about 10 days to prevent the child from touching the lip, and pain relief, such as paracetamol or ibuprofen, is typically given for one to two weeks.
Once the wound has healed, typically after two to three weeks, gentle scar massage can be initiated to help the scar settle and become less prominent. Silicone-based products, such as sheets or gels, are often recommended as a non-surgical intervention. These products hydrate the scar tissue, potentially reducing collagen production and improving scar texture and color. Topical creams, including those with vitamin E, are also sometimes used, though their effectiveness varies.
For more persistent or prominent scars, various medical procedures can be considered. Laser therapy, such as pulsed dye or fractional ablative lasers, can target redness and improve scar texture by modifying collagen. Injectable fillers, like hyaluronic acid, can improve the contour and flexibility of depressed scars, helping them blend with surrounding tissue. Botulinum toxin injections have also shown promise in reducing scar width and improving aesthetics by relaxing muscles around the wound, which can alleviate tension during healing.
Surgical revision options are available for scars that do not respond adequately to non-surgical methods or have significant contour irregularities. Techniques like Z-plasty or W-plasty involve precise incisions to realign the scar and place it in less noticeable skin creases. Serial excision can gradually narrow the scar line by removing small portions of a wide scar over multiple procedures. The decision for surgical revision is often made as the child grows and their facial tissues stretch, potentially widening the scar. Outcomes vary, and a consultation with a multidisciplinary cleft team or plastic surgeon is always recommended to determine the most appropriate approach for individual scar improvement.