Patients are their own worst critics when it comes to surgical scars on the face

Patients who undergo facial surgery think their surgical scars look worse than surgeons and independent observers do, according to new research.


In this study, 81 patients who had Mohs micrographic surgery to remove facial skin cancer were asked to rate their scars one week and three months after surgery. Mohs surgeons and independent observers also evaluated the scars at the two time periods.


Patients’ feelings about their scars improved by roughly 40% from week one to the three-month mark, but they still judged their scars more critically than the other observers did after three months.


“Our research seems to support the saying ‘we are our own worst critics,’” said senior author Dr. Joseph F. Sobanko in a press release. “Patients are probably going to view scarring on their faces as more severe than their own surgeon will and even someone they walk by on the street.”


Dr. Sobanko is director of Dermatologic Surgery Education and an associate professor of dermatology at the University of Pennsylvania.


In the paper, published online ahead of print in Dermatologic Surgery (Feb. 11, 2022), the investigators write that surgeons should explain to their patients in detail how their scar will likely look post-surgery and explicitly say to their patients that they themselves will likely perceive their scars to be more significant than others will.


Surgeons should also speak to their patients about what to expect during the healing process and what their face will look like after the incision is completely healed, Dr. Sobanko said.


“Our goal as surgeons should be to remove cancer effectively while minimizing scarring,” Dr. Sobanko added. “Nevertheless, skin cancer surgery will produce highly visible changes early in the healing process and our job as surgeons is to prepare patients for how their skin will look during the healing process. We should also be direct with our patients and tell them that they are going to be the most critical of their appearance.”


Previous research from Dr. Sobanko and colleagues showed that people are the most sensitive about scars on their faces compared to scars on other parts of their bodies. The researchers also chose to have participants assess scars at the one-week mark and at three months.


“At one week, incisions from surgery are quite visible, and that can be very jarring for patients,” Dr. Sobanko said. “As weeks progress the incisions heal predictably and our prior research has shown that most patients return to their baseline quality of life approximately three months after surgery.”


While the advice for providers is to be honest and clear with their patients about scarring, Dr. Sobanko and his team are planning to study specific ways that surgeons can help patients feel better about their surgical marks.


“One method we have used in our practice is to connect people about to go through Mohs facial surgery with willing individuals who already have been through the surgery,” said Dr. Sobanko. “Anecdotally, our patients have appreciated the opportunity to ask questions to someone who has experienced what they are about to go through and also see first-hand how someone else’s face healed. We’re excited to study whether that and other interventions can ease patients’ minds and help them feel better about the entire surgery experience.”


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