Widening of scars: foe coaxed into a friend? The Millard technique revisited.

Widening of scars is a frustrating event that most if not all plastic surgeons have encountered. Several therapeutic modalities have been proposed, but frequently the result is disappointing. During revision surgery, it is advocated that the dermal scar be used in providing support to the tissues instead of being discarded. The author proposes a technique by which tension on the wound is carried by tough scar tissue instead of the suture line, thereby reducing the incidence of postoperative widening. This technique was used to treat 35 nonburn scars that had widened: 31 scars were facial (24 patients) and 4 were inframammary (2 male patients). All scars were at least 4 months old. The operations were performed between February of 1996 and December of 1998; follow-up was 9 to 14 months. Only one scar widened during the follow-up period. Overall, 71 percent of patients rated the improvement as marked. This is a revisiting of the original Millard's technique, which seems to have fallen into oblivion. The author recommends this technique in dealing with widened scars during revision surgery.