When it comes to facial scars, we are 'our own worst critics'

People with scars on their faces are likely to perceive them as more severe than their own surgeon, or even a stranger.

Maija Kappler 4 minute read March 17, 2022
depression over self perception

Patients' facial scars may feel more visible to them than to other people. GETTY

A study from the University of Pennsylvania brings more evidence to support the fact that when it comes to appearances, we’re often more critical of ourselves than of each other.

Published in the journal Facial Plastic Surgery & Aesthetic Medicine, the study focused on facial scars. Researchers surveyed 81 patients who had gotten Mohs micrographic surgery — a precise form of surgery — to treat skin cancer on the face.

While cancer surgery would typically involve removing visible cancer, and small amounts of the healthy tissue that surrounds it, Mohs is more exact: it involves removing thin layers of skin that’s been affected by cancer one at a time, until the only skin left is cancer-free. The goal, according to the Mayo Clinic, is to cause minimal damage to the surrounding tissue while still removing all of the cancerous skin. It’s generally used on areas of the skin where it’s important to keep as much healthy tissue as possible — namely, the face, hands, feet and genitals.

The 81 patients and their surgeons rated their facial scars both one or two after getting Mohs surgery, and three months after. After blocking out identifying features to protect the patients’ privacy, researchers also showed photos from both sessions to four physicians and 12 medical students who had no relationship to the patients, either personally or professionally.

In the first set of photos, from just after the surgery, the incisions were “quite visible,” Sobanko said. “That can be very jarring for patients.” At that point, each group felt differently about the scars: the patients gave their photos the lowest rating of the three groups, feeling that their scars were extremely obvious, and that they looked unappealing. The medical students gave the photos higher ratings than the patients, while the surgeons rated the photos more highly than either of the other groups.

Three months after the surgery, the scars had healed more. Patients at this point were much happier with the way scars looked on their faces: the overall response was about 40 per cent higher. But at this point, the medical students and the surgeons had a view that matched up — and they both rated the appearance of the scars as much better than the patients did.

“Our research seems to support the saying ‘we are our own worst critics,’” the study’s senior author Dr. Joseph F. Sobanko told Penn’s news outlet. “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.”

The study does have a small sample size, but it still produces information that’s undeniably helpful for patients. Major facial changes, especially ones deemed “unattractive,” can have severe consequences on mental health. A 2018 study found that people with scars are more prone to feel shame and aggression, and to develop depression and anxiety. Another study showed that the more visible a scar is, the more likely people are to deem it unattractive — and there’s hardly a more visible spot than the face.

There’s an important lesson here for surgeons, Sobanko said: in order to avoid frustration and disappointment, and to potentially alleviate some of that mental health burden, it’s important that the patient has a realistic idea of what their face will look like following surgery. It’s also worth mentioning that their scars may feel more visible to them than to other people.

Our goal as surgeons should be to remove cancer effectively while minimizing scarring,” he said.

“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.”

Maija Kappler is a reporter and editor at Healthing. You can reach her at mkappler@postmedia.com
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