LETTER TO THE EDITOR
In the scenario of cervicofacial liposculpture and other aesthetic
procedures, there may be consequences such as the formation of fibrosis
[1,2], being a natural physiological process under any incision that
involves penetration into the reticular dermis [2,3]. Thus, residual
fibrosis must be reviewed, and for the best treatment, it is imperative
to know in detail the stages or classifications of fibrosis formation.
In this context, to understand the effects of the lesion and the
potential for fibrosis formation, the professional in facial aesthetic
procedures must first understand the histology and physiology of the
skin [3-5]. The skin is separated into an epidermis, dermis, and
hypodermis [1,6]. After the epidermis, the dermis is separated into
superficial (papillary) and deeper (reticular). The dynamic process of
fibrosis formation is complex, involving many different cell types,
including epithelial stem cells, located in the stratum basale, and
pilosebaceous units located in the dermis [7].
As a general rule, any wound that extends into the reticular layer will
invariably cause fibrosis or scarring. The process of fibrosis formation
involves three primary overlaps which are inflammation, proliferation,
and remodeling [2,7,8]. Thus, in the first year, there is
re-epithelialization of stem cell migration, deposition of extracellular
matrix, and type III collagen. Furthermore, remodeling with type I
collagen replacement will determine the composition of the final
fibrosis [3,7]. At around 4 to 6 weeks, fibrosis formation reaches
about 60% of its original strength [4].
In this regard, to ensure the best aesthetic result, the appropriate
surgical technique must include delicate tissue manipulation, aseptic
technique, the precision of anatomical dissection, careful hemostasis,
adequate design, debridement of devitalized tissue, closure of deep
layers to obliterate space, wide detachment, edge eversion, avoidance of
tension and aesthetically favorable alignment [7-10].
In this sense, fibrosis can be classified as hypertrophic (HP), keloid
(K), or non-hypertrophic (NHP) [2,11]. HP presents with raised,
pigmented, excessive marks, confined to the original wound edges, and
normally regresses slowly, whereas K is erythematous and elevated
fibrous that invade the surrounding normal dermis to extend beyond the
limits of the original wound and do not regress. [12]. The NHP may
be depressed (atrophic), enlarged, or with unfavorable features.
However, ideal fibrosis is narrow, flat, flush with surrounding tissue,
and difficult for the untrained eye to see [8-10].
Therefore, this article aimed to present a guideline on the
classification of facial fibrosis, as well as to present the best moment
of interventions for the treatment of fibrosis after aesthetic
procedures.