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.