How to best manage and talk to your child about facial scars

Facial scars are not uncommon in children – whether from surgery, an accident or a condition a child was born with. While scars naturally change over time, many parents wonder what they can do to support healing, what additional treatments actually work and how to help their child handle questions or attention from others.

Paymon Sanati-Mehrizy, M.D., Plastic and Craniofacial Surgeon at Children’s Health and Assistant Professor at UT Southwestern, and Celia Elizabeth Heppner, Psy.D., Pediatric Psychologist at Children’s Health and Associate Professor at UT Southwestern, share what parents need to know about facial scar care, long-term management and conversations that can promote confidence, resilience and healthy self-esteem.

“We never want to draw attention to a scar if a child isn’t bothered by it,” Dr. Sanati says. “But if a child starts styling their hair to hide a scar, that can be a sign – conscious or unconscious – that it’s affecting them.”

Understanding different types of facial scars

There are two main categories of facial scars:

• Post-surgery scars, which result from planned repair surgery – often for a difference a child was born with (congenital condition).

• Post-trauma scars, which result from surgery after an injury such as a fall, dog bite or other accident.

When a child has a post-surgical scar, the incision is intentionally placed where it will be least noticeable. For example, the scar may be designed to fall in a natural wrinkle, a shadow or a place where it can be hidden by an eyebrow or the fold of an eyelid.

But post-trauma scars are more likely to be noticeable – or widen over time – because it’s not possible to strategically place them.

Helping a child’s scar heal

After any type of facial surgery, a child’s scar will be noticeable at first. But all scars change over time – and most need at least a year to fully mature.

The best ways to support scar healing include:

• Using silicone scar products. Over-the-counter gels, tape or sheets help keep the scar moist. Silicone can reduce redness, make the texture smoother and relieve itching as the scar heals.

• Sun protection. For the first four weeks after surgery, it’s important to avoid sun exposure and sunscreen. After that, apply sunscreen daily to protect the scar.

• Massage. Gently massaging the scarred area can help prevent nearby tissue from tightening, which may improve healing and appearance.

Ways to improve the appearance of a scar

The large majority of facial scars post-surgery end up looking good. But when a child is unhappy with a scar after a year, there’s almost always something that can help, including:

• Laser therapy. Laser treatment can reduce redness or help make a scar flatter and smoother.

• Dermabrasion. Carefully removing the top layer of skin and letting it heal again can help a scar look more even.

• Steroid injections. Steroid injections can help calm overactive scar tissue and make a scar flatter and softer.

• Makeup. Cover-up, foundation and concealer makeup products can help improve the appearance of a scar and help kids feel more comfortable.

Scar revision surgery

When a scar widens significantly or becomes redder over time, or it’s causing problems in another location of the face, scar revision surgery may be an option.

“For example, a child may have had surgery after a dog bite, and later the scar on their cheek starts pulling down the lower eyelid,” says Dr. Sanati. “When that happens, we talk with families about revision surgery.”

Revision surgery may also be considered if an older child becomes more self-conscious during the tween or teen years.

How to emotionally support kids with facial scars

It’s always important to explain the reason for a child’s scar in clear, straightforward terms. It can also help to explain that scars are just one kind of physical difference – and while other children your child knows may not have the same kind of scar, they likely know children with other physical differences.

Children who had surgery as infants may are unlikely to have identifiable memories of it, so baby photos can be helpful for creating a concrete explanation.

You might say:

• For younger children: When you were born, your lip looked like this. Then a doctor did surgery on your lip to help you eat and talk – and now it looks like this.

• For kindergarten and early school age children: You were born with this facial difference, just like some kids are born with eyes that need glasses and some kids have bodies that need help from a wheelchair to get around.

Preparing for questions or stares

You can help prepare your child for curious questions – especially from younger children who may not yet know how to ask them sensitively. You can coach your child to:

• Keep responses simple. A response to a question like “What happened to your face?” can be as simple as: “I had surgery when I was a baby, and this is my scar.” If questions continue and make your child feel uncomfortable, they can say something like: “I don’t really like talking about it.”

• Redirect conversation. After providing a simple response, you child can redirect the conversation with another question like: “Do you want to play?” or “What did you do this weekend?”

Instilling confidence in your child

Confidence grows when children develop a sense of self-esteem and competence that’s not tied to appearance. Identify what your child enjoys and does well and give them opportunities to build those strengths.

It’s also important to be mindful of how adults talk about appearance so kids don’t learn to value appearance over character. For example, when describing a girl in your child’s class, saying something like “She’s really kind” rather than “She’s really pretty” can help model valuing behaviors instead of physical attributes.

Another powerful confidence-builder for kids with facial scars is helping kids realize they’re not alone.

Online support groups or camps for kids with craniofacial differences can be very helpful. “If a child is the only one in their class or school with a visible difference, it can be incredibly reassuring to meet others like them,” says Dr. Heppner.

Support at school

Introducing yourself to your child’s teacher at the beginning of each school year can help make sure your child’s teacher is aware of your child’s facial difference. The teacher can then help monitor how your child interacts with other kids.

Sometimes, kids may need school accommodations – like changing a seat assignment so your child sits closer to the teacher or further away from a student who’s causing problems.

Be aware of bullying

Any child with a physical difference or a learning disability is at increased risk for teasing and bullying, which often occur in later elementary school or in middle school.

It’s important for parents to be aware of the signs of bullying and know how to take control of bullying.

Some kids think that anything that makes you feel bad, sad or frustrated is bullying. So it’s important to help teach your child that not all things that cause these feelings are bullying.

Getting additional support

With a bit of practice and support, many kids learn to advocate for themselves – and their facial scar or facial difference doesn’t impact their self-esteem or their relationships.

“But when kids do struggle, talking to a mental health professional can help them build the tools and resilience they need to feel comfortable in their own skin. It can also help them feel less isolated and understand that everyone has differences and challenges, even if we can’t see them,” says Dr. Heppner.

Additional resources

• Children’s Craniofacial Association (CCA): Educational resources and support groups for families and kids.

• Camp Amigo: A camp for kids with craniofacial differences.

• Movies:

  • Finding Nemo (age 6+)

  • Steven Universe (age 10+)

  • Wonder (age 10+)

  • Soul Surfer (age 10+)

  • Raising Dion (age 11+)

  • Speechless (age 12+)

• Books for younger kids:

  • It’s Okay to Be Different

  • We’re All Wonders

  • Whoever You Are

• Books for older kids:

  • Stand In My Shoes: Kids Learning about Empathy

  • Wonder

  • I Funny: A Middle School Story

Learn more

Learn more about our Pediatric Plastic and Craniofacial Surgery Program where we treat more than 10,000 patients a year with craniofacial differences. Our multidisciplinary approach offers each child we see unparalleled access to the world's leading specialists in pediatric plastic surgery, as well as speech therapists, psychologists, nurses and imaging scientists.