Facial Laceration: How Face Cuts Are Repaired

First aid before repair

Press a clean cloth firmly on the cut for 10 minutes without lifting to check. Rinse with clean running water once bleeding is controlled and cover with a clean dressing. Cool packs reduce swelling. Full step-by-step home care and when cuts need stitches are on the open wound on the face page. This page explains what happens once you reach a clinic or ER.

How a facial laceration is assessed

The clinician checks more than the skin. The face packs nerves, ducts and bones into a small space.

• Facial nerve: you will be asked to raise the eyebrows, close the eyes tightly, puff the cheeks and smile. Weakness after a cut over the cheek or in front of the ear suggests a nerve branch is cut. These are best repaired by a specialist within about 72 hours.
• Parotid (salivary) duct: a deep cheek cut along a line from the earlobe to the upper lip can sever the duct. Clear saliva leaking from the wound is a clue.
• Tear duct: cuts near the inner corner of the eyelids can cut the tear drainage channel, causing constant watering later. Repair needs an eye or oculoplastic surgeon.
• Bones: step-offs, numbness of the cheek or upper lip, double vision or a changed bite suggest facial fractures. A CT scan may be ordered.
• Foreign material: glass, gravel or tooth fragments. An X-ray or ultrasound can show glass. Dirt left in the skin causes "traumatic tattooing", so it is scrubbed out under numbing.
• Head injury: any loss of consciousness or confusion needs assessment for head injury.

Facial laceration repair options

The area is numbed with local anesthetic injection, or a numbing gel in children. Young children may need a short sedation to keep still. The wound is irrigated with plenty of saline, damaged edges are trimmed sparingly, and the skin is closed precisely, especially where landmarks meet.

Areas that need extra care

• Lip: the border between the red lip and skin must line up to within a millimeter, or a visible step remains. The first stitch is usually placed there. See lip wounds.
• Eyebrow: the brow is never shaved, because it may grow back unevenly and is needed as a guide for alignment.
• Eyelid: cuts through the lid margin or with fat showing suggest deeper injury and need specialist repair.
• Ear and nose: exposed cartilage must be covered. A blood collection under the ear skin needs draining to prevent "cauliflower ear".

Bites

Dog bites to the face are common in children. Because the face heals well, most are cleaned thoroughly and closed, often with preventive antibiotics. Rabies risk is assessed. See animal bites.

Tetanus

A booster is given if your last dose was more than 10 years ago for a clean wound, or more than 5 years ago for a dirty or bite wound.

After the repair

• Keep it clean and moist: gently wash once or twice a day after 24 hours and apply a thin layer of petroleum jelly. Skip heavy antibiotic ointments, which can cause contact rashes. Do not put ointment on skin glue.
• Swelling and bruising peak at 48 hours. Sleeping with your head raised helps.
• Suture removal: typically 3 to 5 days on the face, 5 days on the eyelid. Removing them early prevents "railroad track" marks. Absorbable stitches dissolve on their own.
• Infection signs: spreading redness, increasing pain after day 2, pus, red streaks or fever. Facial wound infection is uncommon but needs prompt review. See wound infection.

Minimizing the scar

A facial scar keeps remodeling for 12 to 18 months. It is typically pink and firm at 6 to 8 weeks, then softens and fades.

• Sun protection: daily SPF 30+ sunscreen or covering for at least 6 to 12 months, because UV light darkens new scars.
• Silicone gel or sheets: start after the wound has closed, usually around 2 weeks, for 2 to 3 months.
• Massage: gentle massage from about 2 to 3 weeks can soften the scar.
• Watch for thick scars: raised, itchy scars may be hypertrophic scars or keloids and respond to steroid injections.
• Scar revision: surgery, laser or dermabrasion is usually considered only after 12 months, once the scar has matured.

Frequently asked questions

Does a facial laceration need stitches?

It usually does if it gapes open, is deeper than about 0.5 cm (1/4 inch), is longer than 1 to 2 cm, or crosses the lip border, eyelid or nostril edge. Shallow cuts whose edges stay together may be closed with adhesive strips or skin glue. Repair within 24 hours gives the best result.

How long do stitches stay in on the face?

Facial stitches are usually removed after 3 to 5 days, and eyelid stitches after about 5 days. This is much sooner than on the arms, legs or back, because facial skin heals quickly and early removal avoids stitch marks. Adhesive strips can then support the wound for another week.

Is skin glue as good as stitches for a face cut?

For short, straight, low-tension cuts, tissue adhesive gives cosmetic results similar to stitches, without needles or a removal visit. It is not suitable for gaping, jagged, very deep or high-tension wounds, cuts near the eye, or wounds in moist areas such as inside the lip.

Will a cut on my face leave a scar?

Any cut through the full thickness of the skin leaves a scar, but on the face it often becomes a fine, pale line. Precise repair, early suture removal, sun protection and silicone gel help. The final appearance is not clear for 12 to 18 months.

Should I see a plastic surgeon for a face cut?

Most facial lacerations are repaired well by ER doctors. A plastic surgeon or specialist is usually involved for cuts through the eyelid margin, tear duct or ear cartilage, suspected facial nerve or parotid duct injury, tissue loss, complex bites, or wounds in a prominent area where the ER clinician recommends specialist repair.