Open Wound of the Face

First aid for an open wound on the face

1. Stop the bleeding. Press firmly with a clean cloth or gauze for 10 minutes without lifting to check. Sit upright. Facial cuts often bleed briskly, which looks alarming but is usually not dangerous.
2. Clean the wound. Rinse under cool running tap water for several minutes. Remove loose dirt gently. Mild soap can be used on the skin around the wound. Avoid hydrogen peroxide, alcohol and iodine inside the wound, because they damage healing tissue.
3. Check the size and depth. If the edges gape, the wound is deep, or it is on the lip, eyelid, nose or ear, cover it with a clean dressing and get it seen.
4. Dress small wounds. Apply a thin layer of petroleum jelly and a nonstick bandage. Keeping the wound moist helps it heal with less scarring than letting a dry scab form.
5. Ease pain with acetaminophen (paracetamol) or ibuprofen, following the label dose. Ice wrapped in a cloth for 10 to 15 minutes helps swelling.

Types of facial wounds

Facial cuts are commonly caused by falls (especially in toddlers and older adults), sports, assaults, dog bites, road traffic accidents and glass. Children most often cut the chin and forehead. See facial laceration for more on repair techniques.

When a face cut needs stitches

Get the wound assessed if:

• the edges gape open or you can see yellow fat or deeper tissue
• it is longer than about 1 to 2 cm in a visible area
• it crosses the vermilion border (the line where the red of the lip meets the skin). Even a 1 mm misalignment here is visible later
• it involves the eyelid, the inner corner of the eye, the nostril rim or the ear cartilage
• it came from a bite, or the wound is dirty

How facial wounds are closed

• Skin glue (tissue adhesive): for short, straight, low-tension cuts, especially in children. No needle and no removal needed.
• Adhesive strips: for very small, straight cuts.
• Stitches (sutures): for longer, deeper or irregular cuts. Fine stitches are used on the face and removed after 3 to 5 days, earlier than elsewhere, to avoid track marks.
• Plastic surgery or specialist repair: for complex wounds, tissue loss, eyelid involvement, facial nerve or tear duct injury.

Face wounds have such a good blood supply that clinicians can often close them safely up to 24 hours after injury, or longer for clean wounds, whereas wounds on the limbs are usually closed sooner.

Special areas of the face

• Lip: cuts through the lip border or through the full thickness of the lip need careful layered repair. See open wound of the lip.
• Cheek: deep cheek wounds can damage the facial nerve or the parotid salivary duct. See open wound of the cheek.
• Eyelid and around the eye: wounds near the lid margin or tear duct need an eye specialist. Always check vision.
• Nose and ear: cartilage needs to be covered. A blood collection under the skin of the ear or inside the nose must be drained to prevent deformity.
• Forehead and scalp: bleed heavily. A forehead cut after a fall can come with a head injury.

Bites to the face

Dog bites to the face are common in children. Even small puncture wounds can be deep. Bite wounds carry a higher infection risk, need thorough cleaning, and are often treated with preventive antibiotics. Doctors consider rabies risk for wild animals and unvaccinated pets. See animal bite.

Tetanus

Any open wound can let in tetanus bacteria. You need a tetanus booster if:

• the wound is clean and minor and your last dose was more than 10 years ago
• the wound is dirty, a puncture or a bite and your last dose was more than 5 years ago
• you have never completed a primary series or do not know your status

Caring for a facial wound as it heals

• Keep it clean and moist with petroleum jelly. Wash gently once or twice daily after the first 24 to 48 hours.
• Do not pick at scabs or skin glue. Glue falls off on its own in 5 to 10 days.
• Avoid swimming until the wound has closed.
• Protect the wound and the new scar from the sun with clothing or SPF 30+ sunscreen for at least 12 months. UV makes scars darker.
• After the wound has closed, gentle massage and silicone gel or sheets can make scars flatter and softer.

Signs of infection

Facial wounds rarely get infected, but see a doctor if, 1 to 3 days after the injury, you notice:

• increasing redness, warmth or swelling spreading from the wound
• worsening pain
• pus or a bad smell
• red streaks or fever above 38 °C (100.4 °F)

An infected wound usually needs antibiotics. Infection around the nose and eyes needs prompt treatment because veins there drain toward the brain.

Scarring and outlook

Most facial wounds heal well within 1 to 2 weeks. The scar starts pink and raised and gradually flattens and fades over 12 to 18 months. People with darker skin are more prone to raised keloid scars and to dark marks. Scars that remain wide, raised or tight after a year can be improved with steroid injections, laser treatment or scar revision surgery.

Frequently asked questions

How should I treat an open wound on my face?

Press firmly for 10 minutes to stop bleeding, rinse under running water, then apply petroleum jelly and a nonstick dressing. Keep it moist and covered while it heals. Get gaping, deep, bitten, dirty or lip, eyelid, nose and ear wounds seen by a clinician for closure.

Does a cut on my face need stitches?

It likely does if the edges gape, you can see fat or deeper tissue, it is longer than 1 to 2 cm in a visible area, or it crosses the lip border, eyelid, nostril or ear. Small straight cuts can often be closed with glue or strips instead.

How long can I wait to get stitches on my face?

Ideally within 6 to 8 hours, but because the face heals so well, clinicians can often close clean facial wounds up to 24 hours later. Do not wait overnight on purpose, as delay raises infection risk and may change the repair options.

What should I not put on an open wound on my face?

Avoid hydrogen peroxide, rubbing alcohol and iodine in the wound, as they slow healing. Avoid makeup until the wound has closed. Do not pick scabs or use heavy perfumed creams. Plain petroleum jelly is enough for most wounds.

How can I stop a face wound from scarring?

Keep the wound moist, avoid picking, get gaping cuts closed properly and early, and protect the area from the sun with SPF 30+ for a year. Once it has closed, silicone gel and gentle massage can help. Persistent raised scars can be treated by a dermatologist.