Patient and Observer Scar Assessment of Facial Keystone Flap Reconstruction in Korean Patients

Background/Objectives: Facial reconstruction using keystone flaps (KFs) provides reliable outcomes; however, few studies have evaluated postoperative scarring using patient-reported outcomes. We assessed scar outcomes after facial KF reconstruction using the Patient and Observer Scar Assessment Scale (POSAS) and explored associations with clinical and sociodemographic factors. Methods: In this retrospective observational cohort study, 43 Korean patients (27 males, 16 females; mean age: 49.95 ± 20.66 [range, 10-88] years) who underwent facial KF reconstruction between January 2020 and November 2022 were stratified by age (≤30, 40s-50s, ≥60 years), KF type (hemi-KF vs. other types), and sex. Results: Patients aged ≤30 years showed significantly higher total Patient Scar Assessment Scale (PSAS) scores (18.53 ± 5.69) than those aged 40s-50s (13.33 ± 3.27) and ≥60 years (11.82 ± 3.28) (p < 0.001). Observer Scar Assessment Scale and patient satisfaction scores did not significantly differ across flap types or sex; however, the hemi-KF group showed a trend toward better outcomes, and female patients reported higher PSAS scores. Conclusions: Facial KF reconstruction yields generally satisfactory scar outcomes. Younger patients are more critical of scars, and female patients exhibit greater aesthetic sensitivity. Patient-reported scar assessments are essential for individualized counseling, planning, and scar care in facial reconstruction.