Please Help Me with What Do I Do About This 1 Inch Thick Tummy Tuck Scar? (photo)

Had a tummy tuck on 10/18/10 and a revision to the tummy tuck to lower the scar on 4/4/11. Wanted to wear a low rise bikini bottom as I told doc all along. Revision was done in office while awake. It's 1 inch thick, way longer (and has all kind of bumps). I had several infections because there were pubic hairs that were left inside and had to be re-opened 6 Xs and taken out (no shaving of pubic hair before surgery). This scar is just horrid. Doc has done 3 laser txs and 4 steroid shots. Help!

Doctor Answers (13)

Problems with tummy tuck

+1

I offer you one word at this moment. Stop! You have had a lot done to your scar over the last 2 years. There is tension on the wound, discoloration, skin thinning, and reaction to the ingrown hairs. I am not sure whether a laser was used for hair removal or pigmentation. They are 2 different lasers. Yes, you will need eventual surgical scar revision with wide undermining, closure of the superficial facial system, and tension free repair of the skin. I think it is really important to let everything settle down first. Massage with a castor oil based serum will help. The ingrown hairs can be treated by laser hair removal, if not done in the past. Over 3-6 months, the skin will settle down, inflammation will reduce, and I believe you will have greater success.


Seattle Plastic Surgeon
5.0 out of 5 stars 17 reviews

Tummy Tuck Scar - How to Minimize It

+1

I am sorry that you have not healed well and had so many problems as well as the bad relationship you have had with your surgeon.t From your photos I believe you will need a future scar revision. As you have lost confidence in his/her ability then I suggest you get a second opinion from a board certified plastic surgeon. 

Here is some general advice about how to get the best post operative scar following a tummy tuck revision with your history of a red raised scar: 

 

Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery.  Patients with scars that are enlarged or not healing well after surgery can be from many causes. Unsightly scars are most commonly due to genetics, underlying medical conditions or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”.
2– Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. NEVER apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection contact your surgeon’s office immediately and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
3. –Protect your scars from the sun - staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.  .
4. – Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best.  There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen,etc). At the present time I prefer BioCorneum  or Kelo-Cote products and if the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
5. – Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Treatment of Keloids and Hypertrophic Scars after Facelift
Best Scar Management Practice – Advice from Dr. Larry Nichter:
In your particular case it sounds like you have a hypertrophic scar rather than a keloid. Either way my advice is similar. At this late point you may well need a scar revision, a minor office procedure to remove your scar and replace it with a new one. Below are what I feel is important to prevent a future bad scar:
Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery.  Patients with scars that are enlarged or not healing well after surgery can be from many causes. Unsightly scars are most commonly due to genetics, underlying medical conditions or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas to minimize tension and keep pressure over the scar.  This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”.
2– Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. NEVER apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection contact your surgeon’s office immediately and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
3. –Protect your scars from the sun - staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.  .
4. – Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best.  There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen,etc). At the present time I prefer BioCorneum  or Kelo-Cote products and if the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
5. – Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical or injection of a steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 38 reviews

Scar widening after tummy tuck

+1

The scar will not get better with laser, creams or ointments. Truthfully, it needs a surgical revision. Overuse of steriod inhjections may cause thinning of skin making this look worse. The solution is to have a revised tummy tuck. Make sure you visit with a board certified plastic surgeon.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 13 reviews

You might also like...

Proper scar revision requires tummy tuck elevation

+1

Hello,

Sorry to hear about your ordeal.  In order to have an incision that is lower and thinner, the two sides of the incision need to be closed using the deep fascial (connective tissue) layer and the skin should be close under only milt-to-moderate tension.  In order to achieve this the abdominal soft tissues should be fully elevated from the pubic symphysis up to the costal margins.  This will allow the maximium amount of tissue laxity.  Closure should be done with long term dissolvable suture through the superficial fascial system (connective tissue) and then layered closure of the skin.  You should remain slightly flexed for about 2 weeks to minimize tension and then refrain from standing fully straight for another 2 weeks thereafter.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 82 reviews

Wide scar following tummy tuck

+1

The scar you have now is not likely to improve much. However, you need to wait for at least a year or even longer before considering scar revision. This would give time to the scar to soften and allow easy approximation of tissue. Also, I find it better done under general anesthesia. The reason is I could do more undermining and less tension around the closure site.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 3 reviews

Tummy tuck scar revision

+1
  Other than the scar, you appear to have a nice result after a tummy tuck.  The repeat infections, combined with some steroid injections, probably contributed to the widening and darkening of your scar. Simple scar revision at this time would not be beneficial, as your skin is not loose enough for wound closure without tension.  If you are not willing to wait 1-2 years for things to calm down, you could benefit from more involved procedure - re-advancement of your abdominal wall skin with appropriate quilting sutures and deep layer closure. 

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 21 reviews

Wide scar after tummy tuck

+1

What a bummer because your belly looks great!  You scar is nice and low and believe me, if I were you, I'd put on a bikini as long as it covered the scar. 

If you were my patient, I would ask you to wait a year for the skin to loosen up and then I would do a scar revision taking extra care to take as much tension off the closure as possible.  I would use progressive tension sutures between the underside of your fat pad and the muscle layer.  I think these sutures really help.  I would then get you into taping or silicone sheeting for your scar as soon after surgery as possible. 

Also, I avoid steroid injections.  In my experience they can cause a scar to widen. 

You should discuss you scar with your surgeon and maybe get a second opinion. 

Lisa L. Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 40 reviews

Widened scar from tummy tuck.

+1

Scars become widened and hypertrophic for many reasons, however tension and closure over time are two of the most common. A revision of a widened scar is always an option, but several important techniques need to be followed to achieve a successful result. Adequate undermining of the skin edges to allow for a tension free closure is a necessity. In addition, strong sutures within the deep fascial system (Scarpa's fascia) should be placed to relieve tension along the skin closure. If the skin availablity is minimal, a staged excision is an option. Postoperative scar management can help, but if the tension is not relieved all the lasers and steroids in the world aren't going to help.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 8 reviews

Tummy Tuck Scar Revision?

+1

Thank you for the question and picture.

I think you will benefit from further  scar revisionary  surgery. You may have to wait for enough laxity to be present ( several months to a year)  to allow for successful tension free closure.

Best wishes.

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 682 reviews

Widened Tummy tuck scar

+1

You have a hyperpigmented hypertrophic scar.  Fortunately, the scar is placed pretty low, so a bikini should cover it up.   And overall your tummy contour looks pretty good.  Since you've already undergone a revision and other treatments, I would give some time before any other interventions.  continue massaging your scar during this time.  let things settle down a bit more. I would likely recommend another scar revision in about 6 months.   

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 114 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.