Hi, Im 7 months post op from my tummy tuck. I had a wonderful surgeon who was very patient with me through out this process. I am a African American female and have a petite frame 5'1 107 lds so I didn't have much fat or skin but I did have stretch marks from my pregnancy. But Im really concerned about my scaring its dark and raised . My doc said I have hypertrophic scaring so I had my 1st steroid injection on my bb and few weeks ago. I also see a fat pocket on 1 side. Do I need a revision ?
Do I Need a Tummy Tuck/ BB Revision? (photo)
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Scar revision after tummy tuck.
Thanks for your questions and your photographs.
It is clear from your photographs that you are prone to hypertrophic scarring. This is when the scar tissue tends to become thick and dense. Unfortunately, particularly in African American patients the etiology of hypertrophic scarring is usually genetic. You can certainly discuss scar revision with your plastic surgeon but if genetics is the culprit the scars may do the same thing all over again. Steroid treatment is a good thing to begin with. In terms of fatty fullness some touch up liposuction may be beneficial as well. It usually worth waiting at least 12 months to see the final result before you embark upon it.
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Will A Surgical Scar Revision Improve My BB & TT Scarring?
The post-op pictures of your abdominoplasty show moderate to severe hypertrophic scarring. If this is, in fact, your genetic predisposition, then a second surgery will yield the same unsatisfactory results. Of interest is the fact that your belly button ring just above the suture line showed no sign of hypertrophy.
Your plastic surgeon would be the best one to consult on whether a touch up surgery would be appropriate or not. He or she will know if there was sufficient tension reducing deep sutures placed in the superficial fascial system (SFS).
I personally would not recommend steroid injections as this can lead to widening of the scar which will make it look even worse. I use tape with a very strong adhesive placed directly on top of the scarring which will cause the scar to flatten, and yet the adhesive will not allow the scar to spread at the same time as flattening. As to the hyperpigmentation associated with the scarring, if this persist for more than 9 months, I treat it with a melasma cream containing kojic acid. Typically, the results of this are very gratifying.
Hypertrophic abdominoplasty scarring
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Hypertrophic Scars after Tummy Tuck
Hypertrophic Scars after Tummy Tuck should be treated conservatively for at least 1 year to 18 months. In many cases, it does not make sense to revise the scar at 18 months, because there is faily good likelihood that it will recur. You always have to consider if it is worth it to heal all over again for a chance that the scar may be a little better.
Try conservative measures on your scars first.
Your photos do show you have hypertrophic scars. You are genetically pron to hypertrophic scars and it was incisions in your skin which caused them, so any more incisions will likely result in the same scarring. Conservative measures include silicone sheeting, kenalog injections and massaging the scars. The scars will take many months to improve so you must be patient. If you feel there are local fat deposits which you would like to contour better, liposuction of the areas can be done to put the finishing touches on your abdominoplasty. The holes can be placed in your present scars so no new incisions need to be made.
Scar revision options
Thank you for the question and the photos. Your incisions do appear to have a hypertrophic and hyperpigmented appearance. One option for improving the appearance of the incisions is to perform massage, wear silicone tape, and inject them with steroids. This process does take some time to allow the body to make improvements. When you no longer see improvement with this modality or if the level of improvement is not enough for you then scar revision can be performed. You will likely benefit from some touch up liposuction as well at the same time. The belly button will have a tendency to resume the same type of healing if tension is placed on the closure and if any of the previous scar is left behind so the belly button will be the most challenging to revise.
All the best,
Dr Remus Repta
Do I Need a Tummy Tuck/ BB Revision?
From the photos it appears that you have hypertrophic scarring. The results look quite symmetric, and I am not sure of the location of the "fat pocket."
Genetic predisposition is the major causitive factor in hypertrophic scarring. Kenalog injection is the first line of treatment, and the"gold standard," not to imply that it works all the time. It is usually done in a series of 3 injections a couple weeks apart. Scar creams sometimes help.
Revision can be done, but the chance of recurrence is high, and the scar will usually be injected with Kenalog during the healing process.
Thanks for your question, best wishes.
Scar revision after a tummy tuck
It sounds like your surgeon is taking a very prudent approach to your scars. I would agree with starting with steroid injections and then progressing to scar revision if necessary.
Keloid/Hypertrophic Scar Management
Thank you for your pictures. It does appear that you have some hypertrophic scarring. This unfortunately can be common in African-American patients. In our office we typically discuss this during the consultation so that we can decide if the pros outweigh the cons. If there is a decision to proceed then we develop a plan to manage the keloid/hypertrophic scarring if it develops (steroid injections/silicone sheeting and sometimes pressure garments. I would give it at least 5 more months before considering revision. You could use some liposuction of your love handles. I would not revise your umbilicus.
Scarring is genetic
scarring has as much to do with your genetics as it does with the quality of the surgery. unfortunately darker skinned individuals do have a higher rate of hypertrophic scarring. having many african american and asian american patients, this risk is definitely discussed. i think starting with steroid injections is very reasonable. you can try using a silicone based scar cream as well. i would not consider a scar revision for at least about a year.
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