I worked as a vet tech for 8 years and with all the surgeries we did on the animals I noticed the ones who received a subcutaneous running stitch had very minimal scaring and it was hardly noticeable. also I had a c-section 15 months ago for my twins and half of the scar is keloids and wondered if an aldara cream could be used after a tummy tuck to prevent this from happening
When Closing a Tummy Tuck Incision Can It Be Done with a Subcutaneous Stitch to Reduce Scaring?
Doctor Answers (12)
Reduced tummy tuck scar
Scar appearance is related to several factors and most important are good surgical technique and genetic factors in each individual. Good technique involves maximizing the healing environment or local factors in the incision. Maximizing the circulation to the incision, minimizing the tension on the closure, preventing the build up of blood (hematoma) and using a subcutaneous stitch are some of the things that we do to improve the appearance of the scar.
We have little control over the genetic factors that each person carries. Things like minimizing the tension can decrease the risk of "keloid" formation, but some individuals will form "bad" scars despite our best efforts.
It is best to speak with your surgeon about your concerns to get an idea about the risks involved. Good luck.
Suturing following tummy tuck
What you describe is called a us cuticular wound closure. This is how I suture closed the skin of a tummy tuck. most Plastic Surgeons do the same, but you should talk to the plastic surgeon to be sure.
Closing a Tummy Tuck Incision with a Subcutaneous Stitch to Reduce Scaring
Most surgeons avoid external sutures when doing tummy tucks. There are several layers of closure to allow for minimal tension on the last layer which has the greatest impact upon scarring.
There are a number of products your surgeon may consider to minimize the chances of keloid. Thanks and best wishes.
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TT scarring and sutures
Most ps do close their TT incisions with a running subcuticular suture for the very reason you mentioned. As for keloids and hypertrophic scars, Aldara is not recommended (at least in people). There are many treatment options for such scarring issues. A local board certified plastic surgeon can address these issues for you.
Best of luck,
Asif Pirani, MD, FRCS(C)
Subcutaneous dissolving stitches are the norm
Most elective plastic surgery operations are done with internal dissolving stitches. This includes a tummy tuck. If external stitches are used they would be removed with in a week of surgery to reduce scarring. Aldera cream would not be recommended but there are other things which could be done to minimize hypertrophic scarring
Suture closure and treatments to reduce tummy tuck scaring
Tummy tuck scars can be reduced by utilizing good surgical techniques. These include avoiding undue tension on the suture line and by performing a multiple layer closure using subcutaneous sutures. Patients can also aide in minimizing scars by maintaining a slightly flexed position for the first few weeks after the surgery. After the first 2 weeks, topical moisturizers and silicone scar sheeting, as well as, topical 1% hydrocortizone cream and sunblock - SPF 30 or higher, can also be of help.
Subcutaneous Stitch to Reduce Scaring?
Great question and observation. I think you would have a hard time finding a plastic surgeon that would use outside sutures. I have used the internal dissolving sutures for my entire practice and I think most other surgeons will tell you the same. But dogs do scar very differently than humans with their different skin and even with excellent internal suturing, sometimes the scar is not what we wish for.
Layered Closure is Key to Nice Tummy Tuck Scar
To have a thin tummy tuck scar, the incision closure should have as little tension as possible. This is best achieved when there are many layers of stitching below the skin. The goal of the tummy tuck is to create tightness and a flatter tummy so some tension is expected, even desired. But the closure at the surface has to have the least tension of all the layers. All stitches should be under the skin and ideally dissolve and therefore leave no suture marks. Even with the best closures some patients have the genetic "hard-wiring" to develop keloids or thick scars. If these occur, they will have to treated with steoid injections of later scar revisions.
Sutures in tummy tuck
In general, most plastic surgeons use only sutures under the skin to close the incision sites. Placing all sutures under the skin does help improve scarring as external sutures can leave stitch marks. Regarding your potential for keloids, you should have a discussion with a board-certified plastic surgeon on options to decrease risks of poor scarring.
Tummy Tuck and Subcutaneous Sutures
Most plastic surgeons use multiple layers of suture under the skin to achieve the closure they desire. For the part these sutures are dissolvable and will be gone in a few months after surgery. Most plastic surgeons also use subcutaneous sutures for the final layer of closure-just under the outermost layer of the skin-to obtain the best closure and final scar possible. On rare occasions, some external sutures may be required in some abdominoplasty closures and these will be removed as soon as possible to minimize any scarring.
Regarding your past wound healing history, this is something to address with your plastic surgeon who will develop a treatment plan to decrease your scarring risks. Best of luck and hope this helps.