Appendectomy Gone Wrong- What Are My Options For Scar Removal? (photo)

Question

My ruptured appendix resulted in a 2-3 in incision down my belly button. The scar ended up much more severe as my doctors were forced to reopen the incision a few days after my surgery because it still needed to drain(not sure if that's the right word). Now I have a wide oval shaped scar down my abdomen. I hate the appearance but I'm also concerned about the effects it may have on pregnancy or even weight gain. What would be the right procedure for something like this?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

John P. Di Saia, MD · Answer

Hello,

	A deep wide scar is ripe for improvement by a good scar revision. Seek an experienced surgeon and see what he or she recommends.

	 

	Best Regards,

	John Di Saia MD

Steven Wallach, MD · Answer

Your appendectomy scar could possibly be revised and more than likely it shoudl have no effect on pregnancy. The scar could even be removed and converted toa tummy tuck scar( transverse) after you have completed all your pregnancies.

Peter A. Aldea, MD · Answer

First an explanation of what happened to you and then we will go over your options.

	It appears you were quite sick when you presented to the hospital and your surgeons knew they had to operate on you but were not sure the process was a contained appendicitis. To leave all their options (and visibility) open they decided NOT to go through a classic right lower quadrant (McBurney) incision and opted for an infraumbilical midline incisions which allows access to the entire pelvis.  They must have encountered a ruptured appendix and tried closing the skin surface anyway but a skin infection with anaerobic organisms (air intolerant germs as are found in the colon) took place. The solution - exactly what they did. Open the skin surface, let air in and clean the wound with daily dressing changesuntil the infection cleared AND the wound resurfaced (referred to in surgical speak as healing by secondary intention)

	Your options at this time are:
	- do nothing. Of course nothing will change for better or worse.
	- REVISE the scar. The scar CAN be significantly made better by using Plastic surgery principles and techniques
	- PUNT - You can delay the revision until AFTER you complete your family. Odds are that if you are like the vast majority of women, the baby(ies) would stretch the tummy wall and underlying muscles sufficiciently so at the time of a subsequent Tummy Tuck or Mommy MakeOver ALL the skin span from the belly button to your Mons pubia (including this ugly scar) can easily be removed. It will be exchanged for a much nicer and thinner transverse scar hidden in your panties' confines.

	The choice is yours.

	Good Luck.

	Peter A Aldea, MD

Tom J. Pousti, MD · Answer

Thank you for the question and picture.

	The appearance of the scar can be improved by excising the scar and rearranging the tissues on either side of it.  This procedure will smoothen out the contour of your lower abdomen. Getting rid of the depression associated with the scar will help make it less visible.

	Another option would be to wait until you have  completed pregnancies and remove the scar completely with tummy tuck surgery. This procedure involves removing all the skin from the belly button down as well as tightening of the abdominal wall muscles that usually spread with pregnancy and/or weight gain/loss.

	When the time is right,  consult with well experienced board-certified plastic surgeons.

	Best wishes.

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