Scar Tissue after BBL? (Photos)

Question

i had BBL a month ago which created a very hard scar tissue on my lower back. i started lymphatic massage on a daily basis, the therapist focuses on the lower back to break this scar tissue. after 8 sessions i feel it is getting more soft, however, I'm still unhappy with the appearance of the skin. my surgeon ask me to continue wearing the garment and continue taking massage sessions. My question is, do i still need to do anything else to speed up healing? is this is going to improve by time?

Larry S. Nichter, MD, MS, FACS · Answer

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. 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:

Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery 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”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.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 right away 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”.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.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. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products 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).. 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.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.

Kenneth Hughes, MD · Answer

Scar tissue after BBL will tend to soften with time, and 1 month is very early.  I would try to email or call the surgeon.  Surgeons want to know about potential problems.

Kenneth Hughes, MD

Los Angeles, CA

Tania Medina de Garcia, MD · Answer

Hello dear, thanks for your question and provided information as well... I will recommend you to continue using your compression garment 24/7 and also to use cavitation massages, they may can help you more that the traditional lymphatic drainage one's.

Mats Hagstrom, MD (license on probation) · Answer

Healing takes time.

There is no substitute.

The healing process is based on various phases your body must go through.

This process is done on the microscopic level through changes in the molecular structures such as collagen cross-linking.

I personally don't believe that physical manipulation such as massage can speed up this process which has to take it's course and again it happens on a molecular level.

Time with or without massage eventually bring the tissues back to their final post operative condition.

Excessive firmness or lumpiness is often seen in areas over treated or if there is residual blood or extensive bruising after the procedure.

I don't believe massage has any direct negative impact on areas other than the exception of areas treated with fat transfer which should never be massaged within the first month.

Any physical activity that causes discomfort after surgery should be avoided in my opinion since pain is our bodies signal that tissue damage is being done.

Most patients results are close to final at three months though in certain cases it may take six months or even longer.

It's generally best to follow the instructions of each individual patients treating physician.

There is no treatment that significantly speeds up internal healing.

You may find providers who recommend ancillary treatments such as radiofrequency treatment, hyperbaric oxygen ultrasound therapy's.

In  my opinion these are too often recommended as sources of secondary income after the procedure.

If there was a scientifically proven method of improving or speeding up healing it would be the standard of care and would be recommended by all plastic surgeons.

The scar tissue formation and appearance of skin incisions can't be improved with the use of silicone sheeting.

Again time usually leaves patients with the same results.

For patients who have a history or tendency to form excessive skin scars I highly recommend using silicone sheeting.

One brand I like is safetac which is available from Amazon for around $20.

Continue following up with your plastic surgeon.

Best,

Mats Hagstrom M.D.

Scar Tissue after BBL? (Photos)

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Scar Tissue after BBL? (Photos)

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