For African American women with dark skin how does the scarring look after having a mommy make over?

Question

Also if you had a c-section do you cut along that same line so you don't have double scaring?

Jason E. Leedy, MD · Answer

A tummy tuck involves an incision in the bikini line.  The way I do it involves an incision below the C-section scar.  When marking, the pubic area is lifted up, this allows for the tummy tuck incision to be below the C-section scar and therefore the C-section scar is removed.  There is no double scar with a tummy tuck by doing it this way.  Using that bikini line incision the skin and fat is lifted up off of the muscles and the muscles are tightened.  The skin is redraped, pulling it down tight, and the excess is removed.  A new belly button is made.  The end scar is low enough to be hidden in a two-piece bathing suit.  Make sure you consult with a plastic surgeon board-certified by the American Board of Plastic Surgery

S. Larry Schlesinger, MD, FACS · Answer

Although the literature claims that African American women tend to have thicker and darker scars in general, that has not been my experience.  Each individual, no matter what their ethnic background, form scars based on the quality of the surgery, location on the body, and their personal genetics.  If you have other scars on your body that are either thin or thick, they would be an indicator of what type of scar formation you can expect to have.That being said, previous C-section scars are one major exception.  With a C-section, no skin is removed, therefore minimal tension.  Once the baby is removed from the uterus, stretched out skin from the pregnancy tends to create even less tension on the C-section scar, and horizontal incisions in the mons pubis follow what is known as Langer's lines, therefore leading to some of the best scarring on any individual's body.  As far as the location of the abdominoplasty scar, each surgeon has his or her own preference.  If you were my patient, I would always go below C-section scars and attempt to make the midpoint of the abdominoplasty incision as low as 1" above the vaginal cleft.  Sometimes, when abdominal skin has not been sufficiently stretched out, it may be necessary to make the incision just below the C-section scar, but never above it.  The lateral wings of the C-section scar, as much as possible, are kept in the crease between the thigh and the abdomen.  This leads to a scar easily covered by a small bikini.

Kenneth Hughes, MD · Answer

In the majority of cases, scarring can be very favorable.  The tummy tuck scar usually removes the C-section scar.Kenneth Hughes, MDLos Angeles, CA

Jed H. Horowitz, MD, FACS · Answer

Your #healing will continue for 2-3 months following the procedure(s) as the #scars will be evolving. If my patients have concerns that something is unusual about their healing process, it is important for them to call the office and discuss these concerns or come in to be examined. Also some severe scars can be treated with re-excision, laser, kenalog/5-FU injections, creams, silicone strips and other methods to reduce and improve healing. Additionally, scar therapy with scar maturation products (e.g. BioCorneum or Embrace) are suggested for managing scars. However, we recommend you wait to use scar improving products until a few weeks following your surgery.

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.

Jerome Edelstein, MD · Answer

Hello,Thank you for your question. I will usually remove the old C-section scar when performing a Tummy Tuck and this typically creates a much thinner, new scar. I recommend silicone sheeting for darker skin tones when visible scarring is a concern. Talk with your Plastic Surgeon about scar care options for you.All the best

Robert Galiano, MD · Answer

Scars in women of color (what we term Fitzpatrick V and VI skin types) tend to heal darker than the surrounding skin, but sometimes heal lighter... each patient is unique.  However, most of the time the scars, if they heal as thin lines, tend to be very acceptable. In addition, the scars will be placed strategically in areas that will be easily covered up by clothing such as underwear or bikinis, and the resulting scars are for most women an easy tradeoff for the improvement in shape and contour. I have done several clinical trials for scar therapeutics, and although we do not yet have a magic bullet that erases scars, if we control tension, minimize inflammation and apply knowledge of wound healing science strategically to our incisions and their management, we can usually  achieve acceptable scars in most women. I wish you luck!

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  In general women of darker skin color will have resultant scarring that is hyperpigmented - darker than their natural skin tone.  Keloiding is also more prevalent but there are steps during and after surgery that can be used to minimize this risk.  Commonly the tummy tuck scar is placed at the level of the C-section scar in order to avoid unnecessary scars.  Hope this helps.

Rodney A. Green, MD · Answer

Although it is true that African-American women have a higher incidence of keloid formation, if you have not developed keloids in the past then you probably will not do so in the future. I find that the redness that we see in the scar of light skinned woman, which persists for a long time does not occur in darker skinned women and the scar looks better earlier.Good luck.

Vaishali B. Doolabh, MD, FACS · Answer

Hi aisha2us.  A good scar will be flat, thin, relatively soft and lightly colored when fully healed.  In the early stages of healing, all scars are raised, firm and darker in color.  Skin with more pigment is at higher risk of scars growing beyond the expected borders (i.e. keloiding) and may be expected if other scars have done the same.  Yes, your surgeon can remove the old C section scar and leave only a single scar for your tuck.  Talk to your surgeon about your concerns and review their photos on patients of all skin types.  Good luck!

For African American women with dark skin how does the scarring look after having a mommy make over?

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