Creased/pleated tummy tuck scar. (photo)

Question

I'm a little concerned with the pleated/creased appearance of my incision. My surgeon says that it should flatten or smooth out as it heals but I haven't seen many photos that look like mine. Well it really smooth out our will I have to have some revision done?

John LoMonaco, MD, FACS · Answer

You had more skin on the top half of the incision than you did at the bottom, so your surgeon wisely did what we call an "advance."  This means pulling the skin inwards, which gets rid of "dog ears" at the end of the incision and changes them into smaller creases.  These almost always go away by 3 months, and a simple office procedure could be done if they don't look acceptable to you by 6 months or so.

Raffy Karamanoukian, MD, FACS · Answer

Abdominoplasty scars can be quite complex, ranging from the simple hypertrophic scar to a multiplane inflamed keloid. Pigmentation, discoloration, chronic inflammation, scar visibility can all occur in the short term. We begin each treatment with combination therapy using Yellow broadband BBL, Vbeam, fractional erbium, intralesional IIT, and scar modulation. Start with a combination of Plato's Scar Serum massaged twice daily after one week of epithelialization followed by Luminase/Exfolase. Scar consultation and revision may be recommended.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Robert Heck, MD, FACS · Answer

This pleating can be normal following surgery and over the postoperative period (up to 6 months) it should slowly improve. If it does not, I would revisit with your surgeon and perhaps a revision can be done but it's best to give it time to heal first. Best of Luck

Ira H. Rex III, MD · Answer

Is hard to answer your question without knowing how old that scar is.  Our body has a great capacity to smooth these things out and improve scars over time.  Somewhere between six months and a year your doctor could probably reassess the scar and decide if there is any reasonable intervention.

Vishnu Rumalla, MD · Answer

Thanks for your inquiry, and yes the pleating you see can decrease with time.  Please keep discussing your concerns with your plastic surgeon.

Jane M. Rowley, MD · Answer

Short answer-yes, it should smooth out.  From a technical standpoint pleating is often necessary when a patient has a lot of excess skin, it allows you to keep the scar shorter.  All patients are different preop so try not to compare your results, especially this early on.  Best of luck. Jane

John P. Di Saia, MD · Answer

Hello,You will likely want some revision, but it will be smaller in scale and look better if you wait for the scar to mature first...at least 6 months.Best Regards,John Di Saia MD

Michael L. Spann, MD · Answer

Early concerns after abdominoplasty are certainly warranted and common. Based off of your picture it seems that you are very early postoperative. The skin "creases" at the edge of the incision are likely a result of the pull of the flap at the time of closure. These typically resolve over a period of weeks to months.

Paul B. Mills, MD · Answer

Pleats and creases after a tummy tuck are not uncommon and can occur for a variety of reasons.  They become more common as the amount of skin removal increases.  They are also more frequent in patients with residual stretch marks.  Regardless they will usually settle out with time.  I frequently have patients wait about 3 months before discussing revision and by that time, revision is rarely needed.  Based on your photo, you still appear to have a significant amount of swelling which means your surgery was fairly recent.  If this is true, I would certainly give it time to improve on its own.  Thanks for the question and good luck.

David Dellinger, DO, FACOS · Answer

This is a common appearance of an early incision. As your body adjusts and heals, the wrinkling/pleating effect will even out. You should see improvement weekly over the next several weeks.