Concerned. Arm lift incisions are getting thicker and look redder/irritated 9.5 weeks post op (Photo)

Question

My incisions started out thin and a "whitish" color. This past week it seems the incisions have gotten thicker, they look irritated and red. I have been using Skin Medica Scar Gel prescribed by PS, and massaging at least daily. Is this normal? Do I need to be concerned?

J. Timothy Katzen, MD, FACS · Answer

Hello SUZJUNCKIE1970 in Des Moines,
Thank you for reaching out with your concerns about the appearance of your arm lift incisions, which are becoming thicker, redder, and more irritated 9 1/2 weeks post-surgery. Your proactive approach in seeking advice is commendable, and I'm here to provide some guidance based on the information and photos you've shared.
Hypertrophic Scarring: Based on your description, it seems you might be experiencing hypertrophic scarring, a common reaction where scars become raised and red but are not infected. Scars indeed go through various stages of healing, and this phase can be a normal part of the process.
Silicone Gel and Sheeting: Continuing the use of silicone gel cream is a good strategy, as silicone is known for its effectiveness in managing scar appearance. Additionally, using silicone gel sheeting can offer further benefits. These sheets should ideally be worn continuously and can be held in place with arm sleeves, which are more comfortable than a garment and can be easily purchased online.
Garment Use: If you're still experiencing swelling, continuing to wear your arm compression garment is advisable. However, since you're beyond the initial 6 to 8-week post-surgery period, arm sleeves can be an alternative to keep the silicone strips in place and provide some support.
Future Scar Management: If, after 6 to 8 months, the appearance of the scars remains a concern, there are additional treatments you can consider. These may include steroid injections, 5-fluorouracil (5FU), microneedling, Morpheus8, dermabrasion, laser therapy, or potentially a surgical scar revision.
It's important to monitor the scars' progress and maintain regular follow-up with your plastic surgeon. They can assess the healing process and recommend specific treatments tailored to your case.
Please remember that while arm lift scars typically fade over time, they may not completely disappear. The key is finding the right balance between improving the scar appearance and managing expectations regarding the final outcome.
I hope this advice helps address your concerns and assists in guiding your ongoing scar management. Wishing you a smooth and successful healing journey.
Good luck, and take care.
Sincerely,
Dr. Katzen

Ira H. Rex III, MD · Answer

The two best approaches for scar management after brachioplasty are usually applying tape or silicone gel. Your scars may get worse before they get better. They tend to progress, getting better over 1 to 3 years. This should be followed by your plastic surgeon until the scars become more acceptable. There are other interventions that they may want to try, depending on your situation.

Marguerite E. Aitken, MD, FACS · Answer

Brachioplasty scars after an arm life can be upsetting if they aren't perfect due to the visibility of the location.  Scars typically go through a phase of healing where they can be very red, even thicker.  Conservative maneuvers such as massaging scar creams, taping of the scars with simple options such as paper or kinetic tape can work.  If the scars are itchy, it suggests that your body is still producing scar and extra care may be needed.  Silicone sheeting is available online and should be placed on the scar 24/7 to quiet them down.  Some lasers can work (pulsed dye) but can be uncomfortable.  Ultimately time will allow them to fade and then evaluation of whether or not they require revision.  Best of luck.

Lane Smith, MD · Answer

Scars will look at their worst the first 6 months and then fade for 2 to 3 years. We recommend scar gels during the day and silicone scar tape at night. It sounds like you are doing the right thing to take care of them. There are also lasers that can help zap out the red. We offer that on our med spa side. Check with your PS and see if they offer any type of laser treatments. =) Best of Luck!

Alicia Sigler, MD · Answer

Greetings,
This scar takes a longer time to undergo the full healing and maturation process. Maturation refers to the process whereby the scar becomes less apparent. Brachioplasty scars continue to heal 12-18 months to fully mature. It will continue to improve and lighten in color. Scars can be revised to try to achieve a finer line but I suggest that patients wait at least 1 year post op before proceeding with scar revision surgery. If after 12-18 months you are still unhappy with the scar, have a conversation with your surgeon in regards to the scar revision surgery.
Have an excellent day!

Donen Davis, MD · Answer

Unusual to have scars wide so soon after surgery.  All scar tissue is pink during early healing phases but raised and wide scars may have too much tension on the closure of wound or risks of hypertrophy. I agree with the silicone scar therapy and no scratching wounds. You should be seen often and may need steroid injections to reduce the scarring.

Ben Gbulie, MD, FACS · Answer

Hi
Thanks for your question.
Scar hypertrophy is not uncommon after brachioplasty. Aggressive massage and compression as well as use of silicone sheathing typically will improve the scars. In severe cases steroid injections may be required. Please see your PS to discuss these options in detail and he or she may advise you accordingly.
I hope this helps.....

Nancy de Kleer, MD, FRCSC (Plast) · Answer

Scars from an arm lift often become red after surgery until they completely mature with time.  Silicone scar gel is helpful, however I would also recommend silicone scar pads.  You can use the pads all day, or if you prefer not to have the pads on during the day, use the gel during the day, and the pads at night.  Massaging the scars is will also speed the maturation of the scars. 
The advantage of silicone scar pads are that they are more effective than the gel.  The disadvantage is that they are more cumbersome to wear.
Best of luck to you.

Frederick G. Weniger, MD, FACS, MBA · Answer

Thank you for your question and photo.  It is normal for scars to become red a couple of months after surgery.  If there is thickness to the scar you need to follow up with your Board Certified Plastic Surgeon to discuss the best treatment option for your situation.

Vasdev Rai, MD · Answer

Your scars in your pictures look within normal range for brachioplasty. Scars do go through red phase before lightening again.

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