What's the best way to treat my hyperpigmented tummy tuck and breast lift scars? (Photos)

Question

My plastic surgeon retired shortly after my surgery. I'm African American brown to fair skin 3years post tummy tuck scar area is very dark in certain areas and breast lift scar areas wide scar with slight hyperpigmented discolorations. 2 out of 5 local plastic surgeons are suggesting surgical scar revision for both areas, 1 medical laser technician wants to try Halo laser with alpha hydroxy bleaching agents and a few Doctors say nothing can be done. What is my best option to improve areas?

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.

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

Steven J. Rottman, MD, FACS · Answer

Thank you for your question and congratulations on your recent surgery. I instruct all of my patients to perform daily scar massage and apply a silicone based scar ointment or tape to their incisions. Biocorneum makes an excellent product. Please ask your board certified plastic surgeon for specific instructions regarding his or her scar management protocol. Hope this helps!

Scott E. Kasden, MD, FACS · Answer

Hi my550iWhat I would suggest is a combination bleaching cream (hydroquinone) with Retinoic Acid.  You are a bit far out from surgery but this treatment isn't expensive, it is not invasive, and it is worth a try.  If it fails, you can always go for surgery if it really bothers you.Hope this helps.sek

Ryan Marshall, DO · Answer

Hi and thank you for your question.  I would start my recommending the least invasive option possible, which are skin lightening agents or creams to be applied directly to the scar.  The ZO brand of skincare has good options, Melamin and Melamix, which include hydroquinone.  I would try these products for at least three months, and you should see some real benefit.

If those do not work, you can move up to more aggressive, and expensive, treatments with a skin resurfacing laser.  These treatments (usually 3-6) are performed in an office setting, while you're awake, with numbing cream applied to the skin for comfort.  I would recommend a "nonablative, fractional" laser as these lasers will give you less downtime and have less potential complications, such as hypo-pigmentation and/or scarring.

You can also combine the above treatments by using the skin lightening agents before laser treatments.  This is call pre-conditioning the skin and will enhance the effectiveness of the laser.  I hope this helps, and good luck!

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What's the best way to treat my hyperpigmented tummy tuck and breast lift scars? (Photos)

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