I Had a Ftt 4 Wks Ago with Plication of the RA. I generally get Keloidal(hypertrophic ) scarring. What steps and for how long should I take to minimise this? Is there anything that I can take orally that helps in wound healing e.g. MSM?
4 Weeks Post- Tummy Tuck. Prone to Hypertrophic Scarring. Suggestions?
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Doctor Answers 8
Scar Management after Abdominoplasty
Use of silicone sheeting can help minimize the development of keloids/hypertrophic scars
Individuals like yourself who are prone to keloids or even hypertrophic scar formation should use silicone gel sheeting, usually starting at 3 - 4 weeks following surgery and continuing for several months. It should be applied for the majority of a 24 hr period.
There is nothing that can be taken orally that will prevent you from developing these abnormal scars. However, I do recommend taking high dose Vit C. and a high protein diet for several weeks to help in the overall healing process.
Tummy tuck and prone to hypertrophic scaring
This is a great question. There are a lot of people prone to hypertrophic scarring that are scared about the length of the scar related from a tummy tuck.
I would guess that you spoke with your surgeon about this issue and her had some recommendations for you, and with everything in plastic surgery, you will find that there are multiple answer for a single question.
My person recommendation is to immediately start using silicone sheeting across your entire incision. I am not sure that any particular brand of sheeting is better than any other, but they do vary in ease of use. If you google silicone sheeting, there are several manufacturers. Find one that is cost effective and has a reasonable way to apply it. You may also want to wear a surgical garment to hold it in place.
I do not think everyone needs to use silicone sheeting. However, if you have a personal or family history of hypertrophic scarring or keloids, I strongly recommend it.
There are gels/ ointments that have silicone in them; they are easier to use than the sheets of silicone and are easier to hid. The jury is out wether they are as effective as silicone sheeting.
I do not have experience with MSM, so therefore can not recommend it. There do not appear to be any peer reviewed articles on its efficacy.
I hope you heal well!
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Poor scarring after abdominoplasty
Unfortunately due to the high tension that one can get after an abdominoplasty, scars can become prominent and thickened (hypertrophic). The most effective means of flattening a scar is the use of silicone sheeting. I usually recommend patients to start using these at 3 weeks. This should be continued for about 4 months. One of the most important adjuncts to this is the compression of the silicone sheeting. We usually give our patients a stretch belt to wear over the sheeting. For very tough and resistant cases occasionally Kenalog injection (steroids) is used. This has to be used with great caution as it can "melt" the fat under the scar and create a significant deformity. I generally try not to use steroids for abdominoplasty scars.
Tummy Tucks and Scars -- How to Sort it Out
Scar issues in tummy tuck surgery
Many patients want the dramatic improvements in body contour that a tummy tuck can provide, but they are afraid of having bad scars or scars in a bad location.
How to sort it out
Scar Location -- Take a careful look at the before and after pictures on plastic surgeon's websites, particularly for patients that look like you. My general "starting point" for a Tummy Tuck or Body Lift scar starts low in the pubic area and stays low, but this can be modified to patient preference.
Scar Tendency -- If you have a C-section or other scar, this is often an indicator of how you may scar after a Tummy Tuck. For hypertrophic or keloid scar tendencies, I'd suggest keeping a watchful eye on the healing process and seeing your surgeon early for any suggestion of scar thickening (at which point a steroid injection would be considered).
Surgeon's Technique -- Taking tension off of the skin is critical. I use multiple quilting sutures (also called "progressive tension sutures") to share the tension of the closure across the entire area of the surgery. If your surgeon uses good technique, you should be good here.
Post-op Scar and Tissue Therapy -- Massage the scar. And massage some more. We include three to five post-op visits with a massage therapist for our Tummy Tuck and Body Lift patients for tissue and scar massage. We've recently begun giving out a 6-inch foam-roller to patients for self-massage of the tissues. And we also give out Dycem non-slip sheeting to help with self-massage of the scar.
Avoid Sunlight -- Should be easy to do. You still need to use sunblock over your scars when going out in the sun in a bathing suit.
Topical Treatments -- These can be helpful, but they cannot replace Scar Therapy and Sun Avoidance! Topical silicone sheeting is my favorite for a scar that can be covered under clothing, otherwise I recommend silicone ointment.
In my opinion, the #1 most important intervention a patient can do for their scar is to give it lots of attention with massage. Dycem sheeting can help with this and is available on Amazon. Next, avoid the sun and use sunblock. After this, yes, the topical treatments such as silicone or ointments have some benefits. Scars that become hypertrophic or keloid may benefit from early injection with steroids.
Hope this helps,
Nick Slenkovich, MD FACS
Tummy Tuck with Hypertrophic Scarring
I too recommend the use of silicone sheeting or silicone gels to try to prevent hypertrophic scarring. I think you can use these products now if you are otherwise healing satisfactorily 4 weeks post-op. If you still develop hypertrophic scars, there are injections which can be done to improve them.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.