4 months post-op. My scar looks nice until halfway down and then starts widening. Why is that? Do I have a keloid? (photos)

Question

Dear Drs I’ve had an arm lift on January 10 2019 The scars looks nice from the arm till half the way down, then the scars starts widening ? Why is that? Plus on my left arm the scar has a lump, I am not an expert but I don’t think it’s Keloid formation. My Dr said that he’s gonna do a scar revision after 4 sessions of laser therapy. Is there a reason behind this? Why laser then scar revision not vice versa? Will the scar widen one more time after the scar revision? Thanks a lot

Farbod Esmailian, MD · Answer

Sorry to hear about your scars, but they do appear rather thickened in those areas.  It can be referred to a Keloid vs Hypertrophic scars.  The definition is a bit different between the two, but for all intended purposed, you have a thickened scar that will unlikely improve over time.I am not certain about laser treatment and don't know of any laser treatment that can improve the appearance of thickened scaring.Things that we know work for hypertrophic/keloid scaring is steroid injections and silicone treatments.In certain cases, a revision surgery may be needed to remove the old scar and start over.  This would still require scar treatment as soon as possible after the revision to prevent the scar from becoming thickened again.Hope that helps.

J. Timothy Katzen, MD, FACS · Answer

Hello, Thank you for your questions regarding your arm lift, arm reduction or brachioplasty results. In my opinion you have a hypertrophic arm lift scar, not a keloid scar. By definition, a keloid is a scar that outgrows the boundaries of the original scar --like a head of cauliflower. I don't see this in your arm lift pictures. Examination of your arm lift scar pictures reveals a thick wide scar, not a scar that outgrows the boundaries. Every plastic surgery has their own ways of treating scar--that's why its called the art of plastic surgery. Personally, I would perform the surgical scar revision first, not after 4 laser sessions. Perhaps, your plastic surgeon is hoping that your arm scar will improve so much that you do not need a surgical arm lift scar revision. When required, which is rare, I perform arm lift, arm reduction, brachioplasty scar revisions in my office under anesthesia. I perform these scar revisions one arm at time with about one month between each arm. I specialize in arm lifts. If you have any more questions regarding the arm lift, arm reduction, brachioplasty or arm scar revision, please contact my office. Since your arm lift requires a revision, please seek an experienced, board certified plastic surgeon with significant experience performing these types of arm lifts. Do your research. Make sure your chosen plastic surgeon has performed at least 100 arm lifts. Make sure they have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon , Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Kenneth Hughes, MD · Answer

Hello, thank you for your question. In general, scarring is a product of genetics. Some people are good scar formers, and others are poorer scar formers.  As scars mature over months to a year, the quality of the scar usually improves.  There is almost always lightening of the scars. There is no one best therapy for scars. Silicone sheets, Mederma, and Biocorneum are reasonable and popular options. I recommend that the scar therapy begin after the scars have healed and there are no open areas.

Camille Cash, MD · Answer

From the submitted photos it appears you are developing hypertrophic scars.  This is different than keloids.  It can takes a one year or more for the scars to mature, so generally it's advised to wait until that time to surgically address them.  In the meantime the lasers can help with the appearance.

David Nguyen, MD · Answer

Hi x3x,
Your arm lift scar looks like it has become hypertrophic. This occurs more frequently near areas of movement such as the elbow. I'm not sure that the laser will help, but I believe the scar revision will make it better once it has settled down and isn't as red. I would continue to massage it and use silicone strips to help prevent it from getting worse in the meantime. Blessings on your journey!

Matthew A. DelMauro, MD, FACS · Answer

Hello! Thank you for your question. Based on your photos and post, it appears that you have widening of the scar near the elbow. There are lots of potential causes but they all boil down to tension on the skin across the incision line while you were healing. There are lots of treatments to improve the appearance of your scar. One of the most common treatments is to revise the scar surgically. This is usually done 6-12 months after the original surgery---to allow time for the swelling to resolve, the tissue to become softer and more pliable, and the scar to mature. The success of this technique can be improved with scar massage and the use of scar management products. Lasers may help the scar fade and look more like the surrounding tissue. But lasers are unlikely to cause the scar to shrink in width. Keep in mind that it is best to discuss your concerns with your plastic surgeon---especially if you have questions about a proposed treatment plan. Best of luck!
Matthew A. DelMauro, M.D.

Jeffrey Antimarino, MD, FACS · Answer

Thank you for your inquiry.  The scars are mildly thickened and called hypertrophic.   This is not uncommon with a brachioplasty procedure.   I feel a simple scar revision in the office under local anesthesia would correct the issues.   I personally don't feel laser treatments will add much to a thickened scar.   Lasers work well on overly pigmented scars but that is not your issue.I hope this helps.

Thomas Trey Sands, MD · Answer

Thank you for your question and I’m sorry for your concern. This is not uncommon with brachioplasty surgery. The tissue quality is different than other parts of the body. There are some things that can be done to improve this scar such as scar cream, sun block and perhaps steroid injections. As ample time is given for the scar to mature, of it does not look like it healed like the rest of the scars then an in office scar revision may be beneficial.

Francisco Sauceda, MD - Account Suspended · Answer

Thank you for your question.I do believe this is an hypertrophic scar, this is common in this kind of surgeries . The use of laser has been more beneficial on other conditions like pigmentation issues at least in my experience . In your case a scar revision probably will be the best option .Take care and best wishes .

4 months post-op. My scar looks nice until halfway down and then starts widening. Why is that? Do I have a keloid? (photos)

Answers (9)

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