There are a couple of issues with your scar that I can point out. Some can be addressed now and more easily, some not so easily and not so immediately. At five months after your latest scar revision procedure, you are still in the early phases of healing from the latest procedure. Part of the ongoing irritation and itching that you are experiencing likely has to do with the fact that you are having to shave that area, and this in itself creates irritation. The skin above the scar isn't being shaved, so it isn't getting as irritated and bumpy. Additionally, you are noticing itching in the lower, hair-bearing part of your skin, but not above the scar, and this makes total sense as the nerves above the scar have been affected with the original tummy tuck, and sensation in that area of your abdomen will probably always be diminished or absent. The itching you are describing “below” the surface of the skin - that deep itching that you can’t ever seem to scratch - is very typical of the nerve inflammation that accompanies this phase of scar healing. These things touch on two immediate issues with your scar and pubic area that can be addressed. First, the scar itself is a bit thick and raised, and that can probably benefit from silicone gel sheets, topical scar products like SkinMedica's scar recovery gel, Mederma, ScarFade, etc, and/or steroid injections directly into the scars to help soften them. Check with your surgeon about which, if any, of those might be appropriate. In addition to this, you might be better off with a more permanent method of hair reduction, like laser hair removal, or electrolysis, for that area. If you are thinking of undergoing laser hair removal, it would be worth inquiring of who ever does the laser treatments if they have the correct wavelength of laser to treat scar hypertrophy too. Not every type of laser can be used for this, though, so you have to make sure that it is the right one being used. This is another potential option for dealing with the scar itself, and if you are having one type of laser treatment for hair, it makes sense to add on scar treatments at the same time as well. Shaving frequently, especially in the pubic region, can be very irritating to the skin of some people depending upon their hair and skin type, and those people are better off finding other ways to manage the hair growth. This leads to the next level of issues with your scar that are not so immediate, and not so simple to deal with. This is a very important topic in the overall discussion of tummy tuck, however, as the scar is a big deal. In my opinion, the final quality of the scar begins to be determined well before the time that the surgeon actually lays a scalpel on the patient. It begins with the planning and marking of the incision for optimal position, and then all of the details of the rest of the procedure follow like a chain reaction, from the angle and position of the scalpel blade on the skin during the initial incision, to the re-alignment of the skin during the repair, and the way the repair is carried out - how many layers of sutures are used, how carefully things are lined back up, and the like. Each part of the procedure, right down to the seemingly most insignificant details, has an effect which can't, or shouldn't, be overlooked. All of this is way before we even get to the stage of asking about what kinds of scar gels to use or what to inject into a poorly healing scar. Thus, in your case we are seeing a couple of issues with this. First, your scar was planned high, and as a result your lax pubic tissues were “dragged” upward, such that now the hair appears above your bikini line and must be dealt with. Additionally, the scar above your pubic area is thickened, and this is very likely, though not definitely, related to tension on the tissues related to planning of the placement of the incision, the amount of tissue removed, and the techniques of closure used. I don’t point these things out to be critical of your surgeon, rather to demonstrate for you the complexity of the problem here so that you will know how challenging it might be to take care of definitively. It is hard to tell how to proceed along these lines in your specific situation, as you show a very limited view of your abdomen, and you have also undergone a subsequent procedure to revise your scar, which may well have removed any residual laxity in your tissues, and with that any hope of repositioning the scar lower. In these cases, one of my first thoughts for definitive correction is to allow everything to heal and soften as much as possible. This may be over a year after the latest procedure. Then I evaluate the tissues of the abdomen, especially the lower abdomen so as to not involve the umbilicus, or “belly button” any more than necessary, for any laxity we may use to lift the tissues back up completely and reposition the entire scar lower. This sounds like a big undertaking, but in the end, if things are bad enough, and we have the extra tissue mobility, it is highly successful, and well worth it. I have done this many, many times with very good results in the right situations. Any more limited attempts, like simply revising the central portion of the scar, while easier and quicker, have not be successful in my experience, and they often just increase the tension on the tissues, or increase distortion of the anatomy, and make things worse, not better. As I said above, however, this is a longer term issue and one that will take more time to fully evaluate and plan for. In the immediate term, look into the other suggestions I mentioned for management of the scar and hair growth, and discuss them with your own surgeon. You should not plan anything right now without at least clearing it with your surgeon. Then, as things continue to heal and settle down, you can more thoroughly evaluate the long term result and things like scar position and visibility, hair growth, tissue mobility, and the like, and you will know better if another more extensive procedure is necessary or worth it, or if it is even possible. Best of luck with your ongoing recovery.
