Wrinkled Tummy Tuck scar. (photo)

Question

Hello I am 3 weeks out from a full tummy tuck hernia repair and diatisti recti surgery. I am very worried cause my tummy tuck scar has some wrinkle ness to the scar. Is this normal I had a hematoma which seems to be going down I see my dr tomorrow. Will this ever go away?

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Ronald J. Edelson, MD · Answer

The wrinkles you have will definitely smooth out over the next few months.  You actually look like you have an excellent result.  I have never had to re operate because of wrinkling on a tummy tuck.  They always get better with time.

Jon M. Grazer, MD, MPH, FACS · Answer

It would be helpful if you had enclosed your pre-operative photos. It appears that some of the wrinkling may be stretch marks were present before the surgery. You state that you had a hematoma after surgery, but you don't mention if it was drained. A hematoma is a blood collection after surgery. When blood is outside the blood vessels,it can be quite irretating to the skin. When there is a hematoma the resulting subcutaneous tissue can be come quite firm especially if it is not drained.Firm areas of the underlying skin flaps and incisions  generally develop 10 to 12 days surgery. This 
healing ridge is normal. The area will soften on its own, but can take 6
 to 8 weeks to resolve, even longer if there is a hematoma.If the area is especially firm or uncomfortably 
you can use ultrasound to soften it. Scars typically are puckered at  first and start to get red and raised at 2 weeks after surgery,
and become the firmest at 2 months. They are the the most red at 6
months, and take 6 months to 2 years to remodel.Silicone sheeting is helpful to improve the results of a scar, but is often uncomfortable to wear
and difficult to stay on. Biocornium silicone cream works well, is easy
to apply and has sunscreen in it. I start my patients on it 10 to 14
days after surgery. You need to use it
for 10-12 weeks. Embrace silicone sheeting also works well as it takes the tension off the scar to help improve it.
Yours,Jon M. Grazer, MD, MPH, FACSPlastic Surgery,Newport Beach, CA

Ryan Hoffman, MD · Answer

Since you are 3 weeks postoperative from a tummy tuck, I think all your questions should be addressed by your operating surgeon.  That being said, there is a large amount of swelling that develops after surgery and is expected.  It may take up to 3 months before early final resutls are even achieved. Most times these wrinkles above  your scar and wrinkles on your scar itself will resolve on their own or with some gentle moisturizer and scar massage. Once again, I would discuss these concerns with your surgeon during your appointment tomorrow.

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Thank you for your question and photos.I don see any thing unusual in these early postoperative photos.you are still swollen and in the early stages of wound healing.It will take at least 6 months for you to see the final results and the scars to mature.I start all my tummy tuck patients on EMBRACE and silicone strips after surgery.I rarely perform revisional surgery before 9 months.Please address your questions to your Plastic Surgeon.My best wishes on a speedy recovery.

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