Scar removal/repair options for an ileostomy scar? (Photos)

Question

Hello! I have now been in remission from Crohn's Disease for 6 years now, and I am hoping to get advice on having plastic surgery to help make this scar better. It is on my right lower abdomen and it's from an ileostomy I had over 10 years ago. The scar is a bit depressed on the skin and hoping to get advice on what's the best course of treatment as I'm hoping to make my scar look much better than how it is now.

Christopher Pannucci, MD, MS · Answer

Hi SB52,
Great question.
In general, when ostomy sites are reversed, the would heals in by secondary intention--that is to say, your surgeon closes the abdominal wall but leaves the wound open and it heals in on its own. The reason is because that skin was next to the terminal end of the bowel, and is plausibly contaminated by gut bacteria. In that scenario, closure would predispose you to infection. Thus, leaving it open at the time of your ostomy reversal was an appropriate decision.
When wounds heal by secondary intention, the body contracts the edges in, producing a V shaped scar like you have. In addition, due to the closure method, the intermediate fascia/strong layer called Scarpas layer would not have been been closed.
Scar revision would remove the existing scar, re-identify the anatomic layers (including Scarpas fascia), and close in layers. This should improve the indentation, and would produce a slightly longer scar.
Most importantly, your surgeon would confirm there is no hernia at the site with a preop exam. In addition, if you are on immunosuppressants for your Crohns, you will have to discuss holding these in the peri-op period with your surgeon and your Crohn's specialist...immunosuppressants are good for your Crohns but bad for wound healing.
Hope this helps!
Best,Christopher Pannucci MDBoard Certified Plastic Surgeon Plastic Surgery NorthwestSpokane, Washington

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

Depressed scars can be improved with vascular lasers like Yellow laser, BBL, or Excel V when they are red --- and with CO2 spot treatments, fillers, microneedling with PRP, and subcision to help with texture and blending. I recommend getting a formal evaluation with a scarring expert. Best, Dr. Emer​

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