Dark Scars at 5.5 Months Post Op?

Question

My breast augmentation scars, located in the crease, are flat but still very dark and noticeable at 5.5 months out. They don't seem to have lightened at all from the 2 month mark, based on a comparison of photographs. In fact, they look almost darker. Am I just a slow healer, or will scar revision be necessary? I have been using silicone gel on my scars for 1.5 months with no visible results. I am satisfied with the results of my operation but the scarring is disheartening. Any chance it will fade?

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.

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Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! After any surgical procedure, you should be careful with incisions as well as avoidance of direct UVA and UVB rays in order to lessen the chance for hyperpigmentation of the skin and scars, which can take several months to resolve, if it ever does. Sunblock is recommended regardless. The ability of the affected area to heal has been slowed and you should try to avoid additional swelling to the area. The area will likely be numb for several weeks to months and will be difficult to feel when sunburn is coming on. Typical recommendations include wearing a hat and/or sunblock to the affected area for at least 6-12 weeks following the procedure. It takes up to one year for scars to fully mature. If after that time of a year, consideration for steroid, laser, or scar revision is reasonable You should also avoid trauma to the area for several months to protect the refinements made during the procedure. Also, avoidance of pools/lakes/jacuzzis/etc for 4-6 weeks is usually recommended to allow adequate healing and protection from stagnant water, that could potentially harbor bacteria. Lifting/exercise restrictions are common for at least 6 weeks. Certainly discuss the postoperative instructions with your surgeon, as thoughts differ among surgeons. Hope that this helps! Best wishes!

Vincent N. Zubowicz, MD · Answer

Hyperpigmentation particularly in dark complected individuals is a byproduct of wound healing. Scar creams and silicone sheeting don't have any direct benefit. This should improve with time. Bleaching creams may be used but only after the information is totally resolved.

Sacha Obaid, MD · Answer

The dark appearance to your scars will likely fade with time. I usually recommend not considering scar revision until 1 year following your breast augmentation. Other things that will help are to avoid all sun exposure to the area and to continue using silicone scar tape or gel. Good luck.

David Bogue, MD · Answer

Hyperpigmentation of the scars is common in individuals who tan easily. This increased pigmentation may take up to 12-18 months to resolve. In some people, the hyperpigmentation stays. Options for these scars include IPL, lightening creams, steroid injections, and complete excision. Scars often respond to tension (which occurs in a breast augmentation) by enlarging and sometimes darkening. After the breast accomodates to the new size, a revision may be performed and the new scar is not subjected to the increase in tension resulting in a more pleasing result.

Robert Brueck, MD · Answer

Since you are only 5 months give it soem time.Soemtimes dealing with hyperpuigmenattion can be difficult but it is unusal following an aug.Perhaps soem over the counter bleaching cream might help.I would be patient.

Richard J. Brown, MD · Answer

Many things can affect the color of your scars: sun exposure, skin type and location of the scar. It is hard to fix. I have had to excise some scars in patients with the hopes that they would heal better and in most cases it works. We can attempt that, but there is always the risk or hyperpigmentation again. Sometimes using a bleaching cream like a hydroquinone can work, but is much less likely. Using sunscreen during the first year is also key. Go see your surgeon and see what they feel will work best. There are no best answers here.

Joseph L. Grzeskiewicz, MD, FACS · Answer

It really depends upon what you mean by "dark" scars. If you mean that they are dark red or purplish, and you can "blanch" them, or rub the blood out of them by pressing with your finger, that is something totally different than if they are darker brown and don't blanch. In the former case, it is not unusual to see dark red scars at this stage postoperatively, and this is called "hyperemia." Basically it is due to dilation and proliferation of the small capillaries in the healing scar as the body tries to repair the damage of the incision. Typically this fades after 12 - 15 months, but if it persists, or if it is not fading quickly enough for your tastes, the process can be expedited by treatment with a very specific type of laser called V-beam, or pulsed dye laser. If you wish to have this done, seek out a board certified plastic surgeon or dermatologist with this specific type of laser and the experience in treating scars with it that is necessary to obtain an excellent result. If, on the other hand, your darkness is more brown pigmentation of the skin, this is traditionally called "hyper pigmentation," and it is due to increased melanin production in the skin as a response to the trauma and inflammation of surgery. This should be treated with topical products like hydroquinone, or Lytera, a recently introduced SkinMedica product designed to reduce melanocyte activity and pigmentation of the skin. There are lasers, like the alexandrite laser, that can address this type of pigment too, but they can also cause increased pigmentation if not used carefully and properly, so best to find an experienced surgeon or dermatologist with this laser and the judgment to use it. Best of luck.

Jeffrey Zwiren, MD · Answer

Hyperpigmentation of a scar is difficult to correct. Some skin types are more prone to hyperpigmentation especially Asian skin types. The beast you can do is continue with the silicone treatments and consider the use of a topical steroid. It may take 1 to 2 years for most of the pigmentation to fade.

Jeffrey M. Hartog, DMD, MD · Answer

Everyone is different as far as healing is concerned. Darker skin holds onto pigmentation longer. I recommend a product called Biocorneum for my patients. They seem to really like it and feel it helps significantly. I don't guarantee it will work but that's the feedback I've received from my patients.

Dark Scars at 5.5 Months Post Op?

Answers (11)

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