Loose/pinched skin post nuss bar removal. How can I fix it? (Photo)

Question

Had a modified ravitch in 2022 for my pectus. Since the op i've now got some loose skin around the side of my chest from where the bars sat for 1.5 years (see pic) and on the other side the pec pinches in oddly due to the scar incision. Neither are huge issues - doesn't look that bad but would love to fix them if possible. Anything anyone can recommend? e.g. creams, treatments that can help with loose skin or pinched in scars. Thanks!

Anna Chacon, MD, FAAD · Answer

What you’re describing is actually fairly common after pectus repairs, especially when bars have been in place for 12–24 months. The skin, subcutaneous tissue, and underlying muscle can adapt to the pressure and contour of the hardware, and after removal it can leave behind:

Mild loose or redundant skin where the bar sat
Indentation or “pinching” along a scar line
Tethering of the skin to the underlying tissue
Small contour asymmetries that are often more noticeable to the patient than to others

The encouraging part is that, from your description and photo, this sounds relatively mild rather than a major chest wall deformity recurrence.

The two issues are treated differently
1. The loose skin / soft tissue fullness on the side of the chest

For mild post-surgical laxity, creams unfortunately have very limited ability to tighten the skin. A good moisturizer or silicone product may improve texture, but it is unlikely to meaningfully change the looseness.

Treatments that may help include:

Radiofrequency skin tightening (e.g., Morpheus8, BodyTite, Exilis, Thermage, depending on availability)
Microneedling with radiofrequency
Fractional laser resurfacing if there is also scar texture change
In some cases, targeted physiotherapy or strengthening of the serratus and pectoral muscles can improve the appearance by increasing underlying support

If the looseness is mostly soft tissue rather than excess skin, non-surgical tightening treatments can sometimes produce a subtle but worthwhile improvement over several months.

2. The “pinched in” scar area

This is the part that sounds more likely to respond to treatment.

A pinched or puckered scar after chest surgery is often caused by scar tethering—the scar is attached down to the fascia or muscle underneath. In that situation, the skin gets pulled inward when the chest moves.

Options that are commonly used are:

Silicone gel or silicone sheets (helpful if the scar is still maturing)
Scar massage several times daily
Intralesional steroid injections if the scar is raised or tight
Subcision (releasing the tethered scar beneath the skin)
Fractional CO2 laser or other resurfacing lasers for texture and contracture
Surgical scar revision if the indentation is persistent and cosmetically bothersome

For a true tethered indentation, subcision with or without a small amount of filler or fat grafting is often much more effective than topical treatments.

Timing matters

You had the surgery in 2022, so you’re now several years out from the original operation. That means the scars have probably reached a relatively mature stage, and further spontaneous improvement is likely to be gradual rather than dramatic. The good news is that mature scars are also easier to evaluate for definitive treatments such as subcision or revision because the tissues are stable.

What I would try first

Given that you describe both issues as “not huge”, I’d start conservatively:

Silicone gel or silicone sheets on the pinched scar for at least 8–12 weeks
Daily scar massage (firm circular pressure for several minutes, 2–3 times/day)
If the loose area is the main cosmetic concern, consider a consultation for radiofrequency microneedling or skin-tightening treatment
When surgery is worth considering

I would think about surgical scar revision or fat grafting only if:

the indentation is visible through clothing,
it causes discomfort or restricted movement,
or it continues to bother you after conservative measures.
My Honest Impression

Based on your description, I suspect the pinched scar is more likely to improve noticeably with targeted scar-release treatments, while the side-chest looseness may improve modestly with radiofrequency-based tightening but is unlikely to disappear completely with creams alone.

The fact that you’re saying “it doesn’t look that bad” is actually important—it suggests you’re dealing with mild contour irregularities, which are often the kind of post-pectus changes that respond best to minimally invasive scar and skin-tightening approaches rather than another major surgical procedure.

Jeffrey H. Spiegel, MD · Answer

If it is loose skin I would do a subcutaneous laser treatment (something like Junera). This is done in the office under minimal local anesthesia and should provide significant improvement after a very short procedure.

Laser Skin Solutions - Portland · Answer

Managing skin laxity and localized tethering following structural chest wall procedures like a Nuss bar or Ravitch repair requires an understanding of how deep surgical incisions and prolonged hardware placement impact the local tissue. When bars sit sub-muscularly or subcutaneously for extended periods, they can create localized dead space, capsular changes, or fibrotic adhesions that tether the skin down (causing a pinched appearance), alongside residual laxity where stretched tissue fails to fully retract.
As a licensed advanced esthetician in Portland, I frequently evaluate patients seeking non-surgical or minimally invasive strategies to improve post-surgical contour irregularities and scar tethering. Depending on the specific presentation, a multi-modal approach is often explored:
Breaking Fibrotic Adhesions (Pinched Scars): For areas where the scar is puckered or pulled inward due to underlying scar bands, subcision or targeted fractional microneedling can help release the tethered fibers and encourage smoother dermal leveling.
Improving Skin Laxity: For mild to moderate loose skin along the chest wall or sides, energy-based skin tightening devices (such as radiofrequency or ultrasound treatments) or collagen-stimulating therapies can assist in promoting firmer dermal resilience and tissue contraction over a series of sessions.
Because structural chest surgeries involve deeper anatomical planes and healing variations differ widely from person to person, an in-person clinical assessment with a qualified specialist is essential to determine whether non-invasive remodeling or minor scar revision is the most appropriate path forward.

Loose/pinched skin post nuss bar removal. How can I fix it? (Photo)

Answers (3)

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