Please Help Me with What Do I Do About This 1 Inch Thick Tummy Tuck Scar? (photo)

I am sorry that you have not healed well and had so many problems as well as the bad relationship you have had with your surgeon.t From your photos I believe you will need a future scar revision. As you have lost confidence in his/her ability then I suggest you get a second opinion from a board certified plastic surgeon. 

Here is some general advice about how to get the best post operative scar following a tummy tuck revision with your history of a red raised scar: 

 

Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery.  Patients with scars that are enlarged or not healing well after surgery can be from many causes. 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:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas 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”.
2– 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 immediately 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”.
3. –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.  .
4. – 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.  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). At the present time I prefer BioCorneum  or Kelo-Cote products and 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.
5. – 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.

Treatment of Keloids and Hypertrophic Scars after Facelift
Best Scar Management Practice – Advice from Dr. Larry Nichter:
In your particular case it sounds like you have a hypertrophic scar rather than a keloid. Either way my advice is similar. At this late point you may well need a scar revision, a minor office procedure to remove your scar and replace it with a new one. Below are what I feel is important to prevent a future bad scar:
Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery.  Patients with scars that are enlarged or not healing well after surgery can be from many causes. 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:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas 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”.
2– 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 immediately 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”.
3. –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.  .
4. – 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.  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). At the present time I prefer BioCorneum  or Kelo-Cote products and 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.
5. – 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 or injection of a 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.

 

Other than the scar, you appear to have a nice result after a tummy tuck.  The repeat infections, combined with some steroid injections, probably contributed to the widening and darkening of your scar. Simple scar revision at this time would not be beneficial, as your skin is not loose enough for wound closure without tension.  If you are not willing to wait 1-2 years for things to calm down, you could benefit from more involved procedure - re-advancement of your abdominal wall skin with appropriate quilting sutures and deep layer closure. 

Your scar is low, well placed, and belly looks great!  Although you've had some difficulty, because it has been a year since your most recent revision, tissue is likely soft, pliable, and can be re-advanced after another scar revision. 

Meticulous plastic surgical technique, including a tension free very durable closure is important.  Additionally, I incorporate measures post surgically to prevent widening of the scar.  Close follow up after the revision and during the period of healing important for a good result.

The scar will not get better with laser, creams or ointments. Truthfully, it needs a surgical revision. Overuse of steriod inhjections may cause thinning of skin making this look worse. The solution is to have a revised tummy tuck. Make sure you visit with a board certified plastic surgeon.

Hello,

Sorry to hear about your ordeal.  In order to have an incision that is lower and thinner, the two sides of the incision need to be closed using the deep fascial (connective tissue) layer and the skin should be close under only milt-to-moderate tension.  In order to achieve this the abdominal soft tissues should be fully elevated from the pubic symphysis up to the costal margins.  This will allow the maximium amount of tissue laxity.  Closure should be done with long term dissolvable suture through the superficial fascial system (connective tissue) and then layered closure of the skin.  You should remain slightly flexed for about 2 weeks to minimize tension and then refrain from standing fully straight for another 2 weeks thereafter.

All the best,

Dr Remus Repta

The scar you have now is not likely to improve much. However, you need to wait for at least a year or even longer before considering scar revision. This would give time to the scar to soften and allow easy approximation of tissue. Also, I find it better done under general anesthesia. The reason is I could do more undermining and less tension around the closure site.

Scars become widened and hypertrophic for many reasons, however tension and closure over time are two of the most common. A revision of a widened scar is always an option, but several important techniques need to be followed to achieve a successful result. Adequate undermining of the skin edges to allow for a tension free closure is a necessity. In addition, strong sutures within the deep fascial system (Scarpa's fascia) should be placed to relieve tension along the skin closure. If the skin availablity is minimal, a staged excision is an option. Postoperative scar management can help, but if the tension is not relieved all the lasers and steroids in the world aren't going to help.

Thank you for the question and picture.

I think you will benefit from further  scar revisionary  surgery. You may have to wait for enough laxity to be present ( several months to a year)  to allow for successful tension free closure.

Best wishes.

 

You have a hyperpigmented hypertrophic scar.  Fortunately, the scar is placed pretty low, so a bikini should cover it up.   And overall your tummy contour looks pretty good.  Since you've already undergone a revision and other treatments, I would give some time before any other interventions.  continue massaging your scar during this time.  let things settle down a bit more. I would likely recommend another scar revision in about 6 months.   

The tummy tuck scar may be as poor as it is because of the multiple infections. We don't see much trouble with pubic hair, though infection and suture spitting can really pose a problem. Steroids, as well, can cause the scar to thin and widen. I think the scar can be revised and improved. Perhaps get another opinion.