Belly button keloid over one year post tummy tuck - how can this be improved? (Photo)

Question

I had a bad TT experience because of keloid scar on BB. It is so exposed that I am open for another surgery to fix it. It has been 1 year 2 months. Please tell me what is my option!

Yasemin Aydinli, MD · Answer

I'm sorry you're dealing with this &mdash; belly button keloids after abdominoplasty are among the more challenging scars to manage because the umbilicus is a high-tension area prone to abnormal healing, especially in patients with a tendency toward keloid formation. After more than a year, the scar is considered mature, and there are several effective options available to you.
If the keloid is small to moderate, I would typically start with intralesional corticosteroid injections (triamcinolone acetonide) every 4–6 weeks for several sessions &mdash; this can significantly flatten and soften keloids. Combining injections with silicone sheeting or silicone gel applied daily accelerates the response. For more prominent keloids, surgical excision followed immediately by steroid injections &mdash; and in some cases a short course of adjuvant radiation administered by a radiation oncologist &mdash; gives the best long-term results. Pulsed dye laser is another helpful adjunct for redness and vascularity.
The most important principle with keloids is that excision alone carries a high recurrence rate &mdash; adjuvant therapy is essential. A board-certified plastic surgeon who specializes in scar management can create a tailored plan based on the size and characteristics of your keloid. You have good options here.

Frank Agullo, MD · Answer

Given the image, the raised scar is located inside the lip of the navel and the surrounding skin is smooth. From what I am seeing, this appears to be a thickened dark scar on an outie-shaped stump that I lean to consider hypertrophic. Hypertrophic scars are generally treatable with an excision and postop treatments. You will need excision with steroid and 5-FU, silicone sheeting and in rare cases, even radiation to fully address. You could probably handle a hypertrophic scar fine, start in the office with silicone and Kenalog to flatten and lighten it over a few months, or move on to a revision umbilicoplasty and restore it to a true innie once it is more mature. At 14 months out you are there.

#StayBeautiful,

@RealDrWorldWide

#StayBeautiful,

@RealDrWorldWide

Fernando Ovalle Jr., MD · Answer

Hello and sorry you are going through this! Keloids are a tough and frustrating, usually genetic way of scarring for which there is no cure. There are multiple options to help the scars that are rough, raised, discolored and uncomfortable start to flatten, soften, fade and become less symptomatic, but keloids always have a risk of recurrence, no matter the modality.

For less invasive/nonsurgical options, I usually advise starting with with steroid injections (usually combined with another medication called 5-FU which helps add synergy to the effect), silicone gel/sheets.  Injections are one of the most common first-line treatments for keloid and hypertrophich scars and certainly have less (no) downtime and are more cost effective than surgery.

If the scar doesnt respond to the injections and silicone treatment, a plastic surgeon may be able to excise/revise the scar and reconstruct the umbilicus to make it look more natural and less exposed.
However, with true keloids, simply cutting the scar out can make it come back or even come back worse. Since excision alone has a high recurrence risk, a revision is usually combined with post op steroid/5FU injections, silicone therapy, pressure/taping when possible, and occasionally radiation (Superficial radiation therapy) for severe or recurrent keloids

My advice is to seek an in person consultation with a board certified plastic surgeon with experience with keloids!

Belly button keloid over one year post tummy tuck - how can this be improved? (Photo)

Answers (3)

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