Laser or surgical excision for abdominoplasty scar? (Photos)

Question

I had a mommy makeover 9 months ago and my abdominoplasty scar healed poorly. I'm not sure if it's keloid or hypertrophic or stretched but it is not a thin little line and is slow to fade . I am weighing out my options for scar revision now. I would love an excision to try and get the thin little line scar but I know this can be pointless if it's a keloid and grows back. Lasers are an option but expensive and I know it won't give me that thin little line of a scar that I can see in parts where I healed better. What would you suggest I try? So far I have been wearing silicone sheets near 24/7 and recently I started applying some tretinoin.

Anna Chacon, MD, FAAD · Answer

First, I want to reassure you that what you’re describing does not automatically sound like a keloid. Looking at your photos and your description, this appears much more consistent with a hypertrophic and somewhat stretched abdominoplasty scar rather than a true keloid.

That distinction is important because the treatment approach is very different.

Why I don’t think this is a classic keloid

A keloid usually:

grows beyond the borders of the original incision,
continues enlarging over time,
becomes thick, rubbery, and often quite itchy or painful,
and is more common on the chest, shoulders, upper back, and earlobes than on lower abdominal abdominoplasty scars.

Your scar seems to remain within the incision line, with areas that are wider, raised, and slow to fade, which is much more typical of a hypertrophic or tension-related scar after a tummy tuck.

At 9 months, I would be cautious about immediate excision

This is the key point: abdominoplasty scars often continue to remodel for 12–18 months, sometimes even longer.

The fact that you already have segments that healed as a thin line is actually encouraging. It suggests that your skin is capable of forming a fine scar, and the poorer areas may be related to local tension, inflammation, or wound healing differences, not an inherent tendency to form severe keloids.

Because of that, I would not rush into surgical revision at only 9 months unless the scar is clearly worsening.

What I would try first

You’re already doing the two things I would most strongly recommend:

Silicone sheets nearly 24/7
Tretinoin (which may help texture and pigmentation modestly)

I would continue the silicone for at least 3 more months if you’re tolerating it well.

Where laser fits in

You’re correct that laser will not magically turn a wide scar into a perfectly thin line. However, that doesn’t mean it’s not useful.

For scars like yours, I often think of laser as a way to improve:

redness or pink color,
thickness,
surface texture,
and overall blending with the surrounding skin.

The most helpful lasers are usually:

Pulsed dye laser (PDL) for persistent redness,
Fractional CO2 laser for thickened or uneven texture,
or fractional erbium in some cases.

If your main frustration is “it is obvious and slow to fade,” laser can make a meaningful cosmetic difference even if it does not create a razor-thin scar.

When excision becomes worthwhile

I would consider surgical scar revision if, after 12–18 months:

the scar remains consistently wide (more than a few millimeters),
the raised areas have stabilized,
and you are still bothered by the contour despite conservative treatment.

In your situation, a surgeon could potentially perform a limited excision of only the worst segments rather than revising the entire abdominoplasty scar. That often gives a better risk-benefit balance.

My honest ranking for you right now

Based on the photos and timing, I would lean toward this sequence:

1. Continue conservative therapy (now through 12 months)

Silicone sheets
Gentle scar massage
Sun protection
Tretinoin if your skin tolerates it

2. Add laser treatment if the scar remains red or thick

Especially PDL + fractional laser combination

3. Reassess for selective surgical revision after 12–18 months

Particularly for any persistently widened or tethered segments
One thing that may help you decide

Ask yourself which feature bothers you most:

Color (pink/red)? → Laser first
Raised thickness? → Laser ± steroid injections
Width/stretching? → Surgical revision is the only treatment that can truly narrow the scar

Since you specifically said “I would love the thin little line scar”, I think you already recognize that excision is the only option that has the potential to narrow the widened portions. The reassuring part is that your scar pattern does not strongly suggest a high-risk keloid situation, so revision would not be pointless if done after the scar has fully matured and by a surgeon experienced in tension-reducing abdominal scar revision techniques.

If this were my own patient at 9 months post-op, I would wait a little longer, continue silicone therapy, consider one or two laser sessions for the thickest/redest areas, and then make a decision about selective excision around the 12–15 month mark, when the scar has had a fair chance to complete its natural remodeling.

Jeffrey H. Spiegel, MD · Answer

If raised and firm you need a kenalog (steroid) injection series to soften it.  If flat you may benefit from IPL treatment (shouldn't be expensive) and morpheus rf microneedling. These together should provide meaningful improvement over time.

Laser Skin Solutions - Portland · Answer

When evaluating an abdominoplasty scar that is 9 months post-procedure and showing signs of poor healing, stretching, or uneven fading, weighing surgical excision against laser treatment involves understanding how mature scar tissue responds to intervention. At 9 months, the scar is approaching biological maturity, making it an ideal time to assess whether structural revision or surface refinement is most appropriate.
As a licensed advanced esthetician in Portland, I frequently consult with patients navigating post-surgical scar concerns. To determine the best path forward, several clinical factors should be considered:
Surgical Excision: While excision offers the potential to replace a widened or irregular scar with a fine-line closure, it involves re-opening the tissue and creating a new wound. If there is inherent tension across the abdomen or a tendency toward hypertrophic healing or keloid formation, re-excising the tissue carries the risk of the scar stretching or recurring wider than before.
Laser Resurfacing & Modalities: Fractional lasers (such as ablative or non-ablative resurfacing) and supporting therapies do not remove the scar entirely, but they excel at breaking down dense, rigid scar fibers, blending uneven borders, and reducing hyperpigmentation or erythema to soften the overall appearance.
Because silicone sheeting and topical retinoids require consistent, long-term application to influence collagen remodeling, an in-person clinical assessment with a qualified specialist is essential to evaluate skin tension, scar thickness, and healing history before choosing between revision surgery and advanced laser therapy.

Laser or surgical excision for abdominoplasty scar? (Photos)

Answers (3)

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