Scar revision needed after laparoscopic appendectomy? (Photos)

Question

I recently had a laparoscopic appendectomy and 2/3 of the incisions are fine but one right above my belly button is weird. It's painful and bruised and it feels like the skin is pinned to the muscle underneath. Not only is it painful, it's made an unsightly change to the contour of my stomach, creating a bulging pocket of flesh above it that folds over when I bend. Almost like a belly button above my belly button. Did the surgeon do something wrong and is this correctable?

Nelson Lee Novick, MD · Answer

Subcision, which I have been performing since 1995, is a simple, relatively inexpensive, minimally invasive procedure for breaking up the fibrous tethering bands that hold a scar down and indented. It further promotes new collagen and elastic fiber synthesis to replace the scar tissue leading to a long-lasting to permanent improvement. If necessary, a robust HA filler can be added to achieve further elevation and smoothing. On the other hand, scar revision, is a true surgical procedure (with all the post-surgical downtime and expense that surgery entails) that involves cutting the scar out entirely and runs the risk for the subsequent development of a stretch scar and tram track stitch marks. You would be wise to consult with a board certified cosmetic dermatologist. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

After a laparoscopic appendectomy, a patient may desire scar revision for a variety of reasons, such as dissatisfaction with the cosmetic appearance of the scar, discomfort, or restricted movement.
Here's a general approach to scar revision after laparoscopic appendectomy:
1. Evaluation: The first step is to evaluate the scar. Consider factors such as its size, location, color, texture, and any associated symptoms (like pain, itching, or restriction of movement). It's also important to consider the patient's overall health, any underlying conditions that might affect healing, and the patient's expectations and goals for scar revision.
2. Timing: Generally, it's best to wait until the scar is fully mature before considering revision, which is typically around 6-12 months after surgery. This gives the scar time to soften and fade naturally.
3. Non-Surgical Options: If the scar is simply discolored or slightly raised, non-surgical treatments like silicone sheets, topical creams, laser therapy, or injections (such as steroids) may be recommended.
4. Surgical Options: If the scar is large, thick, or causing discomfort or restricted movement, surgical revision may be considered. This may involve techniques like excision and closure, Z-plasty (repositioning the scar so it aligns with natural skin folds), or skin grafting.
5. Post-Procedure Care: After scar revision, it's important to protect the area from sun exposure, as this can darken the scar. The patient should also follow all post-procedure care instructions, such as cleaning the area, applying prescribed creams or ointments, and avoiding strenuous activity that could stress the scar.
6. Follow-Up: Regular follow-up visits should be scheduled to monitor the healing process and assess the results of the scar revision.
Remember, the goal of scar revision is to make the scar less noticeable and improve function, but it may not be able to completely erase the scar. It's important to have a thorough discussion with the patient about their expectations and the potential results.

Scar revision needed after laparoscopic appendectomy? (Photos)

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Scar revision needed after laparoscopic appendectomy? (Photos)

Answers (3)

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Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.