I have a 6 inch scar that is about 2 cm thick above my belly button that seems to have a"caved in" look. It also gives me a "tummy roll" look. I think (as well as the plastic surgeon I consulted)that the scar tissue is attached to the stomach muscle (starts with an "f") and that a scar revision procedure can help "smoothe out" the "caved in"/"rolled tummy"look but it wouldn't fix the "mild" fat around my love handles, upper & lower abdomen. Which procedure should be done first? Scar or PAL 1st?
Scar Revison Surgery Before Power Assisted Lipo (PAL) OR Vise Versa?
Doctor Answers 3
Timing of scar revision and liposuction
One of your goals would be to remove the adherence of the scar to the abdominal wall. Doing the liposuction prior to the scar revision would avoid any possibility of disturbing the scar revsion.
I would allow three months or so to pass, letting all the reaction to the liposuction to decrease, then do the scar revision.
There are alternatives, such as doing the liposuction and scar revision at the same operation, lipo first then scar, but doing a scar revsion on stable, non-healing adjacent tissue would be my prererence. At that time you could make sure the scar was not adherent to the abdominal wall.
When i have patients with a high C-section scar who do not require a scar revsion, I usually free that scar from the abodminal wall at the time of liposuction. Otherwise the skin tends to hang over the scar in the standing position.
As you were apparently instructed by the plastic surgeon you consulted, your scar may be adherent to the abdominal wall (fascia / muscle), especially if the scar resulted from a prior abdominal surgery. If that is the case, which should be apparent based on the physical examination, then a scar revision involving removal of the current scar and release of the deeper scar tissue. The scar revision can be performed after the liposuction or simultaneously. Additionally, depending on the amount of laxity of skin of the upper abdomen, an abdominoplasty may be performed to completely eliminate the scar, but this can only be determined by the physical examination. Good Luck.
What to do first...scar revision or liposuction
You're an unusual case. Without knowing the specifics for why you have that scar in the location you do, my thought is that you could do the scar revision and liposuction at the same time. My plan would be do to extensive liposuction of the love handles and abdomen, perform a scar revision with probably skin excision, possible plication of the rectus abdominus muscle, and probable incision around the umbilicus (to avoid distorting its position on the abdominal wall). It's basically a modified tummy tuck, based on your unique scar.
Hope this helps. Best of luck - Sam Jejurikar