Excess skin and hypertrophic scar after tummy tuck. Should I consider a revision? (photos)

Hello. Thank you for your inquiry regarding a hypertrophic or thick tummy tuck score. Thank you also for asking about achieving a flat abdomen. There are multiple modalities which can be used to improve your tummy tuck scar. Minimally invasive techniques include micro needling, skin bleaching creams, injection of steroids or 5FU, and even surgical camouflage tattooing. Interventional techniques include surgical scar revision under local anesthesia. I believe since you are six months from your tummy tuck, that you can undergo any of those treatment modalities.
In regards to getting a tighter abdomen, I would suggest you look carefully at your profile picture. Your abdomen is very flat. I don’t think it can get much tighter. If it could be made tighter, you would not be able to stand up straight. When people flex ti sit, there is always laxity on the abdomen. This allows us to stand up and sit down.
I hope my answers help you to understand the potential treatment modalities of your tummy tuck scar. In addition, I hope you understand achieving tightness of your abdomen.

Abdominoplasty scars can be quite complex, ranging from the simple hypertrophic scar to a multiplane inflamed keloid. Pigmentation, discoloration, chronic inflammation, scar visibility can all occur in the short term. We begin each treatment with combination therapy using Yellow broadband BBL, Vbeam, fractional erbium, intralesional IIT, and scar modulation. Start with a combination of Plato's Scar Serum massaged twice daily after one week of epithelialization followed by Luminase/Exfolase. Scar consultation and revision may be recommended.

Best,
Dr. Karamanoukian
Realself100 Surgeon

In your age it takes over 12 months for scar to settle and mature. There is still significant time for improvement in your case. Using scar remedies in form of occlusive tapes and gels, will significantly help. Talk to your surgeon about your concerns. Good luck.

Dear trickynikky77,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

From your photos it does appear you have a hypertrophic scar. You can use silicone strips, lasers, or potentially steroid injections to help flatten and lighten it. After about a year you could consider scar revision. Your abdominal contours need to be discussed with your surgeon. The shape could be related to excess visceral fat or potentially failed muscle plication. Regardless all patients will have some redundant skin when bending forward to allow for normal movement and flexibility.

Your posted photos are nicely done. I recommend complete revision TT and bb with removal of excess skin and attempt to correct scar position (which btw is very irregular!). I require preop ultrasound that I offer in office to see if muscle repair has failed or not done? Fee $500. Surgery fee $10,000. Best to virtual consult with...

Dear Nikki,
It appears several things are going on here. Your scars are slightly hypertrophic and should be covered with silicone tape and occasional steroid injections to soften and flatten them.
The lower belly is not as flat as I’d like to see. The abdominal skin may stretch back post abdominoplasty so preop photos would help too.

To make an assessment on the cosmetic surgical procedure we need to see proper before and after pictures. without knowing your candidacy it for the procedure it’s difficult to assess a quality outcome.
Skin incisions take 12 to 18 months before they’re mature so you’re a little early to judge the scars at this moment. everyone is going to have skin laxity with a flexed abdomen such as a sitting position. It’s not possible to have tight skin with a flexed torso or you wouldn’t be able to stand up straight. A bulging abdomen after a full tummy tuck usually happens when people have access intra-abdominal or visceral fat. it could be insufficient muscle tightening but the most common cause for a bulging abdomen is excess visceral fat that should have been diagnosed or discussed during a consultation.
The presence of excess visceral fat typically creates pressure against the abdominal wall. This can be accessed Buy an examination.
One way to help decipher if visceral fat is causing abdominal bulging is to see if your abdomen goes completely flat when you lay on your back. during an examination we usually press against the abdominal wall to see if there is counter pressure from increased intra-abdominal volume which indicates the presence of excess visceral fat.
Consider watching your diet carefully and see if weight fluctuations improves the abdominal bulging. I’m guessing that even a modest weight loss of 5 pounds may have a significant impact.
Consider taking pictures and following your weight carefully.
To get a proper second opinion consultation I suggest scheduling those as an in person consultation with other local board-certified plastic surgeons.
Patients getting second opinion consultations should come prepared bringing with them copies of their before and after pictures and a copy of your operative report. These are all available from your surgeons office upon request since they are part of your medical records that you have a right to obtain.
Overall your pictures show a fairly typical tummy tuck result.
A full tummy tuck it’s a pretty major operation and it’s not unusual for patients to go through a bit of an emotional roller coaster during the first year.
Sometimes reviewing before pictures can remind patients of where they started at the hub to see overall improvements rather than focusing on the imperfections.
Revising your procedure it’s a big undertaking it will put you back from the beginning in regards to scar maturation which takes 12 to 18 months.
The decision to have a revision should be thought through carefully with input from your surgeon and possibly second opinion consultations if needed.
Best,
Mats Hagstrom MD