I'm an African-American woman in my mid-twenties who has a history of keloid scarring. Sometimes I scar, sometimes I don't. My skin responds well to Kenalog injections Is it possible to have a hip-to-hip TT scar placed as low as the pubic area with a little loose skin left to prevent tension that I suspect would aggravate scar? Can I have Kenalog injections at time of TT closure? and would taking vitamins for months i.e. A,C,E,omega3s truly encourage more supple, healthier, better skin healing?
Best Strategic Methods for a Tummy Tuck Scar in African-American Women?
Doctor Answers 12
Here are the things to consider:
Very low incision so the scar can be hidden in sportswear
Closure with progressive advancement sutures to take all the tension off the skin closure
Dilute Kenalog into the skin at the time of closure using Kenalog 10 diluted 4:1
Meticulous closure with intradermal monocryl sutures.
Prolonged taping
Strategies:
- Careful incision planning. Sometimes it is possible to avoid incision around the navel, albeit with some compromises.
- All the tension of the closure in the fascia, not the skin
- Use relatively faster dissolving sutures--Monocryl rather than Maxon in the dermis.
- Early attention to scar hypertrophy with kenalog. Probably not at the time of closure.
- Early use of mechanical aids, such as silicone tapes.
All the best.
Thank you for your post. In tummy tuck and other lift/tightening surgeries, tension is the enemy. The scar is healing gradually over 12 weeks or so, and until it is strong, it is the weakest link. As there is a great deal of tension in tummy tucks, body lifts, breast lifts, etc., the scar is at high risk of 'stretching' or widening. Silicone sheeting, although having the ability to make a scar flat, does nothing to prevent stretching of the scar. Creams or steroids or lasers also do not have the ability to prevent stretching of the scar. Those are used if scar is thick or dark, but not to reduce the wideness of the scar, which is the main problem. Massage also does not help keep the scar thin, and can actually worsen the scar in the first 12 weeks because you are actually adding tension to the scar. Massage is for softening a hard or thick scar, but if used early, will hasten the scar widening. Only tension reduction has the ability to keep the scar as thin as possible. You may notice in a lot of tummy tuck scars that the center portion of the scar is the widest with the sides toward the hips being the thinnest. This is because the maximum tension is at the center, and least amount on the sides. Embrace removes a lot of the tension by putting more tension on the skin on either side of the incision and drawing the incision together. It is expensive though at about $100 per week for 12 weeks. When patients do not want to spend the money for embrace, I tape the incision trying to remove as much tension as possible for 12 weeks and recommend no stretching back and to sit most of the time, keeping tension off the scar.
Best wishes,
Pablo Prichard, MD
Best wishes,
Pablo Prichard, MD
Web reference: http://www.aaaplasticsurgery.com/photo-gallery/details.cfm?ID=79&StartRow=21
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There are several factors that affect the quality of the scar:
1. Genetics - this includes your race, but also specifics related to you and your family. I have many African American patients who have no issues with scars after cosmetic surgery, including TT, and have seen pale caucasian patients who do. Unfortunately, neither you nor your surgeon can change this.
2. Wound tension at closure - the tighter the tension on a healing wound, the more likely the scar may be of unsatisfactory quality.
3. Types of sutures used. I am not convinced yet how important this really is. This assumes that you have no reaction to the sutures. I like monofilament sutures that last a long time (PDS) but dissolve in the deeper layers where the strength of the closure is, and use monofilament absorbing sutures that dissolve much sooner in the superficial layers of the wound (monocryl). I have been using a barbed suture that doesn't need to be tied with knots (Quill PDS) and distributes tension across the wound very nicely and I have had some beautiful TT scars.
4. Scar management - massage, use of topical agents, sun avoidance are all very important.
5. Dressings - Dermabond is a tissue glue that seems to contribute to a favorable scar
6. Lasers - We have just purchased two lasers in our practice to treat scars so as to maximize the improvement but I have no data to report as yet. From what I have heard, they can be quite helpful in reducing the time the scar is red and improving the overall appearance. Time will tell.
7. Location of the scar - This probably one of the least thought about factors. One would think "the location is in the waist crease" but the fact is that many scars are either mispositioned or in a suboptimal position. Marking the patient with underwear or bathing suit on is critical to see how her clothing will lie against the body to ensure the scar is kept out of view. So, if the scar should be, for whatever reason, suboptimal, at least no one is ever going to see it when the patient is in a pair of shorts or bikini. There is an art to doing this but its not rocket-science, just common sense.
Web reference: http://www.epsteinplasticsurgery.com
In my opinion, the keys to a successful outcome in your case would be to place the incision as low as possible, to potentially inject kenalog in the post-operative period and to closely monitor your incision for any signs of the keloid starting in the first year after your surgery. If it does start, early intervention will save a lot of difficulty down the road.
Scar management for a tummy tuck will vary from surgeon to surgeon. I prefer to use tape for several weeks and if a patient has a history of unfavorable scarring silicone sheeting may be suggested.
Many of the suggestions listed are very good points. In particular a lower scar to hide if keloid does develop, reduced tension on the skin by placing tension on the fascial closure beneath the skin, NOT using an intradermal running suture and scar care after the surgery.
I have changed my wound closure method by eliminating the intradermal running suture as this adds a foreign material in the dermis which causes more inflammation and subsequently more scarring.
As of April 2013, I now GIVE a 2 ounce tube of SkinMedica Scar Recovery Gel to all my cosmetic patients to apply over Medpore tape for six weeks and then up to six months without the tape. It has really made a big difference in my scars.
I totally understand your conflicting concerns. I am not sure there is one right answer, but here are my thoughts.
I want my patients to get the best result possible based on my ability and their physical presentation. I would not make the skin too tight or too loose. There is a lot of flexibility in scar placement. I have patients wear either underwear or a swimsuit bottom so I can try to hide it. One thing to note however is that if the umbilicus is located high, a residual vertical midline scar will result, and this may influence incision placement.
Finally, there is another post tonight about the complications of kenalog. My suggestion is to only use it if needed. The thing about keloids and hypertrophic scars is that although persons of color and persons who have had them before are more at risk for keloids, they don't always occur. Best to treat them early if they start to develop, and avoid possible complications of needless steroid injections.
The scar is not ethnicly related, it depends on the configuration of your abdomen. A plastic surgeon should take your history into account and explain what is and what is not possible. Kenalog can be used.
The scar can be placed low and meticulous plastic surgical closure is an essential element to reducing thick scar formation. Keloidal and hypertrophic scars are different and an exam would indicate which you are prone to. Kenalog is not used at the time of wound closure but is a good postop method. Silicone sheeting in the early postop period is probably step one. Making the skin closure too loose will diminish the result and not aid in reducing the risk of scarring. Too tight a closure has its own consequences but this is a different issue. The risk of keloiding, if you have keloid scarring, has to be taken seriously, understood and planned for. Best wishes.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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