Best Strategic Methods for a Tummy Tuck Scar in African-American Women?

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.

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.

I have performed tummy tucks on many african-american women.  With meticulous plastic surgery techniques, my experience is that keloid scar formation has been rare.  In addition, the use of early scar reduction methods, including scar gel and scar massage is helpful.

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

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.