Treatment for Tummy Tuck Scar Revision

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

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Scars look good for two weeks, then they begin to get red raised and ugly. It takes two months, to get to the firmest healing, about  six months to get to the reddest, and six months to two years to improve.

I would start using silicone cream two weeks after surgery, two times per day. You need to do this for this for ten to twelve weeks.

There is no laser that removes scars, if the scar is red or dark , you can use a laser to help improve the color. Bleaching creams are also sometimes helpful in darker skin types.

You should use silicone gels/sheets right now since your scar is so new.  It is very difficult to "lower" a scar of that length.  I recommend waiting at least nine months to one year to allow the scar to mature and soften before doing any type of revision. The scar will lighten over time, you just have to be patient for now.

Consult with your plastic surgeon if you have any further concerns.

Best wishes,

Dr. Bruno

You should talk to your board certified plastic surgeon about what treatments including lasers, creams, injections and sheeting might be appropriate for the care of your wound.

See my many other posts on how the location of the tummy tuck scar is determined.  It is not something that you can just put at a low level without several other considerations.

 

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

The placement of a tummy tuck scar varies from patient to patient.  Some scars are placed where yours is and sometimes we are able to place them lower.  Your scar may be higher than you expected but in my opinion it is not out of the norm.  A lower scar would have cut across your tattoo.  Your surgeon may have taken this into account at the time of the markings.  Was this brought up at all prior to your surgery?

Unfortunately, it is very difficult to lower a "too high" tummy tuck scar. After a year or more and with some relaxation of the skin, there may be a greater probability for this to be performed but again it would be quite low and the amount that it could be lowered would generally not be a whole lot.

With regard to ancillary ways to help obtain the best possible scar, consider one of a variety of scar creams or lotions, silicone gel sheeting and a skin bleaching agent such as a hydroquinone that will help reduce the risk/extent of hyperpigmentation which you will be at an increased risk for.

Dear Mon Mon,

Scars usually fade over time, so patience is important. I would speak with your plastic surgeon about ways to reduce the chance of hypertrophic or keloid scarring. There are many options to prevent and/or treat hypertrophic and keloid scars including adhesive tapes, silicone sheets, medicines, lasers, and various creams and ointments.

As far as the location of the scar is concerned, unfortunately, it is very difficult to lower the scar unless the skin significantly stretches or relaxes after surgery.

Best of luck,

Larry Fan, MD

You are not correct in saying that your plastic surgeon made a mistake in your scar position.  Just because you wanted it lower doesn't mean that he/she could make it lower.  If you read the numerous posts on RS you will learn that the height of the scar all depends on how much extra skin you have and you clearly didn't have a lot.