6 months post FDL - should I wait longer for scar to heal? (Photos)

Question

I am 6 months post op from FDL. Part of my scar is healing beautifully, but the rest has keloid tissue. I am wondering if I should ask the surgeon for a revision, or if this is to be expected and I should wait longer for it to heal.

Christopher Pannucci, MD, MS · Answer

Hi Livoie,
I typically wait one year to allow scars to mature and settle before considering scar revision.
That being said, the red and raised scars are hypertrophic scars, and may benefit from steroid injection. I would suggest meeting with your plastic surgeon to be examined and to have a discussion.
Hope this helps.
Best,Christopher Pannucci MD MSBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Daniel Barrett, MD · Answer

Dear Livoie,
I understand you are concerned with the appearance of your scars. As your scars heal, it should flatten out and lighten. Loss of pigmentation or hyperpigmentation may also be experienced but will resolve over time. Always follow your surgeon's post operative care instructions when it comes to scar management to avoid any complications like infection and for faster healing and recovery.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Romy Ahluwalia, MD · Answer

There is some hypertrophic and keloid scarring visible. Consider steroid injections and re excision without tension followed by silicone sheeting

Karthik Ram, MRCS, DNB · Answer

Hello Livoie, 
Yes part of your scar is in hypertrophy. 
Its 6 months post surgery, and its best to intervene now to make it better. 
The treatment is multimodal and includes intralesional steroids, silicon gel sheets and scar massaging. And give it some time with these treatments.  If these measures fail, then you may need a scar revision. 
Please consult your board certified plastic surgeon as soon as possible and start treatment. 
Hope this helps. Thank you for your query here.

Camille Cash, MD · Answer

It can take a year for scars to mature so it is best to wait until that time for a revision.  However you may benefit from other treatments now such as steroid injections, laser treatments, or silicone strips.  I encourage you to visit with your surgeon to discuss these options.

Darryl J. Blinski, MD · Answer

Usually the average time is 12-18 months.... But your results even with dark redden scarring is excellent! Why mess with the scar? Maybe decorative tattooing?

Mats Hagstrom, MD (license on probation) · Answer

What many people call keloids are actually hypertrophic scars. Sometimes it can be difficult to truly differentiate but what you have are hypertrophic scars which are not quite keloids though it’s the same general mechanism that causes both.

In some people in some anatomic areas the healing process which is a balancing act between chemical reactions that favor increased inflammation and those that reduce the inflammation are a little out of balance.

Treatments aimed at reducing excessive scar tissue formation tried to tip the balance towards less inflammation allowing the inflammation reducing factors to work and bring the scar to maturity without excessive scar tissue formation.

Things that aggravate or increase inflammation in immature scars are chronic microtrauma like scratching or rubbing of clothing. How scars heal is highly dependent on what part of the body and the thickness of skin.

When it comes to choosing between a fleur-de-lis tummy tuck versus a wraparound or body lift style tummy tech I tend to favor the wraparound because the vertical scar is known for forming more visible scars in many people.

During consultations are usually do eschar history on people assessing the complexion and history of any scars including scratches and minor trauma they’ve had to get my best guess and how each individual person will heal.

During consultations are usually do eschar history on people assessing the complexion and history of any scars including scratches and minor trauma they’ve had to get my best guess and how each individual person will heal. People with a history of hypertrophic scar information should be managed during the postoperative course to minimize hypertrophic scar information the best possible.

The number one regimen in my practice has always been the use of silicone tape starting at about 6 to 8 weeks from the date of surgery until this car shows signs of being mature.

Hypertrophic scars can be itchy and scratching the scar especially on a regular basis is the absolute worst thing anybody can do it is almost a guarantee for developing a bad looking scar.

In order for silicone tape a.k.a. silicone sheeting to work it must be used for many months.

Typical products can be charge purchased on Amazon in one or 2 inch rolls that are about 6 feet long for around $20.  silicone tape can be cut into strips just wide enough to cover the scar making the product last a little longer.

Some people takeoff the silicone strips wash them and reapply them while others throw them away and apply new ones.

The time between changing strips depends on what each person is comfortable with but 3 to 5 days between changing strips is probably typical.

I recommend the patients take close-up pictures and document change at one month intervals to see if the product is helping this car go in the right direction.

Scars typically look the worst at around three months then gradually improve. Abdominal scars typically take 12 to 18 months to be mature or until the scar no longer changes without intervention.

To do a scar revision without indication is not warranted.

In other words cutting out the scar and watching the same scar form again makes no sense.

Unless the primary closure was done under less than favorable circumstances sky revisions will not improve the outcome.

Something has to be different during the second time in order for a scar of vision to be justified.

Examples of this are scars that come from traumatic injuries, scars that have been infected, scars that were based on a provider good lacked skill in suturing etc. etc.

Before even considering scar revisions and attempt should be made at all non-surgical options for improving the primary scar.

First and foremost is the use of silicone tape. The second option which does come with some risk is the use of anti-inflammatory steroids whether topical or injected.  The injection of dilute canalog or other anti-inflammatory steroids are very effective at stopping hypertrophic scarf for mission but can lead to thining out of this car with dis car widening and becoming excessively thin.  The impact of anti-inflammatory steroids can go on many months after the injection so a conservative slow and steady gradual approach should always be done.  Overuse of anti-inflammatory steroids can cause undesirable side effects.

I recommend you have ongoing follow up visits with your plastic surgeon and discuss all various sky reducing techniques until discard stops changing overtime and becomes mature which is typically going to take 12 to 18 months.

With or without intervention your scar is most likely going to improve over time and the decision to do a scar vision is premature before 12 to 18 months.

Best,

Mats Hagstrom MD

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!We must differentiate the difference between hypertrophic scars and keloids.A hypertrophic scar represents an excessive response to tissue injury, resulting in deposition of excess collagen. Its prevalence is increased after infection or in wounds under mechanical stress. The scar doesn't grow beyond the boundaries of the original skin injury. A keloid is a genetic inherited disease in which scars progressively thicken beyond the boundaries of the original skin injury. Hypertrophic scars usually spontaneously regress with time, the final scar noted when the redness of inflammation has subsided (usually at 12-18 months). Keloids may become inactive but usually do not regress.The application of pressure and immobilization of a hypertrophic scar with silicone gel sheeting appears to hasten resolution of the process. Various creams are available, but their efficacy is questionable. Injection of corticosteroids directly into the scar may flatten the scar and alleviate symptoms of itching or pain, but may also broaden the scar and cause permanent pigmentary change in the skin locally. For this reason, we usually delay its use for as long as possible.Surgical scar revision is an option to consider if regression is not noted at 12-18 months after the procedure. This is often successful in treating hypertrophic scars, but, on the other hand, keloid recurrence is quite common. It has only been 6 months since your procedure. As you are asymptomatic and there is no interference with your activities of daily living, I recommend continued conservatism for at least another 6-12 months. Take periodic photos for evidence of improvement...moisturize and avoid sun exposure to the healing scar.Best wishes...

6 months post FDL - should I wait longer for scar to heal? (Photos)

Answers (8)

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