Tummy Tuck Scar Revision (2nd Time)

Tummy tuck July 2010. Love the results, except that a 4 inch section of the scar (just above my pubic area) was very thick. Revised April 2011- same thing happened. Diligently used silicone scar cream with spf & silicone gel sheets. Had the injections as well. They flattened the scar, but it was still wide. Just had breast reduction 2 weeks ago. My ps revised my tummy tuck scar at the same time. Wondering if I should use the micropore tape on tummy & breast scars this time for better tension.

Doctor Answers 6

Post-Op Care Needs To Be Individualized

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It’s not unusual for patients who’ve had adverse scarring in the past to worry about unattractive incisions following revisional surgery.These unattractive scars occur for a variety of reasons.In some cases they’re related to the patients biologic healing capacity, while in other cases it’s related to mechanical factors such as high tension closures.
Several steps can be taken to minimize the spread of scars following this type of procedure.Anything that decreases the tension on the wound closure can help minimize scar spread.For this reason, we utilize steristrips, silastic sheeting and mircopore tape for 6-8 weeks following surgery.At two months the wound has healed and regained most of its tensile strength.
It’s important to realize, that each patients wound healing characteristics are unique and for this reason port-operative care needs to be individualized.In most cases, wounds have regained most of their strength in 6-8 weeks, but it’s also important to realize that the wound healing process continues for a year.

Anchoring sutures

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Thank you for your post. It is not common for surgeons to anchor the lower incision to the fascia or covering of the abdominal muscles to keep the scar low, however, I do use this technique and agree with it. All the tension on the incision is from above, not below, and thus the scar tends to move toward the area of maximal tension (towards the ribs/bellybutton). This moves the scar higher than desired. I like to keep my scars very low, and feel that anchoring the scar helps accomplish this. The following photo is an example of this.

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

How to Minimize Scars after Revision

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Yes you are on the right track with the micropore tape but there are many approached to obtain the best scar. 

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 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”.
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.  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). At the present time I prefer BioCorneum or Kelo-Cote products especially on areas that silicone strips aren’t applicable, for example, on the face. 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.

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Consider greater undermining and repair of the superficial fascia

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Scar revision where the previous scar is cut out and the skin is closed places tension on the skin closure and predisposes you to a bad scar again.  Freeing up the tissue to allow more laxity and closing the incision by repairing the superficial fascia will place a much smaller amount of tension on the skin closure and hopefully a better scar result.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Scar revision from tummy tuck

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We like to use Hypa-fix tape across scars to help remove tension, but taping is no substitute for surgically managing tissue for tension free durable closure.  Follow up with your surgeon during healing so that if scar begins to worsen, timely intervention to minimize problem can be instituted.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Scar revision

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It sounds like you did everything you could after the first scar revision and there was still widening.  The reason the scar widens in the middle is because that is where the wound closure has the greatest tension on it.i would recommend you follow whatever instructions your plastic surgeon gives you,  Tummy tuck scars can take a year or longer to fade. Although steroid injections can help, too many injections can actually make things worse by causing the scar to thin out and widen too much. If you do have steroid injections done, I recommend a series of three injections one month apart and no more.  Otherwise, it's largely a matter of time and patience.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

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.