Tummy Tuck Scar - Raised and Dark? (photo)

Raised, dark, red, painful, itchy scars after a tummy tuck can be a sign of either hypertrophic or raised scarring or early keloid scarring.  As you are aware, keloid scarring is more common in certain ethnic groups such as African Americans, Asians, Hispanics and some people of Mediterranean Origin.  A keloid is a scar that is larger than the original injury and does not flatten out with time.  Hypertrophic scars tend to remain limited to the area of injury and get smaller after 12-18 months.  The first line of treatment for tummy tuck scars that are less than favorable is silicon sheeting worn daily for 4-6 months.  More aggressive scarring can be treated with steroid injections early on to prevent progression.  This treatment is not without risk, especially in African Americans.  It can cause loss of pigment and widening of the scar if not dosed appropriately.  I would recommend consulting with a surgeon who has significant experience treating keloid scar in African Americans.  Early treatment would be recommended to prevent worsening.  Good luck!

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

Hello! Thank you for the question! It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. These can usually be started at approximately 3-4 weeks postop and when incisions healed. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. Scars will never disappear, but attempt is made to make the finest scar in a concealed location. Incisions may be revised to lower or conceal better if enough laxity exists. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself. Hope that this helps! Best wishes!

 

Scar massage, silicone sheeting, hydroquinone/retin-A creams and ultimately steroid injections are the most effective in treating raised, pigmented scars. Steroid injections must be used with caution to avoid lightening and widening of the scars. 

It does appear that you have thickening of your scar.  Silicone dressings are effective over a long duration.  Steroid injections could be helpful but I would be very cautious with the use of steroids in relatively young incision and because steroids could cause lightening of your incision.

Dr. ES

I recommend silicone gel sheets. I feel that this is the only thing medically proven to help improve the appearance of scars. I would also recommend following up with your plastic surgeon to discuss if a steroid injection would help as well.

Your scar looks like it is slightly hypertrophic. This typically is raised and hard and dark. Many people will call it a keloid but it is in reality hypertrophic.

Treatment involves steroid injections, silastic sheets, bleaching creams, and lasers. Vitamin E doesn't do much and lasers can be problematic in dark skinner people. 

I recommend steroid treatments and silastic sheets for you. The scars will fade with time also. The steroids are repeated about every 6 weeks.

Biodermis.com sells a high quality silastic sheet.

Good luck!!

Dr Saunders

Silicone sheeting may or may not work but this would be a first step.  There are a few lasers that may work.  Lastly, steroid injections will flatten the scar but you want someone that is familiar with these types of injections.  Bleaching creams can be used for the darkness and if this does not work, some nonablative lasers (lasers that do not remove the top layer of the skin) would be an option.

What you have is a hypertrophic scar. All of the usual remedies work some of the time, none work all of the time. Silicone products (sheet or gel) are often effective, are easy to use and do not require visits to your surgeon's office. 

Kenalog injections are often considered the gold standard, again not to say that they always work. They usually require 3 visits a couple weeks apart. Some lasers are occasionally effective, and also require repeated treatments. 

Try the easy stuff first, and if that fails, discuss options with your surgeon. 

Thank you for your question, best wishes.

Hello,

Thank you for the question and photo. Kenalog (steroid) injection may be of benefit. This will have to be injected by your plastic surgeon and there is a risk of thinning the skin too much as well as lightening the skin too much.  The non-invasive treatment would be hydroquinone cream (bleaching cream) and silicone tape.  Discuss this with your plastic surgeon to decide which option you would like to proceed with.

All the best,

Dr Remus Repta