What procedure(s) would help to revise my vertical abdominal scar from hysterectomy? (Photo)

Question

On 8/20/20, I had a hysterectomy with vertical abdominal incision. When I lay down or pull my abdominal skin up under my breasts while standing, the scar appears flatter, but gravity makes the scar and skin/fat/fascia uneven. If I am a candidate for scar revision, which procedure(s) are recommended? Do I need to wait a certain length of time after hysterectomy? Would I need a referral by the surgeon who performed my hysterectomy? Thanks so much for helping to answer my questions and concerns.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Although the overall appearance and quality of the scar will improve with time you would most likely be best served with a tummy tuck to get the best, long-term result.  I would advocate waiting approximately a year's time before any intervention.  Hope this helps.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Kenneth Hughes, MD · Answer

The TT can be performed several months after hysterectomy, provided healing was uncomplicated. Although goal weight is always recommended, a stable healthy weight is acceptable. Once you have lost the amount of weight you want, find the plastic surgeon with ELITE (board certified, experience, education, favorable patient reviews, hundreds of before and after photos0 credentials who performs hundreds of tummy tucks each year. You do not need a referral. 
As an author of Scars and Scar Revision in Reoperative Plastic and Reconstructive Surgery, my research reinforced what we have known for years: Scarring is a produce of genetics. Some people are good scar formers, and others are poorer scar formers. No particular scar treatment is better than another.
I advise that scars not be exposed to sunlight for the first year due to risk for hyperpigmentation. Silicone sheets, Mederma, and Biocorneum are reasonable and popular options. I recommend that the scar therapy begin after the scars have healed and there are no open areas, which usually takes 4 to 6 weeks.

Jason Emer, MD · Answer

this needs a revision and tummy tuck done at the same time. post care will be essential (see link) to ensure no wound issues after surgery for healing.  Best, Dr. Emer.

Robert M. Tornambe, MD · Answer

I am sorry you are having this issue, however it appears that you do have options. First off, your scar is only two months old and it takes a full year for scars to mature, so there should be some improvement with time. After 9 to 12 months, your options then include scar revision, if the scar is still bothersome. However, if you do not plan for the pregnancies, tummy tuck will not only tighten your abdominal wall but it should allow complete removal of the scar and skin below the belly button. You do not need a referral from your gynecologist. Consult with a board-certified plastic surgeon in your area to explore the best options for you. Good luck.

Robert L. Kraft, MD, FACS · Answer

I’m not sure why your hysterectomy was performed with a visible vertical scar but you are early in the healing process and need to give it time. You have indications for an abdominoplasty. This is a cosmetic procedure and would not require a referral from another physician. Best wishes.

What procedure(s) would help to revise my vertical abdominal scar from hysterectomy? (Photo)

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