Tummy Tuck With Scar Tissue

Tummy Tuck With Scar Tissue

Some tummy tuck scars, such as hypertrophic or keloid scars, may need surgical treatment. During scar revision, a surgeon cuts the scar out of your skin and then closes the wound with stitches. Most people need to wait 12 to 18 months after their tummy tuck for scar revision surgery. This is a time when the scar is about as good as it is going to get and the skin has had a chance to further relax and take tension off of the scar.

A tummy tuck scar is a normal side effect of abdominoplasty. However, you may want to diminish the appearance of a noticeable tummy tuck scar. Taking care of your overall health and skin before surgery can help prevent severe scarring. Postoperative wound care, skin ointments, steroid injections, laser resurfacing and surgery may help improve the look of a scar after a tummy tuck.

About 2 to 3 weeks after your surgery, you may consider scar massage. Gently massaging the scar and the surrounding skin can increase blood flow to the area and help with the healing process. Massage can also break up some of the tougher scar tissue. Talk to your healthcare provider before trying scar massage.

It’s extremely important to stay out of the sun as your wound heals. Ultraviolet radiation can make your scar discolored or change its texture, making it thicker. For 12 to 18 months after your tummy tuck, wear sunscreen with an SPF (sun protection factor) of 30 if you have to be in the sun.

Getting proper nutrition is also an important part of wound healing. Talk to your healthcare provider or a registered dietitian about the best way to get all the vitamins and minerals you need. They may recommend taking a daily multivitamin or other supplements as you heal.

There’s a variety of ways that you can help your incision heal after a tummy tuck, which can reduce the appearance of scars. Follow your provider’s instructions carefully about caring for and cleaning your wound. Avoid heavy lifting, strenuous exercise, sexual activity and stretching until your provider says it’s safe to do these activities (usually four to eight weeks after the procedure).

Internal Scar Tissue Tummy Tuck

Hypertrophic scars can develop in wounds that were closed under high tension. The term high tension refers to the way that the incision was closed when it was sutured shut (where you were sewn together).

High tension means that the wound closure is stretched tight. This can especially occur in areas where there is a lot of movement. High tension can cause the scar to expand and become thicker. Wounds that are sutured at deeper layers typically have lower tension. Wounds that are closed only at the surface, usually have a higher amount of tension.

Symptoms and Appearance

Hypertrophic scars usually occur within 4-8 weeks following a Plastic Surgery procedure. The original scar becomes raised, but the borders of the scar do not extend beyond the original wound closure margins. In most cases, hypertrophic scars are linear. These scars can resolve with conservative pressure therapy and with time. The other good news is that hypertrophic scars can be eliminated by surgically removing them.

Incidence

The incidence of getting some degree of a hypertrophic scar following a surgical procedure in the general population is 40%-70%. While this is high, there are varying degrees of hypertrophy, and some scars are more acceptable than others.

KELOIDS

Keloids are irregular looking scars that form after an injury or surgical procedure. Simply put, a keloid is an unsightly scar that oversteps its original borders.

The scar will not only be raised, but it bubbles up beyond the original incision outline. Although there are therapies which can help keloids, they are more difficult to eliminate than hypertrophic scars.

Symptoms and appearance

A keloid scar has a raised and bumpy appearance, which extends past the original scar. In many cases, a keloid can have a cauliflower-like appearance. Keloids can form immediately after the injury or procedure, but can also occur months, or even years after the procedure.

Incidence

Keloids have a very small incidence among the general population, but dark-skinned individuals are much more susceptible. Keloids have an incidence rate of 6-16% in African populations. Family history of keloids is a huge predictor of developing keloids, so anyone with a family history of keloids should be sure to mention it to their Plastic Surgeon prior to their procedure.

HYPERTROPHIC SCAR VS. KELOID SCAR

While both scar complications can create cosmetic concerns, there are a few differences worth noting.

What is the main difference?

While a hypertrophic scar is thick and raised, it looks different from a keloid because it does not extend beyond the original margins of the wound. The hypertrophic scar is usually linear, whereas the keloid scar is irregular and cauliflower-like.

Which procedures can get hypertrophic scars or keloids?

Either one of these scars can develop following any procedure where an incision is made. This not only includes procedures with longer incisions such as the abdominoplasty, but also includes any type of ‘lift procedure’ such as breast lifts, body lifts, face lifts, and lip lifts.

Does gender, age, or family history matter?

The occurrence of keloids and hypertrophic scars has equal sex distribution and are most common in the second or third decade of life.

While family history is not a big factor in hypertrophic scars, family history is highly correlated to the incidence of Keloid formation. More than 50% of all keloid patients have a family history of keloid scarring!

Can hypertrophic scars or keloids be prevented?

A Plastic Surgeon can help reduce the risk of hypertrophic scars during surgery and patients can help reduce the risk following their procedure. Some investigators believe that these factors can also help reduce the risk of keloid formation.

These techniques include:

Reduce tension at the incision during closure

When an incision is freshly closed with sutures, that closure inherently has ‘tension’ at the closure point. This refers to the forces that exist which naturally want the wound to open back up. In order to reduce tension at the surface of the incision, a surgeon can close the wound with several (deeper) layers, so that the tension (the pulling) is distributed deeper down. This allows the incision at the surface to have the least amount of tension on it. With less tension on the wound, there is less trauma and inflammation on the scar.

In all of our tummy tuck and body lift procedures, we close incisions using the Lockwood technique. This technique uses deep wound closure techniques that results in the least amount of tension at the wound closure on the surface.

Control swelling near the incision site

Following tummy tucks and body lifts all of our patients are instructed to wear compression garments around the clock for at least 14 days. Compression helps greatly to keep post-operative swelling to a minimum. When swelling is at a minimum, the scar is less inflamed and has better vascularity. When there is more blood supply and better vascularity, wounds have a better chance of healing without hypertrophic scars and may also help with keloids.

TREATMENT FOR HYPERTROPHIC AND KELOID SCARS

Pressure therapy has been the preferred conservative management for both the preventive case and treatment of hypertrophic scars and keloids since the 1970’s. In addition, therapies that include steroid injections, silicon gel sheeting, radiotherapy, laser therapy or flavonoids (Madera skin care gel) can provide relief to both hypertrophic and keloid scars. However, hypertrophic scars have a higher success rate with most of these treatments compared to keloids.

Most importantly, hypertrophic scars can be successfully eliminated surgically. Keloids are much more difficult to treat surgically as they have a 50% rate of recurrence following excision. However, if keloid excision is accompanied by corticosteroid injections, the success rate of keloid removal can be higher.

Lastly, there are a number of emerging therapies being developed to treat keloids. These include intralesional injections with chemotherapy agents such as Bleomycin and 5-Fluorouacil. You can find information about these therapies in this peer reviewed paper published by Molecular Medicine Journal.

Preventing Scars After Tummy Tucks

Scarring is always a concern for patients wishing to undergo a plastic surgery procedure to address other concerns. Learn more about what our typical tummy tuck scars look like or what breast lift scar options include. As always, it is important to weigh the pros and cons of elective surgery to determine if the rewards of the procedure outweigh the potential risks, including hypertrophic or keloid scars.

We tend to see very few hypertrophic scars, likely because of the suturing technique noted above and our patients’ commitment to following their post-op instructions. While those factors may also help with preventing keloids, family history is more of a predictor for those and we have been successful treating those for patients who had them occur.

Tummy Tuck Scar Treatment

It is crucial to keep your incisions clean and dry on a daily basis to minimise the risk of infection. Make sure to see your doctor if you experience any of the following symptoms: excessive bleeding along the incision line, increased or severe swelling, bruising, redness that isn’t getting better, severe pain that isn’t relieved by medication, yellowish or greenish drainage from the incision, any discharge that has an unpleasant odour, loss of feeling or motion, oral temperature over 38°C, fever and chills.

While your incision will be fully healed by around week six, scar healing and maturation can take anywhere from 12 weeks to a year. You might have to wait till then before exploring any cosmetic treatments to minimise the scars. Meanwhile, you can explore some options that can be done at home. While at-home options might not be able to eliminate the scar completely, they can help improve the size, colour, and texture of the scar and surrounding skin.

Solutions for a Tummy Tuck Scar

Now that you have healed effectively, it is time to work on your scar removal options. We will go from simple at-home treatments that you can try at home to more advanced options. Without further ado, let’s get started:

1. Vitamin E and massage the scar

Apply topical vitamin E on your scar once your incision heals fully to keep it moisturised. Be sure to choose pure vitamin E oil. Make sure to apply it once a day to your scar for the first couple of months and massage gently. Research shows that Vitamin E oil can help minimise the appearance of scars when used regularly over a long period of time. If you experience any skin irritation or an allergic reaction, discontinue the use. Massaging your scar with oil really helps.

When choosing a surgeon, it is important to have a close look at their portfolio of photos, their experience, skillset, expertise and typical results. Make sure to select a highly experienced and skilled plastic surgeon for your tummy tuck procedure. The right surgeon will perform the procedure effectively.

It is important to share your concerns regarding scarring during consultation and what you expect it to look like. Based on the surgery, most patients have a V or a U shaped scar. It can be helpful to bring your bikini bottoms and underwear to the appointment so you can decide the perfect placement of the scar.