Cosmetic Surgery Tips

Keloid Belly Button After Tummy Tuck

Are you looking for a way to get rid of your keloid belly button after tummy tuck? You’ve come to the right place! We’re going to help you get back on track with your health goals.

There are many different types of keloids and we’re going to focus on the one that forms after abdominal surgery, known as an abdominal wall keloid. These can form in any area where there has been injury or surgery, such as scars and incisions. The scar tissue that is formed after surgery can develop into a large growth that is red and raised. It can be painful and may actually cause discomfort when trying to wear certain clothing items or even just putting on pants. In this guide, we review the aspects of Keloid Belly Button After Tummy Tuck, silicone scar sheets, how to prevent keloids after tummy tuck, and Why did my tummy tuck scar keloid?

You may have heard that there is no cure for this type of scarring but there are treatments available that can help reduce the size of these growths so they aren’t as noticeable when wearing clothes or bathing suits. Let’s look at some options for getting rid of your keloid belly button after tummy tuck!

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Keloid Belly Button After Tummy Tuck

Patients undergoing any surgical procedure, such as a tummy tuck, may rarely develop a reaction known as keloid scarring. Incisions for tummy tuck surgery are typically placed below the swimwear line, which prevents the reaction from being seen. However, keloids may still cause discomfort and irritation.

In addition to being uncomfortable, keloid scarring is often raised, red and darker than the surrounding skin. They are created as a result of excess collagen production following wound healing. For those more prone to the formation of keloids, there are certain steps that may be taken throughout the tummy tuck process to prevent this type of scarring.

Who Gets Keloid Scars and How to Avoid Them

It is impossible to tell for certain who will develop keloids and who will not. However, there are a number of factors that may predispose a patient towards this reaction. Those with darker skin and those who are 10-30 years old have a higher risk of developing keloid scarring. A family history of keloid development is also significant.

To prevent the formation of keloids for those who might be at an increased risk, your surgeon may choose to limit the size of the incision, particularly with the tummy tuck or other body contouring procedures such as an arm lift. They may also limit the amount of external sutures or use removable stitches.

Once the procedure is complete, proper wound care may help prevent keloids from forming. This may include:

  • Use of compression garments
  • Laser scar treatments
  • Proper care of the wound to prevent it from opening
  • Silicone gels and gel sheets
  • Following recommended skin care regimen

Should keloids form, steroid injections may be used to treat their development. In severe cases, a skin graft may be used to replace the scarred and damaged skin with healthy skin. Once keloids have formed, future procedures will be done with extreme care for preventing keloid development, as patients are more likely to develop keloids if they have had them before.

Scars are a natural part of the body’s healing process following any surgical procedure that cuts into the skin. It is the body’s way of sealing over the incision wound to protect it from further infection or injury. In most cases, scars will naturally fade over time until they are almost invisible. There are a number of treatments that can be used to reduce the appearance of scars, including tea tree oil or silicone sheeting. The scars can also be hidden with foundation makeup that matches the skin tone.

However, in some cases, patients might experience excessive scarring, in the form of either hypertrophic or keloid scars. Hypertrophic scars will usually be raised and red, but will be confined to the size and shape of the original incision and eventually heal over time. In contrast, keloid scars will not be confined just to the incision site, but can migrate into surrounding skin tissue that was not cut open. Keloids also will not heal over time, but will remain raised, shiny, and thick. Keloids may also be itchy, tender, or painful to the touch.

In the case of tummy tuck procedures, keloid scarring may be particularly troublesome due to the length of the incisions that are needed to perform the procedure. Dr. Paul Pin will use his skill and expertise to prevent keloid scarring as much as possible, but patients should know that there are treatments available should keloid scars develop as the incision sites heal.

What Causes Keloid Scarring

The cause of keloid scarring is still unknown. It is thought that keloids may form because of changes in cellular growth patterns of the skin during the healing process. Although keloids are equally likely to form in either men or women, people with darker skin are somewhat more susceptible. The tendency to develop keloid scars may also be hereditary.

Treating Keloid Scars

There are several methods to treat keloid scars following a tummy tuck procedure. Cortisone injections into the scars every four to six weeks will flatten them out and make them less noticeable. However, the scars will not fade in terms of color.

Silicone sheeting may also help reduce the appearance of keloid scars. The good news in the case of tummy tuck scars is that the sheets can easily be held in place with undergarments.

Finally, some laser treatments may also reduce the appearance of keloid scars. Low level lasers can stimulate healing of the scars. Several treatments maybe required to achieve their desired results.

Fortunately, tummy tuck scars will not be generally noticeable, except perhaps in a bikini. Patients who do develop keloid scars following a tummy tuck procedure have a variety of options available to reduce their appearance when wearing low rise bikinis.

To learn more about keloid scars after tummy tuck, or to find out if you are a candidate for treatment, contact Dr. Pin’s practice today.

An Unusual Case of a Sunken Umbilicus Post Abdominoplasty Complicated by a Keloid

Background: A 34-year-old female patient presented to the Emergency Room with a suspected umbilical abscess status post abdominoplasty 2 years prior. Intraoperatively, it was discovered that her umbilicus was sunken and buried under a keloid scar.

Case report: Our patient, a 34-year-old female, presented with complaints of periumbilical pain and swelling. After initial imaging on CT showed periumbilical soft tissue inflammation, the patient was taken to the operating room for an incision and drainage. Intraoperatively, it was discovered that her umbilicus was sunken and buried under a keloid scar. While keloids themselves are not a rare phenomenon, a sunken umbilicus covered by a keloid has not been described.

Conclusion: Keloid scars pose a challenge for physicians because they are difficult to treat, have a negative impact on patient expectations due to suboptimal results, and may require additional procedures for correction. Further research into such local postoperative complications is needed to elucidate optimal treatments and preventative measures, thereby reducing complication rates and improving aesthetic outcomes. Here we investigate the different techniques to help combat the complications of keloid scarring.

Keywords

Keloid; Sunken umbilicus; Umbilical keloid scar; Abdominoplasty; Umbilicoplasty

Introduction

A keloid is an overgrowth of dense, fibrous tissue, which results from aberrant wound healing. They present as raised dermal lesions that extend beyond the boundaries of the original wound and invade the surrounding healthy skin. The scar tissue does not regress spontaneously and tends to recur after excision. Keloids can appear years following skin injury or they can also form spontaneously without any predisposing cutaneous trauma. Presenting signs and symptoms include cosmetic disfigurement, pain, pruritus, skin discoloration, and restriction of movement. Most frequently involved sites are the chest, shoulders, arms, upper back, and head and neck areas, especially earlobes (Figure 1).

aesthetic-reconstructive-surgery-overlying-umbilicus

Figure 1: Keloid scar overlying umbilicus.

Abdominoplasty is one of the most commonly performed cosmetic surgical procedures worldwide. Although it is considered relatively safe, patients are susceptible to perioperative complications. The incidence of keloid and hypertrophic scars ranges between 1% and 3.7% following abdominoplasty procedures. Male patients tend to present with less cosmetically pleasing scars than women. Necrosis of the umbilicus due to insufficient irrigation through its pedicle occurs in about 0.2% of cases. Special care should be taken while performing the plication to avoid strangulation of the umbilicus. Other common complications of abdominoplasty include seromas, infection, skin necrosis, hematoma, and less commonly, systemic complications such as thromboembolism.

Case Presentation

A 34-year-old female presented to the emergency department with complaints of swelling and periumbilical pain. She denied having any past medical history. Past surgical history included abdominoplasty two years prior in conjunction with a mammoplasty.

On examination, the abdomen was soft and non-distended. A keloid overlying the umbilicus was identified and elicited minor tenderness to palpation. No fluctuance or drainage was noted. A computed tomography (CT) scan of the abdomen and pelvis with contrast was done and showed a 3.5 × 1.5 cm sub-umbilical soft tissue density with adjacent inflammatory changes suggestive of sub-umbilical phlegmon. There was no extension into the intraabdominal cavity (Figures 2a and 2b).

aesthetic-reconstructive-surgery-adjacent-inflammatory

Figure 2: (a and b) showing a 3.5 × 1.5 cm sub-umbilical soft tissue density with adjacent inflammatory changes with no extension into the intra-abdominal cavity.

The patient was taken for incision and drainage of the umbilicus. Intraoperatively, a small curvilinear incision was made and the keloid was excised completely. A minimal amount of serous fluid was expressed. The cavity was then probed with no fluid collections identified, however, there was questionable necrosis noted in the deep posterior aspect of the cavity. After further exploration, we were able to lift the “necrotic” area discovering that it was intact skin and the patient’s sunken umbilicus. The borders of the umbilicus were dissected free from the surrounding tissue and elevated. An umbilicoplasty was performed using 3-0 vicryl sutures in the deep layer and 4-0 monocryl interrupted subcuticular sutures at the skin level. Special precautions were taken to limit the number of sutures used. At the conclusion of the procedure, 5 ml of triamcinolone were injected into the umbilical area. The patient tolerated the procedure well and was discharged from the post-anesthesia recovery unit. Unfortunately, the patient was lost to follow up, and the effects of the triamcinolone were unable to be assessed, as well as future keloid scarring (Figures 3a and 3b).

aesthetic-reconstructive-surgery-sunken-umbilicus

Figure 3: (a) Dissection of the sunken umbilicus. (b) The attached umbilicus.

Discussion

The predisposition to keloids is an inheritable trait expressed in an autosomal dominant mode with incomplete penetrance and variable expression. Keloids affect men and women equally with the highest incidence in the second and third decades of life. The diagnosis is usually made clinically based on the presenting history, as well as scar size, shape, and growth pattern. Different advances have been studied in treating keloids and preventing their recurrence, although a definitive cure has not been identified. Possible treatments include radiation therapy, flavonoids, and use of silicone gel, corticosteroids, cryotherapy, laser therapies, and platelet-rich plasma.

Radiation therapy

Radiation therapy can be used both for the prevention and treatment of keloids. It is important to keep in mind the possible risk of developing cancers in these patients weighing the risks and benefits. The risk of developing secondary skin cancer from the use of radiotherapy has been seemingly rare. According to Nestor et al. the optimal treatment of keloids using radiation is 3,000 Gy in three fractions of 600 Gy over the first three days after surgery. Mankowski et al. conducted a meta-analysis to study the outcomes of various radiation-based treatments -brachytherapy, x-ray, and electron beam – in order to compare efficacy. Their research showed brachytherapy was the most effective form of radiation therapy for the treatment of keloids, showing the lowest recurrence rate of 15% compared to X-ray and electron beams that were comparable at 23%. They also highlighted the most common consequence of radiation therapy is a change in pigmentation of the skin.

Flavonoids

Flavonoids occurring naturally, as in onions, have shown to be used in the prevention of the formation of scars. Exact mechanisms are poorly understood, but it has shown a decrease in the activity of fibroblasts in the extracellular matrix. Pikula et al. described the use of onion extracts in high doses causing apoptosis is dermal fibroblasts. Research is limited however and more investigations should be performed.

Corticosteroids

Injections of corticosteroids, steroid ointment tapes, or plasters are at the forefront of treatment and prevention of keloids. In this patient we injected triamcinolone into the affected area after closure of the incision and removal of keloid to prevent recurrence. Triamcinolone is a synthetic steroid; it works by decreasing the activity of elements in the body that cause inflammation and also by decreasing fibroblast proliferation. According to Khalid et al., although triamcinolone is the gold standard as of now for the treatment of keloids, a combination of triamcinolone and 5-fluorouracil yielded a more effective outcome. Good to excellent results were seen in 68% of patients.

Surgery

Surgery in general is a risk factor for the development of keloids. Incisions with mechanical tension have shown to produce more scarring, described as mechano-transduction. Hence, using a tension-free closure to reduce more inflammation is promising in preventing keloid scars. Examples of such surgical techniques are zig-zag sutures, flap surgeries, and fascial/subcutaneous tensile reduction sutures. Zig-zag sutures are linear sutures that have a faster healing time limiting the progression of keloids in patients. Flap surgeries, more specifically local flaps, help release contraction in scars.

A combination of surgery, radiation, and steroids would provide a better outcome for the treatment of keloids. According to Yamawaki et al. a combination treatment of surgical excision and radiation resulted in an 89% cure rate, during the course of the two years postoperatively patients were followed for any signs of recurrence and were given injections of steroids at the site of the lesions as soon as it was identified.

Laser therapy

Laser therapy is a relatively new treatment modality that has emerged for managing keloids and hypertrophic scars. The mechanism behind laser therapy is based on the principle of “selective photothermolysis” which was coined in 1983. According to this principle, light can be used to target specific chromophores (hemoglobin and oxyhemoglobin, melanin, and water) which respond to a specific wavelength and are then selectively destroyed. Tissue effects depend upon the properties of light and the interaction of light with these chromophores.

Laser therapy has proven particularly useful in treating keloids and hypertrophic scars because it causes vascular destruction, which leads to tissue hypoxia, cell catabolism, and reorganization of collagen deposition . The heat generated by lasers also initiates inflammation and increases vascular permeability, matrix metalloproteinase production, and collagen fiber decomposition. Early application of lasers is thought to shorten the duration of acute inflammatory response and accelerate the time to scar maturation.

Lasers can be classified as ablative or non-ablative. Ablative lasers act on the water present in tissues causing them to vaporize, whereas non-ablative lasers act on melanin or hemoglobin leading to tissue necrosis. There are four main types of lasers that are commonly used for keloids and hypertrophic scars with proven efficacy: pulsed dye laser (PDL), fractional carbon dioxide laser (fCO2), intense pulse light (IPL), and alexandrite and diode lasers. Usually, two or more modalities are combined to improve the outcome. According to medical guidelines, ablative fractional laser or PDL therapy is indicated for minor keloids that failed to improve within 8 to 12 weeks with silicone gel sheeting, or major keloids that failed to improve with corticosteroids and 5-FU. Laser treatment needs to be tailored to the patient, but it is typically delivered in 4-6 week intervals until a plateau in improvement is observed. Laser therapy provides a novel approach to treating keloids and hypertrophic scars, which may result in improved aesthetic outcomes and decreased keloid recurrence.

Platelet-rich plasma

Platelet-rich Plasma (PRP) is also thought to have potential value in treating keloids. PRP is an autologous blood-derived product enriched in platelets, growth factors, and chemokines/ cytokines delivered in a concentrated volume of plasma. PRP is reported to have 3-5 times the concentration of platelets normally found in wounds, and the resulting growth factor release following activation can further stimulate cell proliferation and tissue regeneration.

PRP is shown to stimulate tissue repair, accelerate wound healing, and decrease pain and disability in treated areas. In a study by Jones et al. there was evidence of improved wound healing with lower keloid recurrence with surgical excision and PRP alone, prior to the use of radiation therapy. As a result, it was recommended that all patients receive PRP to the surgical site. Another study by Hersant et al. found that nearly 53% of keloid scars completely resolved with PRP two years posttreatment. This study also concluded that PRP is an effective and safe method for treating postoperative keloid scars refractory to conventional therapy.

In this case, we also considered the likelihood of the cause of the sunken umbilicus to be from a post-operative seroma. A seroma is defined as a collection of fluid under the skin. Seroma formation is the most common postoperative complication of an abdominoplasty, with a range of occurrence between 5% to 43% according to Seretis et al., preventative measures shows a reduction in the occurrence of seromas on average to 7.5%. One of the most common preventative measures are surgical tension suture techniques. At the forefront of this technique, progressive tension sutures (PTS), in addition to drains, during the closure of the procedure are utilized. According to Jabbour et al. the technique involves using adhesion sutures while progressively moving abdominal flap from proximal to distal during closure allowing for the closing of dead space where the seroma would normally form. Seroma treatment is dependent on the size; small seromas often do not require any treatment as they mostly resolve on their own, whereas larger seromas require aspiration to drain the fluid. Without intervention, seromas usually follow a natural course, resolving themselves anywhere between one month to a year. In choosing treatment options and surgical techniques it is important to note that it varies from patient to patient. Various medical history factors and location of the keloid play roles in the choice of treatment.

Conclusion

We have presented a case of an incidentally discovered sunken umbilicus buried under a keloid scar. Although the sunken umbilicus could have been caused by a post-operative seroma, the intraoperative findings and history, led us to believe the more likely cause was a large keloid. This patient was lost to follow up, so a post-operative treatment plan could not be developed. However, with multiple modalities at a cosmetic surgeon’s finger tips, the keloid scar could have been treated or avoided altogether. Especially in the field of aesthetic surgery, identifying patients more prone to keloid scarring and providing the best post-operative treatment plan is crucial.

And this is why it is one of the most popular cosmetic surgical procedures in the US. There were 140,711 tummy tucks performed in 2019 and has been increasing over the years.

Probably one of the most common questions about abdominoplasty is how the scars will look?  In this post, we’re going to discuss tummy tuck scars and what to expect after this procedure.

DISCLAIMER: This information is meant as general health information and is not meant as specific medical advice or as a replacement for direct communication with your plastic surgeon.

Where are tummy tuck scars located?

Regardless of the type of abdominoplasty (mini vs full tummy tuck), scars will need to be created. When skin is cut away, an incision is made, and a scar will result. The final length, position and quality of these scars will depend on several factors. We will discuss a few here.

Scar Locations

Lower Abdomen:

 Most abdominoplasty procedures leave a scar running horizontally across the lower abdomen, usually lower than “normal” modern waistbands. The goal is for the scar to be at the junction of the abdomen and the lower hair-bearing pubic area (mons pubis). The shape of the scar depends on the type of tummy tuck surgery (straight line, bicycle handle or French bikini).

Around the Belly Button:

Most full abdominoplasty procedures will place a scar around the bellybutton.  Your native belly button stays in place, and the skin of the abdomen ‘moves around it’. Although the scar maybe visible at first, for most patients it will blend into the abdomen and becomes less noticeable over time.

Vertical Scars:

Even though most tummy tuck scars are only horizontal, a vertical scar may also be needed.

  • Short vertical scar: Located between the belly button and the lower side to side scar.  These occur when patients do not have a lot of excess skin, but more loose skin than liposuction alone can handle.  

How to make scars less visible

Scars after a tummy tuck are inevitable. Although the scars don’t go away entirely, they typically fade overtime. However, there are some useful things you can do to make scars less visible. These include:

·      Adhere to your plastic surgeon’s postoperative instructions – Your plastic surgeon should have a protocol for wound and scar care. Adhere to these recommendations is one of your best bets for getting the best scar possible.

  •    External scar support – help your scar while it is maturing by providing additional support.
  •      Well balanced diet with protein supplementation.
  •    Tattoo –probably the easiest way to make scars less visible is to get a tattoo, but you will be able to do this once your skin has fully healed (after 12 months).
  • No tanning –UV exposure may cause your scars to maintain more pigment and therefore be darker in color. Avoid tanning your scars (i.e. make sure they are covered by bikini bottom, and sun screen around the belly button).
  • Avoid irritating tape, clothes and products – products with harsh formulas and clothes made of uncomfortable and irritating fabrics can cause redness and make the scars appear prominent.
  • A healthy lifestyle – the best thing to do in the long-run is to make lifestyle changes. For example, you can quit smoking and try to keep weight in a healthy range.
Overview of 3 Types of Scars

What if Your Healing is Not Going Well?!?

There are MANY reasons why this may be happening, only a few of which you will be able to influence directly.  The most important advice is to COMMUNICATE with YOUR SURGEON!  You both will need to work together to trouble-shoot the problem and identify and implement the changes that may help you heal faster and better.

THIS IS WHY YOU SHOULD CHOOSE A SURGEON WITH WHOM YOU CAN EASILY COMMUNICATE!!!!  If you never meet your surgeon before surgery, or only see them for 5 minutes during a rushed consultation, then you can bet that getting face time with him/herAFTER surgery may be impossible.  Choose your board-certified plastic surgeon wisely and avoid cosmetic tourism!

Bottom Line

The tummy tuck is a popular plastic surgery procedure for a REASON!  People choose to get a slimmer profile, look better in and out of a bathing suit, and feel more confident. Scars are NORMAL after this procedure, and most patients who undergo a tummy tuck are very happy with the outcome and would do the surgery AGAIN!  Don’t let scars (which are usually easily concealed under normal clothing styles), hold you back from getting the benefits of a Tummy Tuck!  

Do You Need A Belly Button Revision After Tummy Tuck Surgery?

A tummy tuck procedure effectively:

  • Repairs separated abdominal muscles
  • Repairs small umbilical hernias
  • Removes excess fat around the midsection
  • Tightens sagging skin left behind after pregnancy
  • Tightens sagging skin after significant weight loss

When properly executed, a tummy tuck should also improve the shape and contour of the belly button.  If a more natural and attractive look is desired, bellybutton revision after tummy tuck surgery may be an option.

Ideally, the tummy tuck surgeon begins with a stretched, distorted belly button that is weakened by gravity and surrounding fat and skin thus resembling a “frowny-face,” and creates a smaller, more vertically-oriented belly button that gently contours inward with hidden incisions to enhance the feminine silhouette.  If a surgeon is unable to achieve these goals, the belly button may be too large, too circular, too flat and smooth without an inward contour, or the scar may be too large or prominent. Sometimes an umbilical hernia emerges, or recurs.  Obese patients may have large, cavernous belly buttons; petite patients may not have enough central umbilical recess, and the scar may be obvious. Less fat may remove the “hood” of skin over the belly button; more fat may make it too prominent.

Some of these deformities are more easily corrected than others, but improvements are usually possible through belly button revision after tummy tuck.  Typically, a patient should wait three to six months after tummy tuck before considering revision. Many issues auto-correct during the recovery process, and some surgery can be avoided just by waiting.

If you are interested in umbilicoplasty, we invite you to schedule an appointment with Donaldson Plastic Surgery. We have been achieving beautiful results for years, and our work has garnered awards such as America’s Top Plastic Surgeons. You may schedule your personal consultation today to discuss your options with Dr. Donaldson!

When it comes to abdominoplasty (tummy tuck), a great looking belly button is an essential part of the equation. The best plastic surgeons understand the attention to detail and technique that goes into creating a natural, attractive-looking navel.

If you’ve ever wondered what happens to the belly button during tummy tuck, Dr. Ronald Schuster shares the answer in this post.

Is The Belly Button Removed?

In most cases of full tummy tuck, the belly button does not get removed; in fact, it does not get moved at all. It stays in place, and the skin around it moves.

The tummy tuck incision is made low on the abdomen, and the abdominal skin is lifted. An additional incision is created around the belly button in order to release it from the surrounding skin, but the belly button remains attached to its “stalk” in the abdominal muscles at all times.

Once the separated or damaged abdominal muscles have been repaired, the abdominal skin is re-draped more tightly over the stomach to give it a flatter contour. As the abdominal skin is pulled down, it will cover the belly button, so a new opening in the skin must be made for the belly button. The belly button is brought through the new opening (imagine pulling a button through a buttonhole) and its edges are stitched into place.

In a mini tummy tuck, only the lower abdomen (i.e., below the belly button) is treated. In those cases, the belly button is not touched or moved.

Creating An Attractive Belly Button

Although the tummy tuck scar is low enough to be hidden by underwear or a bikini button, the belly button is in plain view, so it must look natural and attractive.

Creating a natural-looking belly button requires many years of honing one’s surgical skills and using a meticulous approach. The tummy tuck surgeon must pay close attention to the shape of the opening in the skin, and use careful techniques to suture the belly button into its new opening.

As you are in the process of researching plastic surgeons to perform your tummy tuck, browse before-and-after photographs of the surgeon’s previous patients and look carefully at the belly buttons. Do they look natural and appealing to you? If not, you should find another surgeon whose aesthetic is more in line with what you envision for yourself.

silicone scar sheets

ScarAway Clear Sheets are the latest in advanced technology treatments containing silicone, the #1 Dermatologist and Plastic Surgeon recommended scar reduction treatment ingredient.* Each sheet provides consistent treatment for up to 10 days, helping to improve the appearance of scars and prevent abnormal or excessive scar formation.

  • Self-adhesive
  • Easy to apply
  • Water-resistant
  • Lightweight and discreet

Advanced Technology

ScarAway’s Medical-Grade silicone mimics the natural barrier function of healthy skin and is clinically supported to improve scar size, color and texture on both old and new scars.

Prevent and Treat 

ScarAway prevents and treats hypertrophic and keloid scars resulting from injuries, burns, surgeries, acne and more. Even scars that are years old and appear raised and discolored can become flatter, softer and less visible – closer to your skin’s natural texture and color.

Multi-Tasking Scar Treatment

ScarAway hydrates and protects scars while reducing redness, itching and discomfort.

*Of U.S. physicians surveyed by an independent market research firm.

how to prevent keloids after tummy tuck

A scar will naturally form where the incision was closed if you’re having a surgery that involves an incision such as a tummy tuck. This new scar tissue is formed from myofibroblasts and collagen fibers which are produced by your body in response to the injury. The initial scar formation, referred to as the proliferation phase, can last up to six weeks. In the final maturation phase, the scar will look and feel different than the surrounding tissue. A normal scar will generally appear somewhat flat and pale and will typically fade with time. In fact, after several years many scars eventually become undetectable to the naked eye.

However, some scars follow a more aggressive path, and can even get worse as time goes on. When the body produces too much collagen in an effort to repair the damage it can result in a ‘raised’ scar. These are considered ‘bad scars’ or ‘adverse scar conditions’ and they can unfold following any incision, including an incision made during a plastic surgery procedure.

While scars are a necessary evil for any plastic surgery procedure that has an incision, certain types of scars are worse than others. These undesirable scars are known as hypertrophic scars and keloids.

Both types of scars can be unsightly, but keloids tend to be more pronounced and dramatic as they take on a cauliflower-like look. While keloids are more rare than hypertrophic scars, keloids are also much harder to treat. Proper treatment of either scar type is firmly rooted in correctly diagnosing whether it is a hypertrophic or keloid scar.

HYPERTROPHIC SCARS

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.

Why did my tummy tuck scar keloid

A scar will naturally form where the incision was closed if you’re having a surgery that involves an incision such as a tummy tuck. This new scar tissue is formed from myofibroblasts and collagen fibers which are produced by your body in response to the injury. The initial scar formation, referred to as the proliferation phase, can last up to six weeks. In the final maturation phase, the scar will look and feel different than the surrounding tissue. A normal scar will generally appear somewhat flat and pale and will typically fade with time. In fact, after several years many scars eventually become undetectable to the naked eye.

However, some scars follow a more aggressive path, and can even get worse as time goes on. When the body produces too much collagen in an effort to repair the damage it can result in a ‘raised’ scar. These are considered ‘bad scars’ or ‘adverse scar conditions’ and they can unfold following any incision, including an incision made during a plastic surgery procedure.

While scars are a necessary evil for any plastic surgery procedure that has an incision, certain types of scars are worse than others. These undesirable scars are known as hypertrophic scars and keloids.

Both types of scars can be unsightly, but keloids tend to be more pronounced and dramatic as they take on a cauliflower-like look. While keloids are more rare than hypertrophic scars, keloids are also much harder to treat. Proper treatment of either scar type is firmly rooted in correctly diagnosing whether it is a hypertrophic or keloid scar.

HYPERTROPHIC SCARS

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.

Should scarring complications occur following your surgery, be sure to discuss them with your surgeon since proper diagnosis is imperative for determining the best course of treatment!

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