Your Questions
Your Questions
Q: Dr. Eppley, I’m interested in abdominal scar revision. I’m a 35 year old female who has a very big scar on my abdomen from an open surgery on my pancreas (Whipple procedure) done six months ago due to chronic pancreatitis and necrotizing pancreatitis. You can see where the staples were on the scar as well. I also have two small scars on both sides of my belly button from the same surgery where they attempted laparoscopic surgery. I’m most insecure about the huge scar from the open incision. Is it possible to remove this scar? What options are available to remove or reduce this scar? What cosmetic procedure is recommended? Can you tell me about these procedures? As it has only been 6 months since my surgery, how long would I have to wait before having a cosmetic procedure? As you can see I have a few other scars from a laparoscopic surgery to remove my gallbladder years before These scars are inside/right outside my belly button, two on the far right side of my upper abdomen, and one in the center of my upper abdomen right near my new scar. These scars are small and blend in well with my skin now. Will my other smaller scars from this past surgery blend in like these eventually or would it be possible to remove or revise all the scars? Would my current health be a factor in determining if I’m a candidate for cosmetic surgery? Please advise me as best as possible. I would really appreciate your help. Thank you!
A: In answer to your abdominal scar revision questions:
- I believe all of your scar appearances from this past extensive surgery are stable, will not improve, and can be revised at any time.
- As long as your healthy enough to go through surgery and heal uneventfully, then you would have no problem with extensive abdominal scar revisions. I would need to know more general health information and any medications that you may be on to answer this question better.
- Your scar revisions would be complete scar excision with abdominal skin flap raised to close the extensive subcostal excision area. (like a reverse tummy tuck skin flap)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in abdominal scar revision. I’m a 22 year old female who had a major surgery resulting from a self inflicted wound that occurred in a more troubled time as a youth. I still have the ugly scar and started research on my z-plasty scar revision for two years now. I’d love to do a consult with you. I’m turning 23 this year and would love to be in my first two piece. I have attached a photo of “my struggle”. Hope to hear from you soon.
A: When it comes to your abdominal scar revision, I see no reason why you would ever have a z-plasty type revision. Your scar revision would be a straight linear scar revision in which the scar is simple vertically excisioned and then closed in a linear fashion. This is the only type of scar revision you should ever have. While it will not make the scar go completely away, it will make it much more narrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in abdominal scar revision. I had a panniculectomy done six years ago and an original tummy tuck approximately 11 years ago. I’ve been unhappy that the scar is so high. As you can see in the photos there are 2 scars. The one on the bottom was from my first tummy tuck. Do you think another surgery to lower the top scar could be done? There’s not a whole lot of skin to work with but low cut bathing suits are what I like to wear. I’m very self-conscious about my scar. Your thoughts are appreciated.
A: My first reaction is that I am stunned that the intervening skin between the two abdominal scars actually lived and not died. That was a very risky procedure from a skin necrosis standpoint. But it did work although the logic of two such displaced scars remains a mystery.
If the goal is to lower the upper abdominal scar (via an upper abdominal skin flap elevation) and bring it down to the lower one, that is not going to be possible. There likely is not enough skin looseness to allow that much downward mobility after having had two excisional abdominal procedures. I do think it is possible that the skin between the two scars can be removed and made into one scar, but that will only happen because some of the closure will come from the lower pubic tissue being elevated. This will then place the new scar about halfway between where the two scars are now. That will not meet your low cut bathing suit criteria. Unfortunately I do not believe your abdominal scar situation can be improved to meet your aesthetic criteria.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need scar revision or some type of treatment on two stomach scars that are pretty bad. When I was a baby I had surgery where an incision was made across my stomach. As I grew and have gotten older (I am 24 years old now) it has grown increasingly worse in the way it looks. It is stuck down to my muscles and has made a big groove across my stomach. The surrounding skin has grown up around and over it and the top part hangs over the scar. I also have a lower stomach below my belly button which runs up and down and it is very discolored. That scar needs to be lightened. Attached are some pictures of my scars.
A: Scar revision is frequently beneficial for abdominal scars from prior pediatric surgery procedures done as an infant or child. The ‘infant surgery’ abdominal scar is exactly what I would have predicted to see. They all look like that when done very early life, the scar adheres down and the fat grows around it creating this classic appearance. It needs to be completely cut out, released and put back together as a fine line scar that is level with the surrounding skin.
While the lower vertical abdominal scar has a different origin and is not stuck down to the abdominal wall, there is no non-surgical therapy that is going to lighten the scar. Like the upper abdominal scar, it needs to be cut out and reclosed into a fine line scar to remove its dark discoloration.
t would obviously make the most sense to do scar revision on both abdominal scars at the same time during the same procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in scar revision surgery. I have a transverse abdominal scar from surgery I had as an infant. It is “socked in” . My skin is adhered to my muscle and there is an overhanging lip above the scar. I am 27 years old. I also have a vertical 4.5 inch scar below the belly button I would like to have lightened. It is two years old.
A: It is very common to see scars from abdominal surgery done as an infant to be completely adhered to the muscles. This is because at such a young age there is little to no subcutaneous fat between the skin and the muscle. The incision line scars down to the muscle (as there is little to no fat interface) and appears as an indented fixed line as fat tissue develops between the skin and muscle around it as the patient gets older. This can be dramatically improved by scar revision surgery by cutting out the scar, releasing the surrounding tissues from the muscle and advancing and closing the skin edges together. While a scar line will still be present, it will be leveled and a much narrower scar. Such scar revisions can often make for a dramatic change in the appearance of such scars.
When it comes to scar lightening that is a different matter. There are not many effective therapies for scar discolorations other than to cut (excise) out the scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an abdominal scar directly down the middle of my stomach which measures about 15 inches along with train tracks. I had exploratory surgery done decades ago. I would like to have it removed. It’s not that its ugly but I am tired of looking at it and I want it removed. It makes me insecure and I don’t think that Icould ever be in a relationship with this scar. Please help.
A: There are two concepts about your abdominal scar that important to understand. First, the idea of scar removal is not possible. No scar can be completely eradicated from visibility. Scars can be reduced and made less noticeable but completely normal skin contour and color can never be achieved. There are limitations as to what scar revision can do. Second, the width of the train track portion of the scar is important as this will determine how much of the scar can be excised in a single scar revision procedure. If the train tracks are too wide, a staged scar revision procedure may be needed. A picture of your scar will suffice to answer this question.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a scar in on my abdomen (from surgery on my pancreas and spleen) running from my diaphragm to just below the belly button. It goes through my belly button, and thus my previously “innie” belly button is now a bloated mess, let alone the “train tracks” on the scar running through my abbs. I wish to remove the train tracks, fix my belly button (make it an innie again) and fade the scar as much as possible. I’m mainly looking if it can be done and how effective would it be?
A: I would like to see a picture of your abdominal scar to determine what is possible. But having seen many such scars before, I would imagine that it can be completely excised including the suture tracks if there is enough lateral abdominal skin laxity. At the least, the scar can be narrowed considerably. The convex shape of the belly button can be converted back into a concave or inverted form at the same time. Given that the vertical abdominal scar runs completely vertical and perpendicular to the relaxed skin lines of the trunk, a subcuticular skin closure needs to be done with a secure suture such as that offered by the Quill line of barbed resorbable sutures. This can produce a very nice improvement from abdominal scar revision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a car accident in February 2009 that resulted in the need for big operation on my stomach. This has left me with a long big scar. I want to know what percent of it can be removed? I want to remove this scar for me because don’t want to get naked in front of my husband or any person because of the scar. It is so bad that I cry a lot about it as I picture how good my stomach looked before the accident. I am 23 years old, been married two years and have no kids.
A: Scar revision is about scar reduction, not scar elimination. While I wish as a plastic surgeon I could wipe them away for patients, that is not currently possible. Therefore, the judgment about the merits of scar revision are about the degree of improvement. Is the result worthy of the efforts is the consistent question about scar revision.
The answer as to whether scar revision is meritorious for any patient lies in the physical characteristics of the particular scar. There are several features of scars that can be consistently improved by surgical methods. Scars that have surface texture problems such as being wide, raised (hypertrophic), or depressed (indented) are good candidates. These type scars can be cut out and reclosed in a variety of ways whose objective is to make them flatter and narrower. Scar features that are difficult or impossible to improve include lack of pigment (normal skin color) and visible flat narrow scars.
Without even seeing a picture of the scar on this patient, one can be fairly certain that it is a wide vertical scar running down the middle of her stomach area. Such scars often get quite wide and indented as they have healed. Scar reduction can most certainly be done with the goal of making a much narrower and flatter scar. While that will not make it invisible, it will provide at least a 50% or greater degree of improvement.
Dr. Barry Eppley