Scar reduction surgery

Almost a year ago I posted about scar reduction after infant surgery.  I won’t repeat what I wrote then, so if you are really interested in this subject, please click on the link and read that introductory material first: this post adds to it.

Many young and middle aged people are considering having their less-than-attractive scar from infant surgery revised.  Many others who have had infant surgery don’t care about their scar and know little about what caused it, they may even flaunt it with smart humour and even cleverer legends, or they just want to “move on”.  Somebody whose first pyloric stenosis (PS) surgery failed to relieve the obstruction and thus lives with two scars (considerately placed at 90° from each other) wrote recently:

i never had a problem, in fact the reverse.  my scars have always been there so nothing to be ashamed about. some people have glasses, some are bald, that’s me as well, lots of people have far more difficult socially handicapping problems.  accept your scar as a badge of survival and move on. 

Blessed are the extroverts and those whose infant illness is past and forgotten and whose surgical scars are overlooked – neither of them affecting them in any way.

However, not everybody is in that blissful condition!  And these folk are simply too numerous, their emotions too complex and deep-seated, and their well-being is too compromised for them to be brushed off.

This blogsite and that of a fellow blogger are dedicated to giving information, advice, resources, and encouragement to these people, with the message:  “we are not freaks, we are not alone, and healing is quite possible”.

Many may not be able to afford the cost of scar revision, but it seems that in many countries with health insurance this kind of surgery can be covered.  It’s certainly worth asking around and trying.

Even then, scar revision is not for everybody.

  • Some, having experienced past surgery’s effects on them, will not want it again for a non-life-threatening matter.
  • Others have to be told that scar revision surgery would be inadvisable, for any of several technical / anatomical reasons.
  • For others again, there is little or nothing to be gained in cosmetic terms: a surgical scar can only be removed or improved by creating another scar.

Abdominal scars that have become sunken, indented or that sprawl over a large area can often be revised with the most benefit, and when this surgery is done on someone with loose or excess skin (after several pregnancies or weight reduction like gastric banding surgery), there is much skin and tissue that can be removed with great cosmetic benefits: many scars can be cut out, greatly reduced in size, and often even moved far enough downward to be hidden from public view.  Sunken scars can often be separated from underlying tissue and smoothed, and the abdomen can be made taut and more even.

It has been found that whilst most upper and lower midline scars often respond well to revision surgery, but those under the ribcage (from a sub-costal or Kocher’s incision which was often used in the past for PS and gallbladder surgery) can be difficult to work on, as they have often developed adhesions binding them to underlying muscle and abdominal structures.

Those very interested in this surgery should visit several scar revision websites, of which RealSelf seems to be the largest, and there are many more.  Use the Search box for the kind of surgery and scar you’d like to know more about.  You can learn much from these sites’ questions and specialists’ answers, and from the “before and after” photo albums.

With this post I include several “before and after” photos of scar revisions shown in web advertising.  I am grateful to the people and websites who make this material freely available.  They illustrate something of what can and cannot be expected of scar revision surgery.  I have posted the photos in a small format – click on them for more detail, and feel free to ask for links to the related websites.

If you are interested in this kind of surgery, be reminded that –

  • it may not result in a major improvement of your scarring;
  • not all scars can be much improved and none can be totally erased;
  • how a scar heals is critical: good care can result in better healing, but this can never be totally controlled;
  • surgeons differ greatly on what is advisable and possible – so don’t let one closed door deter you, weigh up what you are told, and if necessary shop around;
  • the finest scar revision is usually done by plastic surgeons, so ask about your surgeon’s background and check out a good range of photos of his or her work.

Appendectomy02c b4 & after RealSelfDoctor’s Note: The left image is of a 26 year old female with an ugly indented appendectomy scar from her childhood.  The second photo was taken 2 months after scar revision surgery and this scar should continue to improve with time and scar management.

Belly13c-after PSBelly13c-before PSThese images show a woman’s gall bladder removal scar before and after revision surgery after weight reduction.  In removing tissue the scar is lowered and smoothed but not reduced, and her navel has been reconstructed.

Transverse01-frontA transverse scar that has become sunken can be much improved but without a tummy tuck it’s not out of sight.  A tummy tuck requires excess skin and underlying fat that can be removed, drawing this scar closer to the pubic region.

MidlineUpper02 after

MidlineUpper02 beforeThis vertical midline scar had spread and become sunken and it is marked for removal.  The plastic surgeon has taken great care to replace it with a much tidier and thinner scar-line and will be please it has healed well.

Check01 beforeCheck01 afterThe scars left by the repair of some of the major congenital abdominal conditions of infancy can often be significantly improved in later life. Here the scars from drainage tubes have been removed as well as the old-style “railway line” scar. Again, there was no tummy tuck.

PoustiPS01b afterPoustiPS01a beforeThis 33 year old mother of 4 has a history of bowel problems and surgery which left her with a large scar, ruptured (herniated) abdominal muscles and no umbilicus. Her repairs are detailed here. She had scar revision, abdominal wall repairs, abdominoplasty (a tummy tuck)… and is understandably enthusiastic about the result.

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7 thoughts on “Scar reduction surgery

  1. Wendy

    I am one of the infant surgery survivors with deep-seated, complex emotions about my scar 🙂 so I would never change it. One abdominal surgery is enough! I applaud you for making the information about scar reduction available. The photos really show the possibilities. And the RealSelf link so useful! Thanks for the shout-out to myincision!

    Reply
  2. Fred Vanderbom Post author

    I too have never seriously considered having elective surgery to my abdomen, and I share with you in having very deep and enigmatic feelings about my scar. However, I have learnt from the visits and discussions at scar revision websites, as well as from what many visitors to this blog are looking for, that this is a hot subject for many other people.
    It would be worthwhile to discover the reasons for this: how and why do people differ so greatly over this very personal part of our self-identity and sense of well-being?

    Reply
    1. Wendy

      I bet many people’s feelings about their scars are connected to their parents’ views on their scars. If as children or babies, we sensed that our parents had positive reactions to our scars, then we may feel positively. But if we sense a parent’s disapproval, then we grow up feeling negatively about it. My mother always gave my scar negative attention. “Oh, too bad that it’s stretching” was one comment I shall never forget. We were changing out of our bathing suits and wham, I got hit with that! I know she didn’t mean to hurt me, but…… I felt a lot of shame about my scar and did not see it as a badge of survival and courage until I was 50 years old!!

      Reply
  3. Fred Vanderbom Post author

    This comment is so right!!!
    I have written several times about my mother’s stonewalling and silence about anything to do with my scar. My obvious distress over it must have only added to the pain of her memories of the trauma it represented, and her feelings of failure in herself and towards me… I can only speculate on the complexity of it all and often wish I could revisit with her our close but difficult relationship.

    Reply
  4. pineapplegeorgie

    I’ve just had an operation yesterday to have my indented appendix scar reduced and although it wasn’t nice having surgery, I’m fully confident that it will look 100% better and give me much more confidence as I’m only 16!! My parents don’t have a problem with it, but supported me in whatever decision I made.

    Reply
  5. Fred Vanderbom Post author

    This is great, Georgie. I’m very pleased your parents supported your wishes and that this operation is now behind you. I grew up in different times and would have loved this choice – I certainly know something of how you must have felt about such an eye-catching scar. I’m sure getting this op done also helps you in making the outcome more your own choice – despite the scar being for life. If the result is worthwhile and you feel free, consider posting something about your story here and perhaps even a “before and after” photo. You can email me via the “About” tab at the top of the page. Best wishes.

    Reply

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