Body contouring surgery usually involves the removal of large segments of excess skin and fat after considerable weight loss. Such radical resection usually occurs from tummy tucks, body lifts, and thigh lifts. Lesser segments of skin and fat are removed in breast lifts, arm lifts, and back lifts. No matter what the area of resection, the outcomes from these procedures is often dramatic. Such major body changes, however, come at a price…that of long scars.
Most extreme weight loss patients gladly accept this scar trade-off and are usually well aware of it. They typically consider the scars a far better alternative to loose hanging skin. Few would quibble with that approach given the medical and aesthetic problems that all that loose skin can cause.
But scarring is a process that takes time to get to its optimal appearance, often up to a year after surgery. Understanding the healing of these long incisions and the maturation of the resulting scar is helpful as the patient watches closely as this process evolves.
For a short time after surgery, incisions must heal before they can be truly called a scar. There are many dissolveable sutures used to hold these incisions together underneath the skin. While they will eventually dissolve, it takes a long time to do so. Many times some of these sutures will ‘spit’ or come through the skin because they are so close to it. The body does this because it recognizes them as foreign and wants them out. This never occurs before three weeks after surgery but may occur for several months thereafter. This is not abnormal and most body contouring patients will experience this nuisance problem. It can be frustrating because the incision looks so great initially and then develops these problem areas. Many patients think this is an infection but it is nothing more than the body getting rid of these sutures. After about 6 to 8 weeks after surgery, this process is pretty much over.
Once the incision starts to heal, the resulting scar will change color. Up to about 3 weeks after surgery, the incision looks fantastic…basically because it hasn’t really started to heal yet. Once this healing process starts, blood vessels grow into the incision and it turns red. This is distressing to some patients as they think something is wrong. When in fact this is normal and is part of the process that allows the skin to knit back together and get as strong as it was before the surgery. (a process that takes up to 9 months or so after surgery) The scar will remain red until the strength of the skin from the healing process is normal. As a result, the red color of a scar may not have gone away for up to a year after surgery. This is called scar maturation and is a long process.
Dr. Barry Eppley