How To Reduce Tension And Scarring After Body Procedures

When contemplating a cosmetic procedure, we spend so much time researching everything we can about the surgery – its benefits, downtime, side effects and complications, and what we can realistically expect to achieve from it. In the case of surgical procedures, a piece of the puzzle that you may overlook is what kind of incision (or incisions) are involved. Any time there is an incision, there will be a scar. Other than genetics, one of the most important factors – especially in the first few days and weeks post-op – in determining what that scar will look like? Tension.

While the skill of your board certified plastic surgeon will go a long way toward reducing tension and ensuring as inconspicuous a scar as possible, what you do in the aftermath of your surgery plays a large role in how incisions ultimately heal. If you’re considering a body cosmetic procedure or already have one scheduled, you’ve come to the right place. Read on to learn expert tips on what you can do post-op to ensure your incisions heal optimally and your scars are as minimal as possible.

The Role of Tension in Scarring

Late last year, we ran an article on the kind of scarring you can expect from popular body procedures (if you haven’t checked it out, you might want to read it first). One of the things that came up time and time again in our discussion with plastic surgeons was the idea of tension and how it impacts scarring. That gave us the idea to explore the topic further because, as it turns out, both the surgeon and the patient have control over how much ‘tension’ an incision site experiences.

In the healing sense, tension refers to any force that pulls the wound apart, says Umbareen Mahmood, MD, a board certified plastic and reconstructive surgeon in New York City. When there’s too much tension on an incision, “it is at risk of widening or completely separating,” warns Lauren Chmielewski, MD, a NYC-based board certified plastic and reconstructive surgeon. The former increases the likelihood of a wider scar, while the latter results in an open wound.

There are many ways to limit tension on post-surgical incision sites, and they start in the operating room. “As plastic surgeons, we do a thorough multi-layer closure, which means closing each layer of tissue to reduce stress on the top layer of skin (the final scar),” Dr. Mahmood explains. “We also work to leave a meticulous fine line final skin closure.”

And then there is what the patient can do at home. “The best way to care for a healing scar is to follow your surgeon’s after-care instructions and keep your post-operative visits,” Dr. Chmielewski shares. While the directions vary a bit by provider, they generally include:

• Keeping dressings in place
• Wearing protective or compression garments
• Activity restrictions
• Abstaining from smoking
• Limiting movement of the treatment area

“These are all directions that should be followed closely, as they can affect the ultimate outcome of the scar,” Dr. Chmielewski notes. It goes without saying, but don’t skip out on follow up appointments with your surgeon. They are a time for you to ask any questions and for your provider to monitor your recovery process. “Ultimately, having an experienced pair of eyes monitoring the healing is important, too,” she adds.

How to Reduce Tension & Minimize Scarring

Now that you have a better sense of the role of tension in the scarring process, it’s time to talk about what it means for specific cosmetic surgeries. Below is a break down of expert tips for minimizing tension and scarring after some of the most popular body procedures:

Abdominoplasty (a.k.a Tummy Tuck)

An abdominoplasty, or tummy tuck, removes unwanted skin and fat and tightens the muscles of the abdomen. The scar, which is usually concealed below the bikini line, typically extends from hip to hip. “A tummy tuck, by definition, is going to be a somewhat tight closure,” Dr. Chmielewski says. To limit abdominal movement, any activities that use your core – including lifting, pushing, and pulling – should be avoided for at least two weeks. During that time period, you’ll also want to be mindful of your posture. She recommends maintaining a “beach chair” position, “as not to fully extend and stretch out the torso.”

Need a visual? When laying down, use pillows to prop up the upper body and lower legs (similar to sitting in a beach chair), so that there is a gentle bend of 20 to 30 degrees at the hips. Sitting in a recliner has a similar effect. The goal is to take pressure off the abdomen and avoid laying flat. When standing, now is not the time to channel your inner ballerina. Hinge at your hips and refrain from standing up straight.

Brachioplasty (a.k.a Arm Lift)

A brachioplasty (a.k.a. arm lift) sculpts the upper arm by removing skin and fat. The incision generally extends from the axilla (armpit) to the elbow and, depending on the surgeon, can be placed on the back of the arm or the inner arm crease. In either case, minimizing tension is tough because of how much we use our arms. “It’s obviously impossible to tell a patient not to move their arms for one month after an arm lift,” Dr. Mahmood admits. “But there are certainly movements they can be mindful of.”

For starters, keep hair styling (think: blow drying, ponytails, etc.) and other sweeping motions to a minimum because repetitive movements that involve extending the arms can cause the scar to widen. “Even small things – like wearing a bra that closes in the front – is helpful in the first month post-op, so that a patient doesn’t have to stretch their arms behind their back,” she explains.

Her suggestion for optimal healing: Keep the arms at your side as much as possible and do any unavoidable tasks with your forearm and hand (instead of the whole arm).

Breast Surgery

There are (obviously) big differences between breast augmentation, breast lift, and breast reduction surgeries when it comes to the purpose of the procedure. They also all involve unique incisions. “The biggest scar burden is with a reduction,” Dr. Chmielewski says. “A lift usually has more of a ‘lollipop’ incision, and an augmentation has the smallest scar.” Breast augmentation incisions can be in the inframammary crease (i.e. under the breast), periareolar (read: around the areola), or in the armpit.

Even so, the way in which you go about reducing tension in the area is similar for all three. “Generally, the patient is to avoid any heavy lifting, pushing, pulling or upper body workouts for two weeks,” she explains. Refrain from raising your arms above your head during this period, too. When it comes to the breasts themselves, wearing a supportive (non-underwire) bra that provides the right level of compression is key to keeping everything in place.

To minimize tension while laying down, breast surgery patients are usually encouraged to elevate the head and upper torso. A wedge pillow can get you into this semi-fowler position (meaning your back is at a 45 degree angle), and it also helps improve drainage and swelling. Beyond that, many doctors recommend placing a pillow or bolster under the knees to take pressure off the low back.

Liposuction & Fat Transfer

Liposuction is the gold standard of fat reduction, and it tends to be minimally invasive as far as incisions are concerned. As Dr. Mahmood explains, they are usually small (approximately 3 millimeters) and well-hidden. In abdominal liposuction, for example, incisions are usually concealed low in the bikini line and in the umbilical hood. “They heal well with no issue,” she notes. It should be noted that heat-based lipo modalities (like VASER or SmartLipo) carry a higher risk of scarring.

While tension is less of a concern after liposuction due to the size of the incisions, you may be encouraged to sleep on your back to maintain an even distribution of weight. Creating bumpers around yourself with pillows can help you from turning over. If you have fat removed from your arms or legs, keep the limbs elevated to ensure proper blood flow and minimize swelling.

Depending on your aesthetic goals, the fat removed via liposuction can be purified and transferred to another part of the body via injections (à la a Brazilian butt lift). The fine needles used to inject the fat rarely result in external scars, though there might be other aspects of recovery to keep in mind.

Thigh Lift

The purpose of a thigh lift is to remove excess skin and fat and reposition underlying tissue to lessen the appearance of sagging. The incision usually runs along the inside of the leg and the groin crease, which can be problematic for healing for several reasons. “There is often a lot of tension after a thigh lift,” Dr. Chmielewski confirms. “Compression is absolutely critical to control swelling and prevent shear forces from pulling at the incisions.”

Wound care is part of any recovery, but it’s especially important post-thigh lift due to the treatment region. “Good wound care is also important, as the incision can be in close proximity to the groin, a notoriously high-bacteria area,” she explains. “Infections prevent healing and can ultimately create a very bad scar.

It can be nearly impossible to eliminate all tension after a thigh lift, but there are some steps you can take to relieve as much pressure as possible. “Everything that engages your legs, unfortunately, puts tension on a thigh lift scar,” Dr. Chmieleski shares. “While gentle activity – such as walking – is encouraged, there is no cardio heavy pushing, pulling, lifting for at least two weeks.” When standing, try to keep a slight bend at the hips for the first seven days or so.

The Takeaway

Finding a board certified plastic and reconstructive surgeon who specializes in the body procedure you are interested in is critical to any successful cosmetic surgery outcome, but what you do (and don’t do) in the post-op period also has a lot to do with how you heal. To minimize scarring after any procedure, don’t forget to keep bandages in place and wear post-surgical garments as per your surgeon’s instructions, Dr. Chmielewski says. And, once you’re cleared to do so, invest in skincare. As she explains, “using a high-quality scar cream or silicone tape to optimize the scar is also helpful.”