What Kind Of Scarring You Can Expect From Popular Body Procedures
In a perfect world, cosmetic surgery would be incision-free. We’re not quite there yet, but, in the hands of a skilled surgeon, scarring can be minimal. Here’s what you need to know.
If you’re thinking about undergoing a cosmetic procedure, you are probably wondering what you can realistically expect from the outcome. One aspect of the result that is easy to overlook is scarring. The fact of the matter is: Any time there is an incision, there will be a scar. While there are some things you can’t control when it comes to the healing process (hi, genetics), there are some things you can do — from choosing a highly skilled surgeon to proper scar care — to ensure your incision(s) heal as optimally as possible.
To better understand what types of scars can result from body surgeries — and the best ways to treat them — we’ve asked the experts (and, if you're interested in a procedure above the neck, check out our guide to facial plastic surgery scars).
Scarring After Body Procedures
There are two main factors that determine how surgical incisions heal. One you can control, and the other you can't. “The most important factor in scarring is genetics,” says Jacob Unger, MD, a board certified plastic and reconstructive surgeon in Nashville, TN. “This, unfortunately, is not something any doctor or patient has control over, but it is the most prominent deciding issue when identifying how well someone scars.”
This is true regardless of the procedure, and your medical history should shed some light on how your plastic surgery recovery will go. “For all surgeries — abdominoplasty, brachioplasty, breast surgery, etc. — the primary factor that impacts how a scar heals is the patient’s own wound healing,” says Umbareen Mahmood, MD, a board certified plastic and reconstructive surgeon in New York City. “Some patients form keloids or hypertrophic scars with any trauma to the skin, whereas other patients heal with imperceptible scars.”
The second part of the healing equation is the one you do have a say in. “Surgical technique is a key component to an optimal scar outcome, including types of suture use and how the tissue is handled,” Dr. Mahmood says. Choosing a board certified plastic surgeon who specializes in the procedure you are interested in will go a long way. “All scars heal best under less tension, but the problem, of course, is that patients want to be pulled tight for the best result,” explains Michael Frederick, MD, a board certified plastic and reconstructive surgeon in Fort Lauderdale, FL. “It’s the good surgeon’s ability to be able to balance these factors to create the tightest result with the best scar.”
With all of this in mind, below is a break down of the incisions required of some of the most popular body procedures:
Abdominoplasty (a.k.a. Tummy Tuck)
Also known as a tummy tuck, an abdominoplasty is a surgery that removes unwanted skin and fat and tightens the muscles of the abdomen. “The scar generally extends from hip to hip in order to remove the excess skin in these areas,” Dr. Mahmood says. “Multiple layers of stitches help take tension off the top layer of skin — which is where the scar is — to ensure a fine line scar.” While the length of the incision and subsequent scar is significant, it is strategically placed. “Abdominoplasty scars should be very low and well concealed below the bikini line,” she adds.
Brachioplasty (a.k.a. Arm Lift)
A brachioplasty, or arm lift, is a surgery that contours the upper arm by removing skin and fat. As Dr. Mahmood explains, arm lift scars “tend to be one of the more difficult scars for some patients to accept because they can widen or become hyperpigmented.” This is because the arms are such an integral part of just about every motion we make. “Activities as simple as putting hair up in a ponytail or putting on a bra can cause tension on the scar,” she notes.
With that said, the incision generally extends from the axilla (armpit) to the elbow. “Some surgeons choose to place the incision at the back of the arm,” she says, noting that she likes to put it in the inner arm crease. “In this location, it is not visible when the patient's arms are at their side or in a relaxed communication position,” she shares.
While augmentation mammaplasty (read: breast augmentation) remains one of the most popular cosmetic procedures in the United States, it’s not the only type of breast surgery. Below is what you can expect from the most common breast procedures:
Breast augmentation with implants is a procedure that allows for quite a bit of customization. Patients choose the type and general size of the implant they are interested in, and the surgeon will insert the implants using their preferred technique. “This surgery typically has a very small scar — one to two inches — along the undersurface of the breast along the fold or possibly in the areola or under the arm,” Dr. Unger explains. He personally prefers the “under breast approach” because, with “proper positioning, delicate tissue handling, and meticulous closure technique,” the scars “can commonly be made to be nearly invisible once healed.”
Unlike a breast augmentation, a mastopexy (a.k.a. breast lift) requires a more prominent incision. There are an array of techniques depending on the degree of ptosis (read: drooping), but it can often involve a vertical incision from the nipple to the lower border of the breast fold. In Dr. Unger’s estimation, this scar tends to be “concerning” for patients because “it is visible along the lower pole of the breast.”
With the right care, however, it can be greatly minimized. “At least in my experience, this scar almost always heals incredibly well, and is usually imperceptible for most patients after a healing period,” Dr. Unger says. “For some this means it's almost invisible by three months; for some it's more like one to two years.” Regardless of which camp you fall into, “it almost always fades away to a level that is difficult to identify it at all,” he adds.
For Dr. Frederick, the pivotal component that makes scars better in a reduction mammoplasty (a.k.a. breast reduction) is the technique. As he explains, in a “classic, old-school” inferior pedicle breast reduction, flaps are raised and closed “under tension over the top of the pedicle.” With a superior or superior-medial pedicle, meanwhile, “no flaps are raised” and “the pillars are closed together so there’s minimal tension on the skin,” he shares.
Male breast reduction, or gynecomastia surgery, is one of the most popular cosmetic procedures for men in the U.S. Like a female breast reduction, patients may need fat removal, skin excision, or a combination of the two depending on the grade of gynecomastia. Unlike female breast reduction, the majority of patients do not need significant incisions. “Most gynecomastia is done with liposuction through a small opening,” Dr. Frederick says. “This external scarring is typically not an issue.”
Liposuction & Fat Transfer
Speaking of liposuction, the gold standard of fat reduction tends to be minimally invasive as far as incisions are concerned. “Liposuction scars are small — approximately 3 millimeters — and placed in well-hidden areas of the body,” Dr. Mahmood explains. For example, in abdominal liposuction, incisions are usually made low in the bikini line and in the umbilical hood for concealment purposes. “Incisions are minimal and tend to heal well,” she says. It should be noted, however, that if you opt for a type of lipo that is heat-based (like VASER or Smartlipo), “there is a higher risk of scarring at the liposuction cannula site,” Dr. Mahmood cautions.
Depending on your aesthetic goals, the fat removed via liposuction may be purified and injected into another part of the face or body. Known as fat grafting or fat transfer, the combination procedure is the basis for the Brazilian Butt Lift (BBL) and breast augmentation with fat transfer, in addition to serving as an alternative to synthetic filler when contouring the face and rejuvenating the hands.
As for injecting the fat from the donor site, Dr. Frederick uses an 18 gauge needle and “small pokes” so there are no external scars. “The important thing is to fan out the fat evenly and quickly because it swells almost instantaneously and that will distort the [treatment area] and prevent you from seeing where you injected the fat if you do it too slowly,” he shares.
The purpose of a thigh lift surgery is to remove excess skin and fat and reposition underlying tissue to lessen the appearance of sagging. According to Dr. Frederick, the incision “almost always” runs along the inside of the leg and the groin crease, which can be problematic for healing. “The problem with the groin crease scar is that it’s fighting gravity, as the weight of the leg pulls down on it,” he explains. There are steps a surgeon can take while operating to lessen the burden. Ultimately, “it’s important to anchor the thigh to the more sturdy aspects of the pelvis so that it doesn’t drop back down with gravity,” Dr. Frederick shares.
How to Care for Scars After Plastic Surgery
As we’ve alluded throughout the article, well-healed scars start in the operating room. “As plastic surgeons, we are very familiar with scarring and various techniques to help minimize the visibility and size of scars,” Dr. Unger shares. “There are methods and materials we can use to help improve scar tone and texture and quality.” This includes specific closure techniques and sutures that yield a ‘tension free’ result. “We use multiple layers of stitches commonly and try to make sure there is no ‘pulling’ on the final incision line,” he explains. “Tension or stress across an incision is a major determinant in how wide or thick a scar may end up.”
Once you’re home, you too can work to keep tension to a minimum. “Significant tension on the scar either at the time of surgery or by the patient’s increased activity early in the post-op period, affects how the scar heals,” Dr. Mahmood cautions. Compression garments (worn in accordance with your surgeon’s post-op instructions) are one way to decrease swelling and, in turn, minimize undo tension, as is being mindful of your movement. “For example, stay hunched over after a tummy tuck,” Dr. Frederick notes.
Topical treatments, like silicone gels and strips, can be a helpful part of the recovery process — but consistency is key. “Silicone sheeting can help, but it’s like putting a tomato in a greenhouse,” Dr. Frederick says. “It needs to be there everyday for six months to get a 10 to 15 percent better yield.”
It’s important to remember that scars can take a year or more to fully heal and fade. If you are unhappy about the appearance of your surgical scars, talk to your surgeon. As Dr. Unger shares, there are “a range of minimally invasive skin-remodeling techniques such as dermabrasion and lasers that can help place the body into optimal position for the best possible healing.”
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