Posted by Dr. Miguel Fernández Calderón: 08/12/2023
Abdominoplasty is one of our preferred plastic surgeries. The results are impressive and transform patients’ bodies. Unfortunately, to achieve this beautiful change, we need to create a scar that allows us to remove excess abdominal skin and repair the underlying muscles. Many patients worry about this mark. In this article, we answer frequently asked questions about the abdominoplasty scar. We also advise you on what you can do (and we as surgeons can do) to minimize its appearance as much as possible.
What is an abdominoplasty and what does the scar look like?
Abdominoplasty is a surgical procedure in which excess skin and fat are removed from the middle and lower abdomen. Weakened or separated abdominal muscles (diastasis recti) are also reinforced.
The result is a smooth and firm abdominal profile, as well as a slimmer waist by removing excess skin and tightening the remaining tissue.
In an abdominoplasty, the scar is large, but the advantage is that it can be hidden with underwear, as it is located in the lower abdomen. The type of incision and its location depend on the patient’s skin laxity and the type of abdominoplasty performed.
Horizontal suprapubic scar
As we mentioned, the scar is typically located a few centimeters above the pubis. It extends horizontally along the front of the abdomen (from one iliac spine to the other), from hip to hip. An additional incision is also made around the navel to reposition it.
However, in people with significant skin laxity, the abdominoplasty scar must be longer. In other words, it extends horizontally as far as there is excess skin.
Mini-abdominoplasty scar
Sometimes, there are individuals with skin laxity located only below the navel and without muscle alterations. These patients can benefit from a very short horizontal scar. This is known as a mini-abdominoplasty.
It is a shorter horizontal incision, similar to a cesarean section scar, also located above the pubis. An incision around the navel is usually not made, as the navel is not repositioned.
Vertical scar (extended or anchor cases)
In patients with more laxity, it may be necessary to add a small vertical scar to the horizontal abdominoplasty scar, extending from the pubis to the navel or higher. Fortunately, this is a small, fine line. The result is a T-shaped or anchor scar, which is more visible than the others.
Occasionally, we see patients with excess skin far greater than normal. For them, it may be necessary to create two long scars: one horizontal and one vertical. This is called a “Fleur-de-Lis abdominoplasty.”
As you can see, there is no single abdominoplasty scar suitable for everyone. The horizontal scar can be longer or shorter, and may have an additional vertical scar. The horizontal scar is usually located about 4-6 cm from the pubis. In patients with more laxity, we can place the scar lower (to hide it with underwear).
Stages of the scar formation process
The evolution of scars is divided into three stages from closure to complete maturation. It is important to note that the minimum time for stabilization is nine months; in some cases, it takes longer.
During this time, a series of changes occur in the scars, including color changes and thickening, among others. But gradually they will progress toward their best appearance.
The first stage of scar evolution is closure, which takes three to four weeks. This begins after the incision is made, at which point the body begins to produce collagen to fill the wound.
Next comes the establishment phase, characterized by increased blood flow and collagen accumulation in the wound area. This causes the scar to become darker and thicker. This can last up to six months.
Finally, maturation occurs when collagen formation and blood flow decrease. This means the skin has healed. At that point, the scar becomes less visible, thinner, and lighter in color. However, it does not disappear completely. Maturation can last up to two years after surgery.
Patience is an important aspect of this process. You should know that an abdominoplasty scar takes between 1 and 2 years to “mature.” This means that in the first months, it will appear somewhat raised and reddish in color. Over time, it will flatten and adopt a lighter color.
How to improve an abdominoplasty scar?
Following all of your surgeon’s recommendations accelerates recovery and prevents complications. If we avoid infections and wound separation, the abdominoplasty scar will improve.
What to do before surgery to minimize the scar
The first step to minimize an abdominoplasty scar begins at the initial consultation. When we assess you, we plan how to make the scar as inconspicuous as possible. We design a line with minimal length and placed as low as possible. In the operating room, we suture with precision to achieve the best result. High-quality sutures, multi-layer closure, and meticulous technique allow us to minimize it further.
For better scar healing, it is recommended that you remove hair from the pubic area a few weeks before surgery. This will prevent hair-related complications. It is also better to avoid smoking in the first months of abdominoplasty recovery, as it is essential to prevent wound complications.
Immediate post-surgical care
During the first 3 months, it is sufficient to keep the wound clean. Wash it once a day with warm water and mild soap. Afterward, cover with sterile strips.
It is important to wash gently without scrubbing hard, as the wound is still fresh. Keeping the scar clean and dry will prevent infection risk.
Creams, gels, and silicone dressings
A few weeks later, you can start applying topical products. There are many types of creams available. Moisturizing during this time is essential for proper scar healing. Apply the cream or gel recommended by your doctor twice daily, or as directed, with gentle massage.
The most common options are:
- Rose hip oil application: rose hip is one of the most recommended natural ingredients, along with aloe vera gel, to help scars heal. It helps reduce inflammation and redness during the healing process.
- Using silicone sheets: if the scar appears very raised, you can place Trofolastin sheets over it. They are water-resistant and can last 5-7 days without replacement. This treatment is typically maintained for 4-5 months. In addition to protecting the wound, it prevents excessive collagen production and, therefore, the formation of a large scar.
Use of compression garments
The use of compression garments after such an important procedure as abdominoplasty is key to ensuring results, including good scar formation. These reduce inflammation, improve blood circulation, and help the skin adhere to underlying tissues.
Always use compression garments under the supervision and recommendations of the surgeon who performed the abdominoplasty.
Avoid tension and adopt proper sleeping and movement positions
Generally, after abdominoplasty, you should sleep on your back, ideally with your knees slightly elevated, which reduces tension on the incisions and also reduces swelling in the area.
You should also avoid sudden movements and strenuous physical activity for the time recommended by your surgeon. Avoid sudden movements, walk slowly, and gradually increase your pace as you can, which activates circulation.
Dermatological treatments
After two years, the scar stabilizes. After this period, it is unlikely to improve further. If at that time you are unhappy with the result, other treatments can be considered. Laser therapy, steroid infiltration, or a new surgery to “remodel the scar” are options to discuss with your surgeon.
Laser treatment is used to reduce the size, color, and visibility of scars. However, it is not suitable for all types of scars or skin types, so you should consult with your doctor about whether this treatment is viable.
While skin grafts involve transferring skin from another part of your body to the scar area.
Types of scars
- Immature scar: all scars go through a period where they are immature—pinkish in color, usually with a raised scar line. In these, collagen peaks at 3 weeks after surgery and works for about 6 months to increase its production.
- Mature scar: the transition from immature to mature occurs when the redness fades. A defined band of collagen is visible in the dermis; the scar is flat and can range from white to hyperpigmented.
- Atrophic scar: in some cases, the scar retracts or thins as it becomes mature. This can happen because there is little collagen synthesis and, therefore, less inflammation. Stretch marks are an example of atrophic scars.
- Hypertrophic scar: when the scar does not transition well from immature to mature, there is inflammation and collagen accumulation, causing the scar to become wider and raised with a viscous appearance. This growth can last for months and eventually stop and resolve over time.
- Keloids: a keloid scar behaves differently from hypertrophic scars; they grow like a tumor and can develop years after surgery. They extend beyond the original scar line and may have a mushroom or cauliflower shape. They can have symptoms such as pain or itching.
Factors affecting scar formation
The quality and final appearance of abdominoplasty scars is influenced by various factors, such as genetics. This means that some people have a tendency to form thicker, raised, and darker scars (hypertrophic or keloid) regardless of their care.
Skin type and each person’s healing process also play a role. Additionally, surgical technique—that is, the surgeon’s precision and skill in closing the incision—is key to scar formation.
Post-operative care is also important for scar healing; you should follow your surgeon’s instructions to the letter.
On the other hand, collagen production is relevant, as if your body produces it in excess, keloids or hypertrophic scars will form, and if you have little production, they will be atrophic.
When to see a specialist about an abnormal scar?
Follow-up appointments with your doctor are essential for proper healing. They are also effective in early detection of problems with your abdominoplasty scar.
Infections, hematomas, or seromas can delay scar healing and negatively affect scar appearance. If these occur, consult with your doctor.
Occasionally, scars can widen, forming keloids or hypertrophic scars. These complications will be evaluated during follow-up at our clinic. These are problems with easy solutions (steroid infiltration, Trofolastin sheets).
Frequently asked questions about abdominoplasty scars
How do I protect the scar from sunlight?
During this time, it is essential that you avoid sun exposure on the scar. The sun pigments these wounds too much. Therefore, you should protect them from the sun for approximately 2 years. If you will be outdoors, apply sunscreen with an SPF of at least 30 every two hours to the scar.
How do I massage an abdominoplasty scar?
Massaging an abdominoplasty scar can help reduce abdominal adhesions. This means it will help prevent the mark from becoming indented and allow it to heal properly.
However, you should not rush to start these massages. Mobilizing the scar too early can cause problems. It can facilitate fluid accumulation (seromas) or cause the wound to open (dehiscence).
Therefore, your surgeon will give you permission to start massages when the scar shows appropriate signs of healing. This generally takes about two to three weeks to occur.
Typically, we recommend a few drainage sessions with professional massage therapists. They can guide you and teach you how to perform the massages. Using moisturizing cream and applying gentle pressure on the scar, circular movements are usually made around the entire wound. This should be done once or twice daily.
What is the best cream for an abdominoplasty scar?
Regarding this topic, there are many opinions. We don’t have an exact answer, but we can share our experience. Starting around the third month after surgery, we usually recommend daily application of Cicalfate. It is a disinfectant and regenerating cream. At the same time, it helps soothe discomfort and itching that the abdominoplasty scar may cause.
Additionally, this cream is appropriate and well-tolerated by many skin types. Cicalfate is useful for both fair-skinned and dark-skinned patients.
When you undergo a procedure such as abdominoplasty or a breast lift in Madrid, your surgeon will give you recommendations for caring for the scars.
How long does it take for skin to reattach after abdominoplasty?
Abdominoplasty is an operation that works on large body areas. To achieve the final silhouette, several months must pass. During this time, the skin will gradually adapt to achieve the desired contour.
However, the first 3-4 weeks are crucial for skin adherence. Mobilizing the abdominoplasty scar too much—with massage or exercise—will likely cause complications. The main problem would be seroma, which is fluid accumulation under the skin that usually requires drainage.
Therefore, it is advisable not to put too much friction on the wound in the first month after surgery. After this time, the abdominoplasty scar can be massaged very safely.
How long does it take for an abdominoplasty scar to disappear?
Scars never completely “disappear” from our bodies. However, an abdominoplasty scar can end up being almost invisible. Its evolution depends on many factors, which we have already explained (genetics, individual care, surgical technique).
In the first 3 or 4 months after surgery, the scar is usually noticeably tight and red. After this time, it typically gradually improves. You must be patient, as it can take up to two years to fade.
After these two years, an abdominoplasty scar will not undergo major changes. However, it may improve slightly over time. Nevertheless, the most significant improvements occur between 3 and 24 months after surgery. If the scar does not evolve well, learn more about keloid scars and their treatments.
