Year after year, patients choose weight loss and body contouring surgeries to achieve a sleek, firm body shape. Naturally, one of the biggest concerns for many is the potential for scarring. This article provides a comprehensive overview of the types of scars that can result from weight loss surgery, how they heal, and the various methods available to minimize their appearance.
Understanding Scars and Weight Loss Surgery
When it comes to scars after weight loss surgery, there’s an important distinction that must be made. Weight loss surgery scars are scars that result from bariatric surgery procedures such as gastric sleeve surgery, gastric bypass surgery, and gastric balloon surgery. Post-weight loss surgery scars are scars that result from body contouring after significant weight loss.
Weight loss surgery, also known as bariatric surgery, is proven to be the best way to lose massive amounts of excess weight and keep it off. It can help you live longer, and with proper exercise and diet, help you live healthier, too. Many patients also see a decrease in some diseases, including diabetes, high blood pressure, and even some cancers.
Types of Bariatric Surgery and Resulting Scars
The location and length of scars depend on the type of surgery. There are several types of weight loss surgery, each with its own scarring patterns:
- Gastric Bypass Surgery: Gastric bypass involves making a smaller stomach and changing the small intestine’s path. This can leave scars in different places, including the upper belly and the belly button. Often includes 5-6 incision points, usually located from the upper left to the lower right of the abdomen. Because it involves rerouting the digestive system, the procedure requires more access points.
- Gastric Sleeve Surgery: In this surgery, the surgeon removes a part of the stomach, creating a smaller pouch. Usually involves 4-5 small incisions across the upper and mid-abdomen. These are used to insert surgical tools and a camera to remove part of the stomach.
- Gastric Balloon Surgery: Gastric balloon surgery places a temporary inflatable balloon in the stomach to promote weight loss without surgery. Since this procedure is minimally invasive, it typically results in small and discreet scars, if any.
- Duodenal Switch Surgery: In duodenal switch surgery, the surgeon takes out a part of the stomach and changes the arrangement of the small intestine to affect how food is digested.
- Adjustable Gastric Banding: In adjustable gastric banding, an adjustable band is placed around the stomach, leaving a small scar near the belly button.
Surgical Techniques: Impact on Scarring
The surgical technique used significantly impacts the size and appearance of scars:
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Laparoscopic Surgery: Bariatric laparoscopic surgery involves inserting a thin, long tube with a camera and lights into the abdomen to perform weight loss surgery. With the laparoscope, the surgeon is able to see inside the stomach and make changes to the stomach and intestines through small incisions in the abdomen. Compared to traditional open surgery, this type is less invasive. Most traditional bariatric surgeries require small incisions in the abdomen, which means visible scarring is a natural part of the healing process.
- Scars from Laparoscopic Gastric Bypass: Laparoscopic gastric bypass surgery usually creates five 1/2-1” long incisions on the abdomen. Surgeons usually insert a laparoscope equipped with a tiny camera through one incision at the belly button and make four other incisions for instruments. Typically it leaves behind minuscule scars that can fade to near invisibility within two years in 90% of patients.
Single-Incision Laparoscopic Surgery (SILS): As opposed to traditional laparoscopic surgery, single-incision laparoscopic surgery (SILS) uses a single incision, usually in the belly button, instead of several incisions as in traditional laparoscopic surgery. A single incision is used to insert special instruments and a camera for the surgery. There's less scarring and cosmetic benefits with this technique.
Open Surgery: Using traditional surgical methods, the surgeon makes a large incision in the abdomen, extending from mid-chest down to the belly button. Through this opening, the surgeon accesses the stomach and intestines to complete the gastric bypass surgery. Specifically, the incision measures up to 10 inches. Consequently, the stomach is altered and bypassed.
- Scars from Open Gastric Bypass: Ranging from 8-10” in length, the scar from open gastric bypass surgery runs upward from the naval to the sternum. Moreover, due to the larger incision, the infection risk is greater and the resulting scar is prominent.
Endoscopic Procedures: Instead of making incisions in the abdomen, these procedures are done entirely through the mouth using a flexible scope and specialized tools.
- Endoscopic Sleeve Gastroplasty (ESG): During ESG, the scope is used to place sutures inside the stomach, reducing its size and limiting how much food it can hold. This procedure yields results similar to gastric sleeve surgery. There is no hospital stay and a very short recovery time when compared to gastric bypass surgery. This is a much less invasive option that leaves NO VISIBLE SCARS.
Factors Influencing Scar Appearance
Bariatric surgery scares looks different based on many factors. Several factors influence how scars appear and heal:
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- Surgical Technique: The way the surgery is done - laparoscopic or open - affects scar size and visibility.
- Individual Healing: Everyone heals differently. Age, genes, and health affect scar quality. The patient's age, genetics, and the way the patient cares for their incisions after the surgery. In younger patients, irregular scars are more common because collagen production is higher.
- Patient Skin Type: Depending on ethnicity and natural pigmentation, scars will develop and look differently on everyone. Scars typically appear more prominent on individuals with darker types of skin.
- Scar Care: Taking care of scars matters. Following aftercare instructions can help avoid an infection that can make scarring worse.
- Sun Exposure: Sun can darken and thicken scars, making them stand out. When exposed to the sun too much, scar tissue can thicken and change color.
- Lifestyle: Smoking can slow healing and make scars more noticeable because smoking stunts the healing process and increases the likelihood of infection.
- Skill of the Surgeon: Surgery performed by a less skilled surgeon will result in an increased amount of scarring.
The Healing Process of Scars
The journey of scar healing is marked by distinct stages, each characterized by specific processes and changes within the scar tissue.
- Inflammatory Phase: Immediately after surgery, the body initiates the inflammatory phase, characterized by redness, swelling, and tenderness around the incision sites. Right after surgery, bariatric scars often appear red, swollen, or raised. This is a regular part of the healing process.
- Proliferative Phase: During this phase, new tissue forms, and collagen production peaks. The scar tissue gradually matures and gains strength.
- Remodeling Phase: As scar healing progresses, the remodeling phase commences. Collagen fibers undergo realignment and reorganization, leading to a flatter and less noticeable scar texture. In most cases, bariatric scars flatten and fade within 6 to 12 months, but they rarely disappear entirely. Over time, scar patterns that were once bright pink or red should become less pigmented and flatter. Twelve to eighteen months after surgery, scars are considered mature, although they may still be slightly visible.
Types of Scarring
Following bariatric surgery, there are four types of scars that can form:
- Hypertrophic scars: Scars that are raised above the skin's surface.
- Keloid: Scarring that extends beyond your incisions. Younger people, whose collagen production is high, often develop these raised scars called keloids due to an overproduction of collagen.
- Larger scars: Scars after wounds caused by infection or reopened incisions.
- Discolored and thicker scars: Scars due to direct sun exposure.
Minimizing the Risk of Scarring
There are several measures you can take to minimize the risk of scars after bariatric surgery.
- Follow the Diet Plan: Be sure to follow the diet plan recommended to you by your dietician. In the beginning, you should stick to a clear liquid diet and then gradually introduce purees, soft foods, and solid foods.
- Exercise: Your surgeon will recommend exercises to help you promote blood flow, which will help your wounds heal faster and decrease scarring. Follow the instructions but keep in mind not to stretch your skin too much, or your incisions may pull apart or break.
- Avoid Tobacco Products: You should avoid tobacco products because smoking stunts the healing process and increases the likelihood of infection.
- Rest: While your incisions are healing, get plenty of rest, and don't overdo your exercise. When you are fully rested, your body's healing response operates at its best.
- Monitor Incisions: Any bleeding from your incisions, or any fluid that has changed color or thickness, should be reported immediately to your surgeon since this can lead to infections. In the event that you do not treat the condition quickly, your scars might get worse and you might face serious medical complications.
- Protect from Sun: Utilize a sunscreen or cover up your scars to prevent them from getting sunburned. When exposed to the sun too much, scar tissue can thicken and change color.
- Stay Hydrated: Be sure to drink plenty of water to prevent dehydration from interfering with the healing process. Skin that is dry is more susceptible to damage and scarring.
Scar Management and Reduction Techniques
Active scar care empowers your healing journey. Various treatments can help lessen the appearance of scars:
Topical Treatments: Topical options such as Vitamin E, cocoa butter, and vaseline can reduce scarring after a sleeve gastrectomy or other weight loss surgery. It is important to keep the skin moisturized and lock its moisture. Solutions and creams like Cocoa buttercream, vitamin E, silicone gel, and other over-the-counter products like Vaseline and Aquaphor can often help heal scars. Additional options like scar massage, moisturizing ointments, and over-the-counter scar creams can further improve texture and appearance.
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Medical Procedures: Sometimes doctors use surgery to change a scar’s appearance and make it less noticeable. Scars can be reduced in appearance with cosmetic procedures and treatments:
- Microdermabrasion
- Morpheus8
- Microneedling
- CoolPeel Laser Resurfacing
- Chemical Peels
- Laser treatments or corticosteroid injections. For more persistent scars, dermatologists may suggest laser treatments or corticosteroid injections.
Compression Garments: Wear your compression garment.
Lymphatic Massage: Dr. Thompson offers post-operative lymphatic massage with the Ballancer®Pro system.
Scar Massage: Gentle scar massage can also help mitigate fibrosis in the tissues or keloid scar formation, resulting in a smoother, flatter scar. This can help to reduce pain and itching, and it can also make the scar less noticeable. Massage also helps to improve circulation and lymphatic drainage, which can help to reduce swelling and inflammation.
Scar Concealers: Specialized makeup products designed to cover scars and blemishes are called scar concealers. They are thicker and more opaque than regular makeup, which helps them to hide the appearance of scars. Scar concealers can be a great way to temporarily conceal scars, especially when you want to dress up or attend special events. However, it is important to remember that they are not a permanent solution.
Surgical Tattoos: Surgical tattoos can help hide laparoscopic weight loss surgery scars by using pigment to match the surrounding skin color. This can be a more permanent and effective way to conceal scars than using scar concealers or makeup. The artist will carefully match the pigment to the surrounding skin color, and they will use a variety of shading techniques to create a realistic-looking tattoo.
Body Contouring After Weight Loss
Post-weight loss surgery scars are scars that result from body contouring after significant weight loss. These scars tend to be more substantial because larger incisions are required, and this simply means more scar tissue. More scar tissue means more visibility.
Common Body Contouring Procedures and Incisions
- Tummy Tuck (Abdominoplasty): A full, or standard tummy tuck, involves the removal of excess skin and fat, as well as abdominal muscle repair as needed. Standard tummy tuck incisions are placed very low on the abdomen, just above the pubic area. The incision for a standard tummy tuck extends from hip to hip. This will leave a scar that falls along the natural crease within the bikini line. Its length and visibility varies. This technique has the most extensive incision, wrapping around the sides of the torso and extending along the back. That said, this technique addresses excess skin and fat all around the torso, making it one of the most transformative approaches to a tummy tuck.
- Panniculectomy: The most common plastic surgery after weight loss surgery is panniculectomy. The incision extends around the circumference of your body in a bikini-line pattern to be hidden in your underwear. The incisions stretch from hip to hip just above the pubic area.
- Breast Lift: Incisions vary because there are different types of breast lifts, each with different scarring patterns. Your surgeon can conceal some incision lines in natural breast contours, but others will be visible on the breast surface.
- Arm Lift (Brachioplasty): Incisions are generally inside the arm or on the back of the arm and may extend from the underarm (axilla) to just above the elbow. If you only have a small amount of extra skin, your surgeon may recommend a mini brachioplasty, where the incision is limited to the underarm area.
- Thigh Lift: Incisions for an inner thigh lift are in the groin fold. For a vertical thighplasty, a vertical incision starts at the groin crease and extends to the inner knee. An outer thigh lift requires an incision extending from the groin around the hip. For a spiral thighplasty the incision is below the buttock fold and continues over the groin crease at the junction of the thigh and pubic area.
- Liposuction: Liposuction does not usually cause noticeable scars.
Managing Expectations
Initially, bariatric scars may look red, pink, or purplish, especially in lighter skin tones. Over time, they typically fade to a pale or skin-toned color and flatten out. In darker skin tones, scars may appear darker or develop hyperpigmentation before gradually lightening.
Remember, scars are part of healing after bariatric surgery. Scars might look different, but they show your body’s incredible change. The best way to envision how your post-weight loss body contouring scars might look after one year is to Google before and after photos of past patients. Do keep in mind that everyone is different, however.
Scar-Free Weight Loss Options
For individuals concerned about scarring, endoscopic procedures like Endoscopic Sleeve Gastroplasty (ESG) offer a scar-free solution. These procedures are performed entirely through the mouth, leaving no external scars.
Choosing a Surgeon
If you are considering tummy tuck surgery, it’s important to choose a surgeon who is highly trained and will take the time to listen to your unique concerns. When undergoing post-bariatric surgery, your surgeon will make every effort to make incisions and scars as small and inconspicuous as possible. Board-certified aesthetic plastic surgeons can skillfully hide incisions in body creases whenever possible.