Scar Tension: Problem and Solutions

Wound healing is a complex process that takes time.  A surgical scar is the visible part of the scar tissue that results after the skin incision (wound) heals.   This is the type of healing that is of most concern to patients – the visible scar.  As I have discussed in a previous blog post, there is no such thing as scar-less surgery, and plastic surgeons can only minimize and mitigate scarring, not eliminate it.

One of the enemies of a nice scar is tension.  Tension is the body’s tendency to pull the wound apart, which can widen and/or thicken a scar.  Some degree of tension happens with almost all wounds, but it is most apparent in procedures like tummy tucks, where we remove a large amount of lower abdominal skin, pull the upper abdominal skin down, flex the patient to help get the two edges together, and put layered sutures in to keep the closure closed.  The most tension, as you can imagine, tends to be in the central area of this scar, above the pubic area.  This is the area that is more prone to widening or thickening as the weeks go by.

Using paper tape (good) or silicone tape (better) are two options that, unlike scar creams and ointments, help prevent the wound edges from spreading.  There is now a new product called Embrace that adheres to each side of the wound and helps pull the skin together slightly, taking tension off the wound.  One application lasts a week, and is repeated for up to 8 weeks.  There are a couple different sizes and although it can be used for other procedures such as breast augmentations, I see its best use for abdominoplasties (tummy tucks), brachioplasties (arm lifts), and thigh lifts, procedures most commonly compromised by widened scars from tension.  The Embrace is the most expensive option for post-op scar management, but for certain procedures is probably worth the additional cost.

– Dr. Douglas Mackenzie, MD, FACS, Pacific Plastic Surgery, Santa Barbara, California

Douglas J. Mackenzie, MD

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