One of the most common incisions on the human body is called a Pfannenstiel incision. This incision lies roughly between the vagina and the bellybutton or umbilicus and is a very common place for entry into the pelvic cavity for things like cesarean sections, tummy tucks, and other gynecologic procedures. In most cases, the scar heals really well. Even if a plastic surgeon did not close the scar (for example, after a baby is born), there is laxity and abundance of skin that literally allows the edges of the wound to fall together under minimal tension. Scar tension is one of the leading causes of a widened or pigmented or nodular scars! When the scar is closed in a tension-free manner, it is typically a better looking scar. Of course, other factors, like ethnicity, skin type, infection, contamination of her procedure, and artistic placement of the scar have a role in optimal scar healing.
It is all too often that I see the patient presents to me with a fine line scar above the mons pubis that bothers her. The story is pretty typical: I take a picture and the scar looks pretty good. Of course, the camera that I use has a flash that casts a light directly towards the scar eliminating a downward shadow. Downward shadows, like the ones that you get with typical lighted rooms and sunlight, are more relevant and really can accentuate the importance of shadows to scar healing. When a woman or man presents to me and they say I cannot stand the scar in my abdomen I quickly attribute that to either an ugly scar itself, or an imbalance between tissues above the scar and below it. When you have tissues above the scar based on gravity or fat or anything like that causing the upper part of the scar to be thicker or fall over the lower part of the scar, you, by definition, cast a shadow downward. It’s this shadow, not the scar itself, that requires intervention.
I present a case in today’s video of a woman who looks great overall. She had a previous gynecologic procedure and while the scar healed well, the wound was never closed in layers. Therefore, the scar and the skin itself really did stick down to the abdominal wall. With time, gravity, and the small amount of weight gain, the upper tissues are starting to literally fall over the scar itself which is tethered in position. To correct this, I addressed 3 main factors. First off, I will debulk some of the fat and soft tissue excess above the scar. Second I will actually tighten the tissues above the scar by radiofrequency skin tightening and direct excision of skin. Finally I will revise the entire length of the scar itself and everted with a five layer closure making sure that the top most layer of skin never scars down to the abdominal wall again. Although the postop picture here is only two weeks out, I think the point is clear. Elimination of shadows equals better scars.