Vertical Sleeve Gastrectomy (VSG) is a frequently performed procedure that helps individuals achieve significant weight loss by permanently reducing the size of the stomach. For many patients, the cosmetic result, specifically the appearance and longevity of the scars, is a significant concern. Understanding the typical healing process and what to expect regarding the final appearance of the incisions is part of the overall decision. This article examines the nature of these surgical marks, their maturation timeline, and strategies for scar management.
The Nature of Gastric Sleeve Scars
The vast majority of gastric sleeve procedures utilize a minimally invasive approach called laparoscopy. This technique involves creating several small openings in the abdomen rather than a single large incision. A patient undergoing standard laparoscopic VSG typically has four to five small incisions on the upper and middle abdomen, usually ranging from 5 to 12 millimeters.
One incision is often slightly larger to allow for the removal of the resected stomach portion. Scarring is the body’s natural biological response to deep tissue injury, where the skin produces new collagen fibers to repair the wound.
Incisions are often strategically placed, with one commonly near the navel to help conceal the resulting mark. Advanced techniques, like single-incision laparoscopic surgery, place the entry point directly within the navel, making the scar virtually undetectable. The body’s repair process forms a scar, which initially appears as a pink or red line.
Scar Maturation and Permanence
Gastric sleeve scars do not vanish entirely, but they fade significantly over time. The final result is a line of remodeled tissue that is often faint, flat, and pale. This transformation involves a predictable, multi-phase biological process known as wound healing and scar maturation.
The healing process begins with the inflammatory phase, followed by the proliferative phase, which lasts approximately three to four weeks. During proliferation, specialized cells called fibroblasts lay down a disorganized network of new collagen tissue to close the wound. In this early stage, scars are often raised, red, or dark, and may feel firm and itchy.
The final and longest phase is remodeling, or maturation, which can last from 12 to 18 months, or up to two years. During this period, collagen fibers reorganize, strengthening the tissue and making the scar flatter, softer, and much paler as blood flow decreases. Most surgeons advise waiting at least one year before judging the final cosmetic outcome, as the most dramatic fading occurs within this time frame.
Factors Influencing Scar Appearance
The visibility of a gastric sleeve scar is influenced by several patient-specific and surgical factors. Genetics play a role, particularly in the predisposition to forming abnormal scars. Keloids are raised scars that grow beyond the original wound boundaries, while hypertrophic scars are raised but remain confined to the incision line.
Skin tone is another factor, as individuals with darker skin tones have a higher risk of developing keloids and may experience more pronounced hyperpigmentation. The surgical technique and the tension placed on the wound closure also affect the final outcome; excessive tension makes the scar more likely to become wide or raised.
Post-operative care is also important for scar quality. Avoiding sun exposure is necessary during the first year of healing, as UV light can cause permanent darkening of the sensitive scar tissue. Complications such as infection or wound dehiscence (reopening) during the initial healing period can also lead to a more prominent scar.
Treatment Options for Scar Reduction
Several active treatment options exist to minimize the visibility of gastric sleeve scars. These interventions are most effective when started early, ideally during the remodeling phase. Non-invasive management often begins with topical silicone products, such as sheets or gels, which help to flatten and soften the scar tissue.
Applying gentle pressure massage to the healing scar multiple times a day is another effective home method. Massage helps to break down dense collagen fibers and improve pliability. For raised scars, medical interventions may be necessary.
Medical Interventions for Scar Reduction
- Corticosteroid injections, such as triamcinolone acetonide, can be delivered directly into the scar to reduce inflammation and collagen production, helping to flatten hypertrophic or keloid scars.
- Laser therapy offers an advanced option for addressing discoloration and texture. Pulsed dye lasers target blood vessels within the scar, effectively reducing persistent redness.
- Other lasers, like fractional CO2, can improve texture and overall appearance by stimulating skin cell turnover and collagen remodeling.
These treatments are typically performed in a series of sessions and can be combined with other therapies for optimal results.