It is normal to worry about what your body will look like after a bariatric procedure (including scaring). After all, it's major surgery. Does gastric sleeve surgery leave scars? Does gastric bypass surgery leave scars, a duodenal switch, or a SADI-S procedure? The short answer is yes, you will have weight loss surgery scars, but scar tissue won't become a problem for most patients.
Why Do Weight Loss Surgery Scars Occur?
Most bariatric surgeries leave little to no scarring, yet the possibility of visible scars is real as scars are part of the body's healing process. When you have a surgical procedure, white blood cells rush to the wound to fight germs or infections. This process often results in the wound turning pink or red, accompanied by swelling. Your body begins growing new tissue at the wound site, producing collagen when it links itself to the wound site. Granular tissue fills the inside of the wound, and voila, you have a scar as new skin grows and strengthen the area. Depending on the size and shape of the wound, scarring may be flat or raised. Those with darker or brown skin may have scars that are significantly lighter than the surrounding area. Over time, visible scars fade through the healing process, although not always completely. A scar's appearance can continue to fade over two years.
Where Are the Incisions Placed?
The location and length of your incisions depend on the type of bariatric surgery performed. All gastric sleeve operation and bariatric procedures are performed laparoscopically, leaving only tiny incisions and small stomach scars.
Single-Incision Weight Loss Surgery
If your surgeon elects to perform a single-incision surgery near your navel, you'll have virtually no gastric sleeve scar tissue. The lone scar will be in your belly button where no one will notice it.
Multi-Port Laparoscopic Gastric Sleeve Surgery Scars
Patients with gastric sleeve surgery or a gastric bypass procedure will most likely have multi-port laparoscopic surgery. In this case, you will have three to five small scars from incisions placed across your middle and upper abdomen. This technique is quite effective at reducing complications and minimizing scarring.
Open Surgery Scars
Open bariatric surgeries rarely occur, usually only when there is a complication or an emergency. When it does happen, patients generally have a long vertical incision that results in a large scar.
How Visible Are the Scars?
The scar is hidden inside the navel if single-incision gastric sleeve surgery (SILS) is performed. Therefore, it is not visible at all. Following traditional laparoscopic gastric sleeve surgery, small scars are somewhat visible. However, they fade significantly over time and become more difficult to see. Open surgery stomach scars often are visible years after the procedure, but open procedures are rarely performed.
Patients will encounter four types of stomach surgery scars:
- Hypertrophic scars that rise above the level of your skin
- Keloids, bumpy scars that go beyond your incisions
- Scars that are larger than necessary, resulting from large wounds or infections
- Discolored, thick scars, resulting from sun exposure.
How to Minimize Scars From Gastric Sleeve and Other Bariatric Surgeries
You can prevent excessive weight loss surgery scars by following your surgical team's guidelines. These include:
- Caring for incisions properly by allowing them to heal and not picking at the scab
- Keeping surgical sites clean by washing them thoroughly daily with soap and water, then patting them dry with a towel
- Drinking plenty of water to promote healing
- Moisturizing daily to keep the skin soft and supple
- Wearing proper sun protection to protect your skin from UV rays
- Avoiding tobacco as smoking stunts healing, along with alcohol and caffeine
- Follow exercise recommendations as activity will promote blood flow that will help heal wounds faster and reduce scarring
- An appropriate diet per your dietician's instructions, including vitamins and liquid intake, is crucial toward healing
Sometimes, no matter what you do, you'll have abdominal scarring. Remain aware of danger signs that indicate problems that will ultimately lead to excessive scarring. If your incisions turn bright red or if you see any fluid leaking from them, these signs can indicate an infection, making scarring worse as you may face serious medical issues.
Discuss what you can do to minimize scarring with your surgical team. Options include silicone sheeting or scar-minimizing creams, lotions, ointments, or natural substances like aloe vera or raw honey.
Many products claim to minimize scarring, yet none of them has significant proof or testing that shows the reduction or removal of scars. Silicone gel sheeting can heal small incisions by healing the top layer of skin. Nevertheless, some patients recommend applying antiseptic spray, triple antibiotic ointment, or Neosporin while the incisions heal. Others indicate you should wash your incisions daily, let them air briefly, and then dress them in gauze and tape.
Among over-the-counter products and other items that patients recommend to minimize scarring include:
- Vitamin E
- Cocoa butter
- Essential oils
- Coconut oil
- Laser resurfacing treatments
Internal Gastric Sleeve Scarring
Abdominal adhesions are bands of internal scar tissue that occur after bariatric surgery. They can cause chronic abdominal pain, bowel obstruction and female infertility. During any bariatric procedure, internal organs are moved around, leading to internal scarring as your organs can stick to each other or abdominal walls. Abdominal adhesions are common, so you should look for the following symptoms after weight loss surgery:
- Intermittent abdominal cramping or severe pain
- Nausea and vomiting
- Inability to pass gas
- Abdominal swelling
Patients who experience mild abdominal cramping from time to time can often ease this discomfort by going on a liquid diet for 24 hours.
To find out whether you have a bowel obstruction caused by an adhesion, your surgeon will order a CT scan or X-ray of your abdominal cavity. Surgery is the only way to break up the adhesion and fix the blockage.
The best way to avoid abdominal adhesions is by using minimally invasive single-incision laparoscopic surgery or multi-port laparoscopic surgical techniques. They reduce the risk of adhesions by:
- Reducing the risk of blood and blood clotting
- Helping to prevent the organs from drying out by touching the air or surgical gloves
All patients have a different experienced when recovering from weight loss surgery, even when minimally invasive techniques are involved. Adhesions forming around incisions are a normal part of healing. Some will disappear in the first few years, while others are noticeably long-term.
Removing Weight Loss Surgery Scars
If your bariatric surgeon uses minimally invasive surgery, you most likely won't have to do anything as the scars fade on their own within the first few months. Most patients find that the tiny incisions leave inconspicuous marks enough not to warrant any treatment. However, if you are worried about how your stomach looks in that summer swimsuit, you have two options: steroid injections or plastic surgery involving laser resurfacing.
Usually, only scars from open abdominal area procedures will leave cause for concern. Neither steroids nor plastic surgery will remove incision scars from gastric sleeve or other bariatric surgeries altogether, but if you are concerned about your looks, you may want to pursue this route.