LAM FACIAL PLASTICS

Dear Dr Lam,
I was intrigued by your YouTube video on scar revision and although you specialize in facial surgery, I'm hoping you might be able to answer a question about healing of an abdominal incision.
Seven weeks ago I had an abdominal myomectomy to remove a very large (>1.5kg) uterine fibroid. Although my surgeon said he would try to make a transverse "bikini" line incision, I ended up with a (16cm) midline incision from pubic bone to navel which was closed with a continuous subcutaneous absorbable suture. I am not happy with the way the scar is healing for two reasons, however:
1) Although the skin on either side of the developing scar seems even and flat when I am lying down, when I stand up, I have a crease in my abdominal fat on one side of the scar. It starts as a dimpled line perpendicular to the scar but gradually curves toward the scar (imagine a curve like a highway "on ramp" where the scar is the "highway"). This pulling or crease appears on only one side of the incision site and gives me a lop-sided appearance. I am relatively thin (21 BMI) and have no creases (apart from this one) in my abdominal fat at all.
2) I have a tendency to keloid scarring and the scar is sore, raised, red and nearly 0.5cm wide at points.

My surgeon has told me that the appearance of the scar will improve with time, but I do not think the creasing or puckering (which I believe is due uneven suture tension or poor wound approximation) will ever improve, particularly now after the sutures have dissolved. Can this creasing rectify itself with time? Is there anything I can do to improve the the creasing or the width of the scar before it becomes permanent (eg massage or silicone gels) or would I be making the situation worse and risk causing complications (eg dihiscence or herniation)? I would like to get pregnant some day and I worry that future scar revision in this location would not be advised. If there is something I can do now to improve things I would like to know.

Thanks for any comments you may have,

Kay

as you know, i cannot offer you direct medical advice nor really comment on body issues. however, on principle, i can say if a wound is red, raised, irritated, it can be the beginning of a keloid. in those individuals, silicone sheeting can help. i also use KTP laser and 5-FU mixed with dilute steroid to help control it every 3 to 4 weeks. if it is raised and red and angry, most oftentimes it is better to treat it earlier than later. hope that helps as a start.
best,
sml