Different people scar differently. Some people develop thick ugly scars, which are called keloids, and sometimes those scars have to be revised or removed— typically, this happens to people who have a lot of pigment in their skin.

The scar will look its worst about six months to a year after weight loss surgery. There are several reasons for this. Your body is constantly remodeling itself—worse than a Beverly Hills house husband. As time goes on, your scar will shrink and it will begin to look better. After a couple of years the scar will pretty much look the way it will always look.

Scars respond to motion and forces. For example, scars on joints tend to be thicker because the joint is always moving (very seldom will you find a pretty scar on a knee). In weight loss surgery patients with large abdomens, the scars can be very thick because the force of the abdomen is from side to side, and if you have a scar in the middle (up and down) it will tend to become thick. Here is where plastic surgeons always look good—after we bariatric surgeons do the great job of rearranging guts, and the patient loses some pounds, the plastic surgeons do their tuck and nip and patients have smaller scars—perhaps I went in the wrong field here. Another reason some weight loss surgeons like their patients to wear a binder for several weeks after a bariatric operation is that it decreases the forces on the incision.

Someone always wants to sell you something to make your scar look better. It might be vitamin E based, aloe Vera based, or some entirely new brew from their cauldron. There is no evidence that any of this stuff works terribly well. But the rules for your scar are simple—don’t put anything on it the first few weeks. Always keep it out of the sun, certainly for the first couple of years, and don’t ever be afraid of soap and water. Wound infection or not, soap and water will not hurt you—honest.

Non-prescription medicines

—Over the counter: what can I take when I get a cold, or the flu?

There are a few simple rules with bariatric operations, and one of them is to learn about your body and the medicines you put into it. If you have a cold, or the flu, and want to take something remember: it will take about a week to get over it, if you take nothing it will take seven days. Tylenol is ok to take, but it is also found in many other cold and flu medications, so be careful to read the label of every medicine you might take, and do not exceed the maximum daily dose of Tylenol (acetaminophen). Many cold and flu remedies are time-released, and if you have had a bypass weight loss operation, you may not absorb a portion of that time-released medicine, so it will be wasted (Contact tablets, for example, will not work well with weight loss surgery patients who had a duodenal switch). Some weight loss surgeons do not want their bariatric patients to take non-steroidal anti-inflammatory medications, such as Motrin or Aspirin, and you should have a list of these if that is the rule.

Prescription medications

Again, know what you are taking and why – and avoid time-released medications if you have had a distal bypass, and if you have had a proximal bypass you should be monitored carefully by your primary care doctor to make certain that you are getting a therapeutic effect.