Author: Steve Laverson, MD, FACS
Feel Beautiful Plastic Surgery, Encinitas, CA www.feelbeautiful.com
Aesthetic (cosmetic) surgery, sought by many for improvement of personal appearance, incorporates techniques and involves scars that may detract from or damage ones appearance. One such example is the abdominal scar that is part of every tummy tuck procedure. “Tummy tuck” is the common term for abdominoplasty, an operation performed under general anesthesia to remove loose skin many women are left with after pregnancy. Tummy tuck also tightens the abdominal wall connective tissue stretched during pregnancy. In the best circumstances, a youthful and attractive figure with a narrow waist, and flat abdomen are restored. Tummy tuck, however, comes with a scar across the lower abdomen that is a distinctly non-esthetic side product of the procedure, and an obvious disadvantage.
Different Tummy Tuck Techniques Generate Different Scars
Many different techniques have been developed in order to change the appearance of the scar by making it shorter, relocating it or simply avoid it altogether, such as “mini”, “reverse”, and “endoscopic” abdominoplasty. Skin expanded by pregnancy is distributed across the lower abdomen and around the umbilicus (“belly button”). The most effective and most cosmetic method to remove this excess skin is by placing a scar horizontally across the lower abdomen behind panty lines, with an additional smaller scar around the belly button. This means that a traditional abdominoplasty is the best alternative for most women (since it is the most effective).
For plastic surgeons to justify this scar from a cosmetic procedure, and to ask for patient consent to such a scar, expected benefits of abdominoplasty must be worth the price of the procedure, the recovery time, the potential complications, and a permanent horizontal scar on the lower abdomen. The amount of sagging skin and striae (“stretch marks”) to be removed, the abdominal bulge, the amorphous contour, and the patient’s desire for enhancement must be strong enough that she agrees to the planned scar. In general, moms presenting for tummy tuck want a sexy, feminine shape. Because a bad scar is distinctly un-sexy, unattractive, inconvenient, and possibly a lifelong liability, surgeon and patient best join in common purpose to minimize visibility of tummy tuck scars. This effort spans:
- the pre-operative (before surgery) planning stage,
- the surgical procedure itself,
- and several months after surgery (post-surgical period).
Scar location, length, and quality are characteristics that are managed separately. Cigarette smoking impairs wound healing, and worsens the final scar. Patients who smoke are not good candidates for a tummy tuck, unless they stop completely at least three weeks before surgery. My advice is for women to arrive of the day of their procedure wearing the style of bottoms they most prefer. This allows marking of the proposed scar location behind bikini straps and fabric (see image below). Expected scar position is drawn in the mirror, so women understand what to anticipate.
Patients with a high belly button may still achieve a low scar, but sometimes a small vertical extension above the pubis is required. This short midline vertical portion of the scar is well camouflaged, and permits lower swimsuit bottoms and lingerie than higher placement of the entire horizontal scar that women with a high belly button have long endured. The scar should be as short as possible horizontally. The plastic surgeon often pleats the tummy tuck closure to accomplish this. The pleats are shallow folds, visible above the scar after surgery, that smooth and flatten over time. Some surgeons however, still believe an “extended” abominoplasty with a longer scar is preferable. To prevent a wide scar, tension across the wound closure should be avoided. Diligently designed skin removal, “progressive tension” stitches, a multiple layer plastic surgical flap inset, and positioning the patient in hip flexion during closure all help to prevent tension. Uncomplicated wound healing diminishes scar formation. Vascularity (blood flow) to the abdominal skin must be preserved. Technical aspects of surgical execution contribute to maintenance of flap vascularity, but ultimately, individual variations in human anatomy and physiology determine whether or not blood flow will be sufficient. Patients must participate in their own care after surgery to reduce scarring. Commonly recommended measures include:
- Specialized skin tape to control tension during healing,
- Avoiding excessive movement and physical activity,
- Use of a post surgical compression garment,
- Application of silicone directly upon the scar for several months.
Here follows one last simple but powerful tip in order to conceal the scar:
- Use bright colored clothing, jewelry (belly button), or ornamental body tattoo(s) to divert attention away from the skin colored scar. That way you “camouflage” the scar.
Despite all best practices, if an unsightly or troublesome scar develops, rather than accept lifelong embarrassment, women and their surgeons should be willing to amend the scar, usually a minor office procedure, for the most desirable result.
Schedule a Free Consultation With a US Board Certified Tummy Tuck Surgeon
To schedule a free consultation with one of 3.200+ board certified US surgeons, simply complete the contact form or call the number found on the upper right corner of this page and we will get back to you shortly.