Hidden Tummy Tuck Scars
Beautiful tummy tuck (abdominoplasty) scars are important to both patients and their surgeon. Removal of loose skin is the reason for a tummy tuck scar. If only fat reduction is needed, then liposuction or CoolSculpting would be recommended. Typical tumy tuck patients present with moderate or prominent loose skin in the lower abdomen, often loose throughout the abdomen. This can result frequently from multiple pregnancies, but it is also associated with major weight loss or unfavorable genetics or skin tone. During a typical tummy tuck we work beneath the skin and fat widely in the lower abdomen, and more narrowly in the central and upper abdomen. To some extent this varies with patient anatomy and the degree of necessary tightening of the underlying muscle tissue. Having released the deep attachments, the slack is removed drawing the skin downward. The patient is placed in a partially flexed position ont the operating table to allow measurement of the overlapping excess skin and fat. The excess is trimmed off and the incision is closed.
Patients with more loose skin will have longer scars. If a overly short incision is used then gathering and bunching makes the scar unattractive. The length must be enough to smoothly blend toward the hips and flanks. Placement of the scar is important; how high or low?, how curved?, and how to reestablish the belly button (umbilicus). For most patients, their body suggests a low gently curving location above the pubis and along the groin, extending out to or beyond the ilica spine, a bony prominence near your finger-tips when your hands are on your hips. This location is low enough to be covered in almost any swinwear or bikini underwear. Women who favor high cut leg openings might want the outer incision ends somewhat higher.
The belly button is typically left teathered to the abdominal wall, while the loose skin moves down past it. Once the skin removal is complete, we can create a small opening to allow the belly button stalk to come out to the surface, in the middle of the abdomen. Tear drop or inverted V shape openings usually give attractive looking belly buttons. The scar around the belly button is hidden by the natural belly button appearance in most patients. In many of the postoperative photos on our website (photo gallery) https://www.expertplasticsurgeon.com/photogallery/tummy-tuck-abdominoplasty-4814 you can see a small vertical scar in the lower abdomen. This represents the old belly button site as the skin moves down toward the pubic area. When there is much loose skin in the upper abdomen, this is removed along with the large skin segment. When there is less loose upper abdominal skin, we can only eliminate this small scar by locating the entire tummy tuck scar higher, which we usually avoid, but discuss with patients before surgery.
Our closure methods may vary, but generally begin by using absorbable sutures to close the deep space and minimize duration of drains, and similar sutures on the deep fibrous support layer (Scarpa's fascia), Insorb absorbable buried dermal staples, and finally absorbable sutures - - - all beneath the surface. (There are a few surface knots we remove at the 2-3 week visit.) These materials and methods minimize inflammation in the healing wound to allow better healing and appearance.
