I'm 4 weeks post op from TT & BA. I love my BA results, but my TT incision seems way too high, especially since my surgeon told me it would be lower than my c-section scar and this is much higher. I'm not particularly happy with it, and I wanted to ask here if there seemed to be an outside reason that the scar would be this high (like my bone structure, etc) before I get upset with my PS. I don't understand the crazy high "smiling" curve. Thanks in advance for any input.
TT Incision Way Too High? (photo)
Doctor Answers (10)
Tummy tuck scar too high
You brought up an important point. Every woman seems to wear her clothing differently. Some wear it high enough to cover your scar, others like yourself wear it low. As a surgeon i just cant predict at what level the waistband will lie. I find it easiest to mark the waistband of the underwear just before surgery so I can keep the scar below it.
If i had to venture a guess, you did not have enough laxity of skin between rib cage and belly button to allow the incision made around your belly button to be pulled below the horizontal scar unless the horizontal scar is either elevated or the hole created in theskin flap is closed as a small vertical scar on the lower abdomen.
Your surgeon chose to elevate the waist crease scar. i prefer the opposite for the reason you are dissatisfied. There is no right or wrong here, its a matter of personal preference and is best discussed prior to surgery.
Tummy Tuck Compromises.
Tummy tuck incision way too high
We do indeed plan to place the incision just below the typical C-section, and have to be carefiul over the hip to keep the scar low and straight below jean and bathing suit lines. The reason for your scar is in the planning.
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Tummy tuck scar location
Most surgeons can predict where their scars will end up at. Most surgeons ask their patients to bring in a swimsuit bottom they would like to cover the scars so it helps us place the incisions. Most surgeons ask their patients if they wish to have a bikini cut or a hi-cut type incision. Most surgeons have a good idea where the scar will be when done. But some surgeons don't worry about the scar and only work for the final contour result which your contours look good. What kind of surgeon did you have? And since you said he said your scar would be lower then your c-section scar, you can view your pre-op photos together and you can ask him about it then. Perhaps he has a good explanation for your.
Scars from tummy - how to create a low incision - and what questions to ask
How low is the scar?
The final scar from the tummy tuck will be somewhere between where the lower incision and the upper incision are made.
How long is the scar?
Given the amount that is remove, the horizontal scar will have a certain length, usually 2.5 times as long as what is removed. That's just physics. Cheat physics by removing too much over too short of a distance, and the incision will be puckered, just as a piece of fabric would be.
How can you lower the scar?
In your case, a full tummy tuck was performed, and the expected result obtained.
There are techniques that allow a lowering of the incision in many patients (especially patients with a long umbilicus to pubis distance) or patients who are very fit and have not had a large amount of fascial laxity.
There is still another category of procedure where the umbilicus is not moved but the deep fascia is tightened to the xiphoid (hybrid tummy tuck) for very fit moms.
ALL tummy tuck scars are higher than the lowest mark in the pre-op ellipse drawn on your tummy.
Every surgeon answering tummy tuck scar questions here wants to reassure you that their scar will (probably) be low enough to wear your skimpiest bikini bottom and hide the scar. Some even have a "special" name for their procedure as if to imply that he or she has the "secret to the perfect and lowest scar position!" Some even talk about secrets to hiding the belly button scar to make it "invisible." While most of my colleagues are honest and scholarly, you could imagine some wearing plaid pants and white shoes as they extoll the virtues of their capabilities, like some bad used car salesman ad. None of them are lying, but you know what I mean!
Since the loose abdominal skin is freed up from the pubic area to the lower breastbone (sternum's lowest point, or xiphoid), the upper edge of the incision (after the loose "extra" skin from the lower pubic incision to the belly button area has been removed) is stretched over the belly button (requiring a new opening through this tightened skin) and sutured to the still-attached pubic and groin tissues. The idea is that these tissues remain anchored, and the scar will remain at that position. However, tissues stretch, and once secured by sutures, there is ALWAYS some migration of the scar upward. Sometimes a lot, most times a little. There are techniques for securing the closure sutures to the lower abdominal fascia to help minimize the upward migration, and most surgeons use some form of this. These techniques usually allow the scar to be low and appropriate for bikini bottoms to conceal them.
Your surgeon told you the truth when he said your (lower) incision would be below your C-section scar. What he failed to explain was that after he removed ALL of the skin between this lower incision and a second curved incision ABOVE your belly button, the remaining loose upper abdominal skin is sewed to the lower skin edge, pulling the final scar higher than that lower incision you had in your mind's eye.
Some final scars are lower, and some are higher, but ALL end up higher than the lowest mark below your old C-section scar.
Styles and requests for incision and scar placement have varied over the years--from the high lateral scar for the Rio or tanga bikini bottoms, to the present Brazilian hiphugger low lateral scar. Careful closure in layers by an experienced, board-certified plastic surgeon will usually give you a great result, but each patient's unique anatomy, and each surgeon's individual skill and experience, make each result totally unique in itself. Sorry your expectations were not realistic; that is partly your surgeon's job, because anything that is said now seems like an excuse, whereas before surgery it is an explanation.
The good news is that this scar will likely fade significantly over the next 6-12 months, particularly if you are careful about ultraviolet avoidance. Revision is possible when things have fully softened, but dropping the scar by much is not a realistic expectation either. Best wishes! Dr. Tholen
Where should a tummy tuck incision be located?
The location and the overall curved shape of the scar for a tummy tuck can be placed low or high depending on the patients choice. I always ask my patients if they plan to wear low-rise pants or high french-cut bathing suits. Then we decide together exactly where to put the scar. Over the past 10 years or so every one of my patients has chosen the low-rise choice and we have been making our incisions very flat, straight across and low on the hips. Your incision is definitely not one of these. Unfortunately, there is not much that you can do now to alter the location of the scar. Your best option is to do everything possible to make sure that the scar fades as well as possible. Talk to your surgeon about the best products or treatments to achieve this result.
Diana L. Elias MD
TT Incision Way Too High?
Yes it appears that way but not much to be done to correct the location. Very hard to determine the reasoning of the incision placement. Best to ask your surgeon.
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