Full TT That Needs Vertical Incision Due to Thin Skin Around Navel, Is This Technique Normal?

I'm considering a full TT and recently had a consultation with a PS. The PS is concerned about tissues in umbilical area which are much thinner than other tissues. He is recommending Removing this skin which will lead to a vertical scar in addition to the standard transverse scar and the umbilical scar. I saw 2 other surgeons in the US and no one ever mentioned this before. I had to move to the UK before I could do the surgery so this is a UK board certified physician. Does this sound right?

Update: Photos Added 1/11/12

Doctor Answers (6)

Vertical Scar during Tummy Tuck

+1

Sometimes a vertical scar maybe necessary in patients undergoing tummy tucks. The vertical scar is from where the belly button used to be attached to the abdominal skin. The scar is typically small and very low. The occasional need for this scar comes when there is some loose skin, but not enough to remove all the skin from the belly button down to a very low scar. If this type of patient, the trade off is a small vertical scar or having your horizontal scar slightly higher. You do have a significant widening of your muscles and repair of the muscles should be an important part of your surgery. 


Jacksonville Plastic Surgeon
5.0 out of 5 stars 13 reviews

Tummy Tuck and Vertical Incision?

+1

Thank you for the question and pictures.

I think the plastic surgeon you have seen with concerns about thin tissues around the umbilical area is raising a valid concern.

Generally, I would suggest that you pick a well experienced board-certified plastic surgeon to do your operation. At that point, ask that he/she does  whatever is necessary to avoid complications and to keep the operation as safe as possible. If a short vertical incision is necessary,  this will not necessarily be a “big deal”.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 754 reviews

Tummy tuck technique

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Your tummy is somewhat unique in appearance.  You have a diastasis of your muscles where they have split and a protuberance of your tummy. 

What does your tummy look like when you say down flat?  If it still protrudes, you will have some difficulty obtaining the result you may dream of. 

If you have a lot of skin laxity, a vertical scar is very nice to help resect as much skin as possible BUT if you are darkly complected, you risk for poor scarring is higher.

So ask yourself whether you could handle an ugly, stretched out, raised scar in the midline for a better profile and if so, a vertical would work well.  If not, then consider staying with the traditional scar as much as possible.  You should clarify this with your surgeon before scheduling.
 

Curtis Wong, MD
Redding Plastic Surgeon
4.5 out of 5 stars 16 reviews

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Routine TT does NOT require a vertical scar

+1

The skin around the belly button is removed at the time of the TT, the fact it's thin is irrelevant.  The only part that remains is the umbilical stalk and it's always thin.  From what you described, I see no reason for a vertical scar, however you may need another surgical opinion.

Best of Luck,

Gary M. Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 126 reviews

Vertical scar in tummy tuck

+1

Thanks for posting your pictures. You have a very large rectus divarication, and the skin just above your umbilicus is damaged. What happens is that the fat under the skin splits apart, leaving your skin without the normal thickness of fat underneath it. It is repairable though I think, and I would not recommend a vertical scar. A conventional tummy tuck should do well, and once the muscle repair is done there will be plenty of loose skin to enable a low transverse scar only. One important thing to add though: you might well need a scar revision of the low transverse scar 6 to 12 months post procedure to achieve the best result. The damaged upper abdominal skin after what was clearly a really big pregnancy won't look really smooth just above the scar initially. Over time it will get better, and if it needs a touchup later onto achieve the best possible scar, in my opinion that's a better option than a vertical scar. Any touchup would've minor in nature and recovery. Good luck. This is a good question.  Some surgeons feel they need  to add a vertical scar in to a tummy tuck to achieve the best shape.  The problem is, the operation is supposed to make your tummy look better! So the burden of a new scar there if there was not one there before is a significant detractor from the appearance.

I am not a believer that a vertical scar is necessary.  Over 20 years and with a large tummy tuck practice ( more than 50 per year) I have used a vertical scar no more than 5 times.

Of course, without seeing your pictures I can't be certain - I have seen the skin around the belly button so damaged that all you can do is remove it, but that is RARE.

The aim of a tummy tuck is to restore trunk slimness, smoothness and the integrity of the muscle wall, with as inconspicuous a scar as possible.  Often the scar is long: but if it's low and transverse, then underwear will completely disguise it, and no visible scar should be evident.

If the skin is thin, adjunctive measures such as fat cell grafting can be used to restore the thickness.

My advice would be to seek at least another opinion, or talk to your PS about alternatives to the vertical scar.  And consider posting some good quality pictures on realself, where our advice can be much better.  YOu won't be identifiable!

Good luck. 

Howard Webster, MBBS, FRACS
Melbourne Plastic Surgeon
5.0 out of 5 stars 57 reviews

Vertical scar

+1

In some cases a vertical scar is necessary in addition to the lower horizontal scar.  There are a number of reasons for this.  Usually the scar is relatively short and low on the abdomen adjacent to the horizontal scar so it will be covered by most bathing suits etc.  I have not found that patients object to that scar if it is necessary and because typically the improvement from the tummy tuck procedure is quite significant so it outweighs the presence of the scar.

Thank you for your question and good luck.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.5 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.