What Causes Pointed Protrusions on Either End of Abdominoplasty Scar?

I am considering abdominoplasty and have 3 friends who all had this same procedure years ago with the same surgeon. All 3 have soft but pointed protrusions-the almost look like horns-at either end of their incision. These women affectionately call them their "squishy-squishies".I am wondering what possibly caused these and if they can be avoided. I understand scarring is inevitable, but I would be unhappy with that result.

Doctor Answers (20)

Dog ears from Abdominoplasty

+2

It sounds like what you are describing is what most people call "dog ears."  This is an out-pouching of skin at either end of the incision in an abdominoplasty.  This happens when the surgeon make the incision too short or the patient demands a mini-incision.  It is physically impossible excise skin and bring the edges together smoothly while trying to cheat the incision shorter.  This only leads to "dog ears" or irregularities in the skin contour.  Without pictures or seeing you in person, it is impossible to give you specific advice.  However, if you draw a line from your pubis (top of your pubic hair) to your belly button and measure the distance, your incision will have to be at least three times this distance - oriented horizontally in your lower abdomen.  This usually is just a little sider than the distance from hip bone to hip bone.  Another way to guide your incision length is to look at your lower abdominal skin fold.  If your skin is hanging over, follow the distance laterally (to the side) as far as the fold extends on your sides.  This is usually the approximate length of the necessary incision.

 

Good Luck.


New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

Pointed protrusions at ends of abdominoplasty scar are "dog ears," and additional surgery can fix them.

+2

These abdominoplasty dog ears are a direct result of the operating surgeon's technique, and proper initial incision design can MINIMIZE (but not completely eliminate) how often this occurs in tummy tuck patients. Extending the incisions laterally (more to the side) can also eliminate them, but the scar length is increased.

Hence, the trade-off every surgeon and patient has to be aware of!

Either the surgeon tries to keep the scar as short as possible and sometimes gets a pair of dog ears (which do diminish over time, but may require an additional small, local anesthesia operation to remove), or a long(er) incision is chosen to reduce the likelihood of getting dog ears in the first place.

Proper design and skillful execution can minimize the tendency for dog ears, but scar length is an issue for many patients, so when any plastic surgeon tries to keep the scars short, sometimes dog ears result. Big ones should be fixed at the time of the initial surgery, for they will NEVER soften and settle to a completely flat and normal contour. But small ones do indeed get better, and just as your friends seem to be OK with their "squishy-squishy" dog ears, if small dog ears are all they have, no further surgical revision is needed.

You, on the other hand, are honest enough to explain that you would not like these, and should share this with your surgeon, who can take your request to heart and extend the incisions slightly, diminishing the likelihood for dog ears. The mathematical analysis of dog ear prevention, formation, and correction is beyond the scope of this forum, but understand that individual patient anatomy has a factor in this whole "dog-ear" equation, not just a surgeon's measurements, marking, incisions, and surgical technique.

But, the more skilled and experienced the surgeon, the less the likelihood for dog ears, or if they do occur, the lower the likelihood they will be large and require a larger touch-up procedure. Discuss with your surgeon the cost policy for revisional or touch-up surgery, where it is done, and if there are charges for the OR and anesthesia  at the hospital or surgical center. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 126 reviews

Dog ears after abdominoplasty

+2
These are usually called dog ears and can be avoided with a slightly longer incision. Some surgeons will make a very long incision and call it an extended abdominoplasty so they can charge you more. If you do happen to have a dog ear, most surgeons will revise this under local for no additional charge because it really should have been dealt with with the original procedure.

Richard Dale Reynolds, MD
El Paso Plastic Surgeon
4.5 out of 5 stars 17 reviews

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What causes pointed protrusions (dog ears) on either side of tummy tuck scar?

+2

The "squishy-squishies" or soft but pointed protrusions after a tummy tuck or abdominoplasty are often termed "dog ears" or "standing cones". The best way to avoid this and have a better abdominal contour is to perform an extended abdominoplasty. By extending the scar, the abdominal contour and waistline are improved and dog ears are avoided. It is better to have this corrected in the first surgery than having to have a future revision. Hope this helps, Frank Agullo, MD, from El Paso, Texas. 

Frank Agullo, MD
El Paso Plastic Surgeon
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Tummy Tuck Scars and Dog Ears?

+1

Thank you for the question.

The areas you are referring to (dog ears)  amount to " excess" skin and/or adipose tissue at the end of the tummy tuck incision lines. These can be avoided by making sure the incision is long enough to remove the redundant skin and adipose tissue. Otherwise, patients may be displeased with the appearance of these  areas  and revisionary surgery may become necessary.

Address your concerns with your surgeon prior to surgery.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
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Dog Ears

+1

What you are describing are termed dog ears. They are usually the result of not extending the incision far enough laterally. Usually they are small and can easily be revised under local in the surgeons office. some patients present for tummy tuck surgery that have excessive amounts of excess or large fatty hip rolls that make the prevention of dog ears difficult to avoided without extending the tummy tuck incision on to the back requiring different positions at the time of surgery.This is more common in patients having tummy tucks after severe weight loss or bariatric surgery

Richard Linderman, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 7 reviews

Dog ear from a tummy tuck

+1

What you have described can be a common problem after having a tummy tuck and is referred to as "dog ears". It is usually caused by technical error in the initial design of the incision. This is the result of the removal of a significant amount of skin with an incision that is not long enough.  Correction is general straight forward and usually consist of excising more skin/tissue. However in certain situation liposuction by itself may be all that is needed. In any event, these are both easily done in the office.

Mark A. Jabor, MD
El Paso Plastic Surgeon
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Dog ears and tummy tucks

+1

Dog ears, excess of skin at the end of the incisions, after a tummy tuck are generally due to a lack of intra-operative attention and meticulousness. Once the upper abdominal skin is brought down during the abdominoplasty there are methods that we use to assess the need to take care of the dog ear. This generally includes slight extension of the incision to a point that there is smooth transition. This takes a little time and passion to do. If not done, then patient will come back later for a fix. So, dog ears are preventable. If they do occur they can be fixed very easily. Best of luck

Sepehr Egrari, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 30 reviews

Dog ears after tummy tuck surgery

+1

Irregular scars at the end of tummy tuck incisions are referred to as "dog ears"; which are raised areas of skin. These can be avoided at the time of surgery by careful incision planning as well as by liposuction of this area so that the "corners" are flat. If this is recognized at the conclusion of a tummy tuck, the incision can easily be extended a few centimeters and the extra skin is trimmed until the contour is flat.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 150 reviews

Dogears after tummy tuck

+1

Dogears are not that uncommon after tummy tuck.  These are usually from trying to keep the incision short.  They can be removed easily under local anesthesia after things have settled.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 5 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.