I am almost 3 weeks post-op tummy tuck. I am 5'8" and weigh 115 pounds. I chose the tummy tuck to remove stretch marks and loose skin so I could wear a bikini. The scar was made at my pubic hairline but now that I am trying to stand up straight, I have noticed that my scar and pubic hairline are much higher. I still am not even at a full upright position and am afraid of it continuing to pull upward. Now the scar and my pubic hair are visible when I wear a bathing suit or panties. Help?
Why is my Pubic Hairline and Scar Being Pulled Upwards After my Tummy Tuck?
Doctor Answers (11)
The Migrating Scar
Tummy tuck scar migration is due to one thing only, tension. At the start of a tummy tuck the surgeon cuts around the belly button. After the skin is pulled down the hope is that enough skin can be removed so that the top incision is made at the top of the belly button incision, thus removing it. If not then the belly button incision can end up as a small vertical incision. Not such a big deal. In fact none of my patients have ever complained about it.
Some surgeons get fixated on getting out the belly button incision and will severely flex the patient on the operating room table. Although they can then make the top incision high enough the tension that it puts on the wound closure can lead to several potential complications. First, the tension can cause the blood flow to the skin to be severely comprimised leading to wound healing issues or at worst skin loss. And secondly the severe tension eventually pulls up the skin in the midline, because that's where the most tension is. Unfortunately, there's no way to correct it and it will continue to migrate until the tension is gone.
I tell my patients when I think they may have a small vertical scar because patients prefer this to a migrated scar.
Tummy tuck scar
Scar and pubic hair position after tummy tuck
If the scar was positioned to account for the looseness of the pubic skin (with the pubic skin pulled upward during marking), then the scar should be properly positioned. However, in many patients, this low scar position will mean that the old belly button hole will not move down far enough when the skin is redraped for the hole to be removed, and it must be closed with a relatively short vertical scar. Some surgeons try to avoid this small vertical scar by moving the tummy tuck scar more superiorly. Unfortunately, this scar may then be higher than a bikini line, AND the stretched out pubic area may be pulled up and the pubic hair travel too far superiorly. You are early after surgery, and things may settle over time. If not, a revision may be possible to lower the scar and pubic hairline, but only after some laxity of the abdominal skin has developed, and that may take a year or more.
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The incision from a tummy tuck will rise after surgery during the healing process. It is crucial to plan the final position of the incision during the marking. Meaning placing the original incision lower so that the anticipated rise when the patient is completely upright the incision is still hidden in the panty line.
Abdominal scar and hair bearing area too high following tummy tuck
Without preoperative and postoperative photos, the following answer is somewhat based on conjecture. However, it sounds like the planned incision at your pubis was initially not placed low enough. Add to this possibly a somewhat lax mons pubis (hair bearing area), mobility of this tissue and tension created by removal of the excess abdominal skin and the result was an incision that got pulled up along with the hair bearing area.
Depending on how high this has been displaced, it can be quite difficult to correct. If there is only a small amount of elevation, with time and some relaxation of the tissues, it may be able to be lowered. With a considerable elevation, the solution becomes either very complex or effectively "impossible" or imprudent.
It is unlikely that with time that the scar will migrate back down again if there is any significant elevation of it to begin with.
Upward Migration Of Pubic Hairline From A Tummy Tuck
What you are experiencing is a natural outcome of many full or extended tummy tuck procedures. The pubic area and its hairline will be raised from its preoperative position. This is because the pubic region is not a fixed area so, although most of the final skin closure comes from the upper skin flap being pulled down, a small amount of it comes from the lower skin flap (pubic region) being raised up. This is often not avoidable for many patients. Some of the potential issue can be addressed in the markings of the incisional pattern before surgery but it can not always be avoided. It may be possible as a secondary procedure to lower the level of the horizontal scar a little bit but the pubic hairline will always come right up to the scar line.
Why is my Pubic Hairline and Scar Being Pulled Upwards After my Tummy Tuck?
From your description I see two issues. First, the pre operative discussion was not clear between you and your surgeon. In other words, you should have requested that the incision be low enough to be covered by your bikini. Second, the experience of the surgeon, maybe he did not or does not know that the incision moves upward in a TT. Well best to allow some more healing than consider a revision.
Keeping a low tummy tuck incision
Although it is difficult to know if the incision was placed in the optimum position without seeing photos of the markings I can contribute one additional piece of information in addition to what has already been answered already. When a tummy tuck is close there is tension placed on the incision and this naturally results in a scar that migrates up from its initial location. To prevent or minimize this some surgeons place deep sutures from the soft tissue to the abdominal wall. My philosophy is a little different. When laxity develops in the abdomen through pregnancy, weightloss, etc, the abdominal skin and soft tissue sag downward but so does the mons tissue. Because of this I always place my initial tummy tuck incision into the hair bearing part of the mons since 1) I know that the incision will migrate up a little, and 2) I want to elevate the mons a little as well.
At this time I would allow ample time for healing. The incision may fade and the tissues may relax sufficiently. Worse case scenario you could always lower the incision a little by removing a little more tissue below the scar as in my description above.
All the best,
Remus Repta, MD
Pubic hair line elevation after Tummy Tuck
I agree that it sounds as if your scar was placed properly.As the upper abdominal skin is pulled down, it is natural for the skin below the scar to be pulled up. But this will likely relax a bit as you continue to heal.
Please communicate your concern with your surgeon now, but try to relax and let yourself continue to heal. By the way- you should be standing upright by now.
Probably need another procedure to lower scar, allow time first
It is common for a tummy tuck scar to pull upward with time, even if it is correctly placed low, within the bikini line. I use anchoring sutures to hold down the deep tissue and help prevent this upward tension, and this seems to work for me in keeping the incision line below the bikini line and preventing the upward migration of pubic hair.
If it is already too high, it is not going to go back down. The best course of action is to allow time for the tissues and skin to relax (6 months minimum), then return for another procedure to lower your scar. I've done this on many occasions on patients whose scars are too high. Obviously, discuss this problem with your surgeon, as well as the cost. He or she may be willing to waive their fee and have you just pay for the facility and anesthesia (it may also be possible to do this under local anesthetic, but I tend to recommend a short IV sedation).
If you wish to compare your scar placement with others, you can glance at examples on my website (reference attached).
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.