Why does my tummy tuck scar go up and down verses the typical smiley face shape? Is this typical and what is the reasoning? Thanks in advance
Is the Shape of my Tummy Tuck Incision Normal?
Doctor Answers (13)
Why the W?
it's funny to read the other answers because whle they recognize it as a type of TT incision the reason it was used has not been stated. simply put, you make a cut that is of equal length on both the upper and lower edge of the skin you are trying to remove, Then to close the gap we lift and pull the upper flap down until it reaches the lower skin flpa and creates the scar. this maneuver leaves a discrepancy in length with the stretched upper flap ending up longer in length as it contacts the stationary lower flap. this creates what is commonly referred to as a "dog ear". by designing a "W" in the lower incision, it takes up the "longer upper flap without having to "chase" the incision around the hips. plastic surgery often boils down to the art of managing "dog ears". you can look it up. good luck.
In rare cases, sometimes the vertical incision is employed. This is usually done because there was a pre-existing condition requiring a vertical incision and a scar was there originally, or there is so much lateral lax skin the surgeon felt the only way to pull that much skin tight was that approach.
W-type scars in tummy tucks.
The use of a W-type scar in a tummy tuck is to improve the likelihood of wound healing. If too much tension is placed on the incision, it is common to see breakdown of the wound and worsening of the scar appearance. By leaving slightly more skin, this design is thought to lessen these risks. It appears that in your case, you had a previous midline incision from another surgery. This previous scar puts you at higher risk of wound healing complications and therefore using the W-type closure is a good way to mitigate some of this risk.
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Shape of Abdominoplasty Incision/Scar
The incision and resulting scar looks to be a Regnault or W type. It is argued to have properties to take tension off the center of the wound, and provide good vascularization where it is most needed. The soft tissue is stretched in the abdominoplasty operation, with the most stretch in the center. Various incisions have been devised over the years to attempt to give the best results. This would be seen by most as an incision type well known to plastic surgeons. Best to discuss any questions you have with your surgeon.
Shape of the tummy tuck scar
You have a W shaped scar which is very acceptable and popular. The scar still looks like it's red and, therefore, has not yet fully healed. By the time it is fully healed it should be less percebtible. Normally the design of the scar and its length is reviewed by your surgeon with you prior to surgery so the configuration should not be that much of a surprise. But overall your result looks very satisfactory as does the scar.
Different incisions used in tummy tucks
There are numerous incisions used in tummy tucks and the choice is based on physician preference as well as patient body types. I prefer an incision that is based on the natural resting tension lines of the body... in other words, your natural crease lines. The scars tend to blend in better and not be as noticeable. One of the arguments for using your type of 'fleur de lis' incision is that this incision does not raise the pubic area. The standard incision lifts the pubis slightly. My patients prefer a slight lift because the pubis does sag a bit with gravity too. Your doctor should have described the nature of the incision before surgery.
Tummy Tuck Incision Shapes
Both the W-shaped incision you have and the curvilinear incision are used in tummy tucks and both are acceptable. Most are performed according to surgeon preference (my preference is the curvilinear). This is something that should be addressed pre-operatively and most surgeons will accede to your strong preference.
Scars from tummy tuck
Different surgeons prefer slightly different design of scars for tummy tuck. In fact no two surgeons will probably use the exact same incision. Though I personally do not use this incision, some surgeons do. As your tummy skin will stretch and settle with time, the angles of the 'W' will get softer and less noticeable.
Shape of tummy tuck scar
Tummy tuck scar placement and design needs to be discussed with the patient prior to surgery so you won't end up with surprises. The incision you have is a Regnault or W incision, more popular in the 70's. If you are very tight, this gets accentuated if the pubic area is not fixed to the pubic bone. Usually when the pubic area advances upward due to increased tension, it creates a gentle curve, not as sharp as yours. I do not use this incision, because it is unnatural and brings pubic hair whereit does' t belong. I personally keep my suprapubic incision low (6cm from the confluence of the labia majora superiorly) and laterally carry the incision toward the pelvic bone. In the last few years, our incisions tend to be lower to bring it in lign with the current fashion.
Tummy tuck scar design is individualized
Your tummy tuck scar has a more classical "W" shape that is one option and is entirely normal. During surgery the skin around your navel was stretched downward as far as possible. For patients with less laxity, the skin will not stretch down as far as it can with others. The options are to have a peaked middle part of the scar like you have, move the entire scar up to the level of the peak or keep the scar low and have a short vertical scar in the mid-line to close the transposed umbilical "donor" site. In many cases it is possible to discuss this plan in advance but in the OR the plans occasionally need to change to achieve a safe closure of your incisions. Many of my patients would prefer to have the entire scar lower and horizontal even if this means having a vertical scar in the lower abdomen.
Your shape is excellent and once your scar matures you should be very satisfied with your outcome.