I am thin but had a blown out tummy after large babies. I had a Full TT about 10 months ago By a very reputable surgeon in BH. I still have loose skin and am unhappy with the results. My surgeon will revise with a vertical incision to remove excess skin. I am confused, I want to do it if it will be worth it but I will trade off loose saggy skin for a vertical scar. Is it worth it? My skin is mainly loose above my belly button. Please help!!
Thin, Unhappy with Full TT Still Have Loose Skin...vertical Revision?
Doctor Answers 8
Complete correction of excessively loose skin is sometimes impossible. Because the quality of the skin is so bad it has lost its snap-back ability. No matter how much tightening is done the remaining skin can become loose again. I would think long and hard before having a surgeon perform a vertical scar on your abdomen. You may want to see another reputable plastic surgeon for a separate opinion.
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You could also try some other treatment options to tighten the skin.
Therenre several tereatment options available for skin tightening especially with stretch marks. I have performed CO2laser resurfacing of stretch marks which helps to tighten the skin and make stretch marks less prominent. You may have too much excess skin for that to be effective though.
Be careful before doing the vertical scar in a tummy tuck
Vertical scars in a tummy tuck don't heal as well as the horizontal ones do. Also, they can't be hidden in bathing suits and undergarments so the laxity of the skin better be so bad that it is worth the scar. If your laxity IS that bad, even the vertical won't make you "tight" so be careful because you can't take it back. I have never needed a vertical scar except in the face of massive weight loss or where there was already a vertical scar present.
Are you SURE you had a "full" TT because it is often in a mini where laxity is left over above the umbi and that is why minis should be rare?
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Revisoin tummy tuck
Without an exam, it is difficult to say. If you had a very large weight loss sometimes a vertical excision can help, but the trade off is a scar up and down.
Vertical tummy tuck revision
You have to determine if you are willing to exchange loose skin for a vertical scar. You are the only one who can make that determination. If you have had a significant improvement with a full tummy tuck you may not want to end up with a very visible scar just to get a little bit better. Proceed with caution.
Tummy tucks in thin patients
Tummy tuck surgery in thin patients is particularly difficult. Their body shape creates some unique challenges. One of the concerns during the surgery is that the skin of the abdominal wall can become devascularized. What that means is that in the process of undermining the skin in order to allow for redraping the blood supply to the skin can be compromised which can have devastating complications. A thin patient has a thin abdominal flap and this can make a surgeon nervous during the undermining portion of the surgery. The problem is that if the skin isn't undermined enough then the skin will not redrape and the result will be loose skin, particularly in the upper abdomen. Your problem may require a revision of the abdominoplasty in order get the upper skin to lay more flat. An alternative to a redo is to do excision of the excess skin in a vertical fashion. That will work as well but commit you to a more visible scar. I try to avoid this whenever possible. Without seeing you of course there is no way to know what is best.
Revision Tummy Tuck
I am sorry you are not happy with your result. A vertical incision is designed to correct horizontal laxity, something usually seen in massive weight loss, but is certainly possible with extreme overstretching during pregnancy. This is easily determined by putting your hands on your waist with the thumbs pointing backwards and your fingers pointing toward your belly. Pushing your hands towards the center of your belly will determine laxity. However, if there is residual vertical laxity but minimal horizontal laxity, than a more standard revision would be most appropriate. Another way of assessing laxity is by seeing the direction the skin folds most easily: vertically or horizontally; the skin incision should parallel those skin folds. Have another discussion with your doctor about his reasons for this unusual, but possibly plausible choice. There is no harm in having a second opinion too.
Best of luck!
Loose skin after tummy tuck
Loose skin of the upper abdomen can be seen in woman who have lost a significant amount of weight as there is a horizontal component to their skin excess. This is less common in cosmetic abdominoplasty and can be avoided with either a high lateral tension technique or suture techniques to advance the skin of the upper abdomen at the time of the tummy tuck.
It is difficult to know the best way of treating you without photos or an examination. A vertical midline scar will resolve horizontal excess but the tradeoff is a midline scar. A reverse abdominoplasty with incisions beneath the breast may also be an option for you. These incisions are easily covered by the bra as compared with the vertical midline.
Discuss these options with your board certified plastic surgeon. I hope this was helpful