Three persistent horizontal abdominal creases – what is causing them and would a tummy tuck fix them? (Photo)

Question

I’m a 21-year-old female, 5’4” (163 cm) and 50 kg. I lost approximately 25 kg and have maintained my weight. My biggest concern is three deep horizontal creases across my abdomen (upper, middle, and lower), not just the lower abdomen. I had these creases even before losing weight, although they were deeper when I was heavier. I expected them to disappear after weight loss, but they remain. Additional details: * The creases are visible when I’m standing but disappear completely when I lie flat. * They feel like the tissue beneath the skin is folded or tethered inward rather than just superficial skin wrinkles. * I’m not concerned about loose skin. My only goal is to correct these horizontal indentations. * My weight has been stable. My questions are: 1. What is the most likely cause of these three horizontal creases? Are they due to fibrous tissue tethering, fascial attachments, skin laxity, fat distribution, or something else? 2. Would liposuction help, have no effect, or potentially make the creases more noticeable? 3. Would a mini or full tummy tuck improve this type of contour deformity, or am I not a candidate? 4. If neither lipo nor a tummy tuck is appropriate, what procedure would you recommend to achieve the smoothest possible abdominal contour? I’ve attached standing and lying-down photos for comparison.

Semih Yildiz, MD, FEPOBRAS · Answer

In the standing photo that is visible, you look quite slim, and the horizontal lines look more like soft-tissue folds/skin memory after weight change than a problem that liposuction alone would correct. The fact that they disappear when you lie flat usually suggests a dynamic fold from skin quality, mild laxity, posture, and how the superficial tissue drapes, rather than a fixed deep fascial attachment. A true tethered scar-like band is possible, but it would need to be confirmed by an in-person exam where the surgeon can pinch and move the skin.

Liposuction would not be my first choice for this concern. When there is little fat to remove, lipo may have no effect on horizontal creases and can sometimes make loose or folded skin look more noticeable. A mini tummy tuck mainly treats lower abdominal skin and would not reliably improve upper or middle abdominal creases. A full tummy tuck can tighten loose lower abdominal skin and repair muscle separation if present, but it also leaves a significant scar and still may not fully erase upper abdominal crease lines.

For the smoothest result, see a board-certified plastic surgeon in person to check skin elasticity, any diastasis, and whether the bands are truly tethered. Depending on the exam, options might range from observation/strengthening and modest skin-tightening treatments to targeted subcision or fat grafting if there is a real depressed tethered area. If the issue is mostly skin laxity, surgery may be more predictable than non-surgical treatment, but it should be weighed carefully since your photos do not show a large amount of excess fat.

Kadir Berat Oyur, MD · Answer

Based on the photo and your description, the horizontal creases are more likely related to natural fascial attachments, skin folding, or fibrous tethering rather than excess fat alone. Liposuction is unlikely to improve them and could potentially make the indentations more noticeable. Since the creases disappear when you lie flat and you have minimal skin laxity, you may not be an ideal candidate for a tummy tuck. Depending on your examination, limited scar release, fat grafting, or other contouring techniques may provide a better solution. A consultation with a plastic surgeon experienced in body contour revision is recommended.

Ajaya Kashyap, MD · Answer

Thank you for your query. The creases are because of both the loose skin and the fascial attachments. Liposuction will not help but a tummy tuck will help. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best.

Ira H. Rex III, MD · Answer

An in person exam is always best to get you good advice, but it seems like you are an excellent candidate for a tummy tuck which I would expect would improve these irregularities.  You might expect to always have a little fullness under the breasts depending on how prominent rib cage is.  Good luck with any surgery.

Yasemin Aydinli, MD · Answer

These creases are typically fibrous attachment lines between the skin and the deeper fascia, reinforced by years of skin folding &mdash; weight loss unmasks them rather than causing them. Creams and non-invasive tightening rarely release them; a full tummy tuck removes the lower crease zone entirely and can improve the upper ones, though a high upper crease may persist in softened form. At 50kg with good skin quality, your result potential is high but expectations about the uppermost crease should stay realistic.

Three persistent horizontal abdominal creases – what is causing them and would a tummy tuck fix them? (Photo)

Answers (5)

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