Why would I have a vertical scar for a tummy tuck? (Photo)

Question

I’ve written in regarding possible liposuction and thank you to all the doctors who responded. I’m now considering a tummy tuck because want a predictable outcome. I really don’t want to take the chance with lipo and be left with loose skin only to have to have another surgery. I’ve have 3 consultations and everyone mentioned a vertical scar, plus the traditional TT scar. Why would I have the extra scar if my skin laxity is less than the typical TT patient. I’m 5’, 101 lbs, no stretch marks

Gerald Minniti, MD, FACS · Answer

Hello,
The vertical scar your consultants are referring to is the scar left from the circular incision in your skin where it was attached to your belly button. This is because you don't have enough skin to transpose far enough downward to excise that small defect along with the excess skin.  I am not opposed to that small vertical scar at all, and do it frequently; it is infinitely more aesthetically pleasing than placing the long horizontal scar of the tummy tuck too high, or floating a belly button too low.  However, in your case you should know that no surgery is completely predictable, including a tummy tuck. Additionally, although photos don't tell the whole story, your major issue appears to be fat, not skin excess or loss of skin elasticity (you said you don't have stretchmarks). Therefore assuming there is nothing more going on than what is apparent by photos, you should do very well with liposuction.  The reason you feel lipo is so unpredictable is because there are so many unqualified, poorly trained, and inexperienced doctors performing it (fact), many of whom are very busy, thanks to social media and the increased ability to market oneself (opinion). Add to that the high likelihood that said doctors are more likely using high energy devices (opinion) - Vaser, laser, radiofrequency - which can unpredictably melt fat and cause thermal injury (fact).  Regardless of the surgery, having it performed by a surgeon who is not only properly trained and skilled, but also extremely experienced - decades preferably - will most likely lead to a predictable result (fact).

Ronald J. Edelson, MD · Answer

many surgeons will mention the possibility of s small vertical segment from a tummy.  I have done many tummy tucks like yours and have never needed a vertical scar.  I think it can be done with the standard scar only but some plastic surgeons might want to make sure you are aware of it being a possibility.

Jerome Edelstein, MD · Answer

Hello,thank you for your question. Based on photos alone, it doesn't appear that you have much excess skin on the abdomen which means trying to pull skin from your belly button, all the way down to the bikini line, may not be possible. If you want your horizontal scar to be low, the vertical may be necessary to close up the space where belly button was. You could consider a modified or mini tummy tuck as well.I recommend that you discuss this thoroughly, in person with your plastic surgeon so that you feel good about the plan.All the best

William Bruno, MD · Answer

The vertical scar is the closure of your previous belly button opening. However, you may be a candidate for an umbilical float, where there is no incision made around your belly button and the excess skin  in the lower abdomen is removed. Your original belly button will be "floated" downward a few inches.I hope this helps answer your question.Best wishes,Dr.Bruno

Anita Patel, MD, FACS · Answer

This question is actually easier to answer with a drawing, but I will try to give you the same visual in words. For any given patient, there is a certain amount of laxity (or looseness) of the abdominal skin. After having kids or large weight changes, most women have enough laxity to be able to remove the skin between the belly button and the lower horizontal tummy tuck scar (the placement of this scar varies surgeon to surgeon, but I like to make it low so that it would be hidden in a bikini). In patients who do not have that much skin laxity, there are 2 options.One involves leaving a small vertical scar between the new belly button and the lower horizontal scar, and the other involves "floating" the belly button and avoiding the vertical scar. Normally during a tummy tuck, an incision is made around the belly button, the skin flap is elevated off of the muscle fascia from the lower abdominal scar all the way up to the ribs and lowest part of the breastbone in the center, and pulled down tight like a windowshade, and the belly button is popped out through the skin where is was sitting. The hole made in the skin by cutting around the belly button and dunking it in while the flap is raised, ends up being removed in a standard tummy tuck since there is that much loose skin. In the version where you end up with a small vertical scar, the scar is where the old belly button hole was closed, and there wasn't enough loose skin to remove that hole completely. In the option where the belly button is "floated", instead of making an incision around the belly button that gets closed as a vertical scar, instead the belly button is detached from below, and re-attached at a slightly lower position once the skin is tightened. This leaves a normal looking belly button, just positioned a little lower. Whether or not you are a good candidate depends on how high or low your belly button currently is, and if you mind that it is no longer at it's natural position.

Kenneth Hughes, MD · Answer

Thank you for your question and based on your picture it does not look like you need a tummy tuck, seems like  you can get away with liposuction and bodytite of the abdomen, an in person consultation would be best for a more detailed examination and evaluation. Consult with a board certified PS

Robert W. Kessler, MD, FACS · Answer

Thank you for your question and photos.A formal tummy tuck takes all the skin from the belly button to the horizontal incision which is placed low within a garment line. Often the skin is loose but the excess does not allow for complete removal of the skin from the belly button to the pubic hairline. In this case a Modified tummy tuck is done.There are two versions of a modified tummy tuck. One is called an Umbilical float. No incision is made around the belly button. The belly button is lowered on the abdominal wall. As a general rule you don't want to bring the belly button down by more than an inch because it will appear too low. So this is chosen for woman with minimal skin excess.The second version is done the same as a formal abdominoplasty but now the  opening in the skin, which is where the old belly button was, remains somewhere between the new belly button position and the pubic hairline. Usually quite low and still within a garment line. This has the advantage of removing the maximal amount of skin and keeping all incisions hidden, with the possibility of the vertical incision being visible depending on the amount of skin laxity. The vertical incision is usually no longer than an inch.Your surgeon has discussed this option as a possibility which is wise. Once in surgery all the skin may be removed but it is better to be prepared for a vertical incision and not have one than the other way aroundGood luck and I hope this was helpful

Himansu Shah, MD · Answer

Thank you for the question and photos. It is difficult to answer your question without examining you however from reviewing your photos the reason why vertical scar was mentioned is because the plastic surgeon did not feel that there was enough skin to be removed. Normally you have to make an incision around the belly button and that opening comes out if you have enough skin. Your board certified plastic surgeon will be able to decide during the procedure. Good luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you are a great candidate for a tummy tuck with liposuction.  This can be done through a low and short
incision, all completely below the bikini line. 
The belly button can be designed to look natural and have no scars on
the exterior.   Your muscles can also be
plicated resulting in a flat abdomen. 
Some surgeons may have mentioned a vertical component of the incision in order to help provide easier closure, but based on the laxity in your photograph, I don't think that would be needed.  Make sure you specifically look at before and after pictures of
real patients who have had this surgery performed by your surgeon and evaluate
their results.  The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Robert M. Kachenmeister, MD · Answer

Thanks for reaching out and sharing photos. A vertical scar will allow a surgeon to get your scar as low as possible and reconstruct the belly button. Hopefully the surgeons explained to you the reason for a vertical scar, but it is absolutely to benefit your end result! Best of luck! Dr. Kachenmeister

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