What Causes the Center Crease in Abs After Tummy Tuck?

Are you talking about the vertical crease or the horizontal crease.
The vertical crease is typically due to a natural thinner layer of fat beneath the skin. Insetting the umbilicus in a tightly repaired abdomen will oftentimes accentuate this vertical crease. Occasionally during surgery, patients have an excessively thick layer and a thin strip of fat is removed to create this crease. This is similar to abdominal etching.
The horizontal creases are due to natural creases in the rectus abdominis muscles called tendinous inscriptions. These are generally only visible in thin patients and can be more pronouced from repeated flexion (situps). These can be artifically created using abdominal etching.

Hello BaBegrl. Thank you for your question regarding the appearance of a center crease in the abs following a tummy tuck.

A center crease or line down the middle of the abdomen after a tummy tuck can be due to several factors related to the surgical technique and individual healing processes:

Muscle Plication: During a tummy tuck, the abdominal muscles that may have been stretched out, usually due to pregnancy or significant weight changes, are often tightened. This process is known as plication. If the suturing is particularly tight or if there's any irregularity in how the muscles are brought together, it can create a noticeable indentation or crease along the line where the muscles meet (the linea alba).

Swelling and Healing: Post-surgical swelling can unevenly subside, which might temporarily accentuate folds or creases in the skin, especially around areas where significant tightening or suturing was done. As the healing progresses, these creases can become less pronounced.

Skin Redraping: How the skin is pulled and secured during the procedure can also contribute to this appearance. If the skin is pulled tightly in conjunction with the muscle plication, it may adhere more closely to the underlying tissue contours, highlighting the midline crease.

Fat Distribution: Any residual or uneven fat distribution beneath the skin might also become more visible after the skin is tightened, contributing to the appearance of a crease.

Managing and Addressing the Crease:

Time: Often, as the healing progresses over several months to a year, many of the initial irregularities, including creases, can soften or resolve as the tissues relax and swelling fully subsides.

Massage and Compression: Some surgeons recommend specialized massage techniques or compression garments to help even out contours and encourage optimal skin draping.

Revision Options: In cases where the crease remains prominent and is aesthetically displeasing, a revision might be considered. This could involve adjusting the muscle plication, revising the skin redraping, or targeted liposuction to address any residual fat contributing to the crease.

Follow-Up Care: It’s important to discuss any concerns with your surgeon, especially if the crease persists or if you notice any other changes in your abdominal contour. They can provide guidance based on the specific details of your surgery and your individual healing process.

It's good to keep in mind that every patient's body reacts differently to surgery, and the final results of a tummy tuck can take a while to fully manifest. Regular follow-ups with your surgeon are crucial to ensure that your recovery is on track and to discuss any concerns or adjustments needed.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

I personally try to create a vertical groove in the upper abdominal midline by dissecting the tissues with my finger which creates a separation of the fat and brings the skin closer to the muscles making a more muscular look. I also use a specific dressing for the first week to accentuate the groove. You can see this effect in my tummy tuck photos at: