Thank you for your quesiton. Subcuticular sutures are typically used to close the tummy incision to avoid any track marks. Sometimes a special type of mattress sutures are used to close the belly button incision but not the main transverse tummy tuck incision. Bunching of the incision is a different story. Sometimes bunching is done on purpose when there is more redundant skin towards the center however this settles down with time and heals in a straight line.
Although there are many types of skin closure suture techniques, you are correct in your assumption that some leave better scars than others. Any technique that leaves a staple or suture outside the skin for more than a week will leave track marks where the suture or staple crossed the skin. For this reason, most experienced plastic surgeons use subcuticular sutures for the final layer of closure.
Each surgeon has their own way of closing incisions on different parts of the body. The technique (sutures or staples) and type of stitch used is the surgeon's preferred method. They are all acceptable methods. The subcuticular suture tends to leave a better scar.
A layered closure using a combination of absorbable sutures in the superficial facial system (SFS) in addition to deep dermal sutures and a running subcuticular suture yields the best postop scar. Tension is reduced in a layered closure and no external sutures are placed to eliminate the railroad tracking that can happen with external sutures or staples. Seek a board certified plastic surgeon who will take the time necessary to help you achieve your aesthetic goals.
Thank you for your question. Because of the amount of time needed to allow your tummy tuck incision to heal, most surgeons opt for a subcuticular closure because anything placed above or through the skin surface may lead to additional scarring. I would discuss the anticipated closure technique with your surgeon and voice your concerns if staples or mattress sutures will be used.
Yikes, metal staples on the skin or visible external mattress sutures both can leave long-lasting telltale signs of a hole where the skin was pierced. Most cosmetic surgeons I know would take the time to put a subcuticular suture that has a better chance of making a nice scar. If I were you, I would try and find the surgeons that know how, and take the time, to make the scar look as good as it can. Good luck.
In general, subcuticular sutures build a cosmetically superior incision as opposed to mattress sutures. Mattress sutures are rarely used in cosmetic surgery at the skin level. There are two common types of staples that are used in tummy tuck surgery. These can include subdermal staples which are under the surface and dissolve. The other type of staples are stainless steel ones that are used on the surface of the skin. These can save time for the surgeon. In appropriate patients, if the staples are removed very early they can yield an acceptable cosmetic result. Personally I try to avoid skin staples in cosmetic surgery as there is a risk that the small holes in the skin that the staples leave may persist.