Hand-stitching or Stapling for Tummy Tuck Incision?

In general, hand-sewing the skin will result in a better tummy tuck scar than stapling. There are a number of other factors that influence the ultimate appearance of a tummy tuck scar, including the placement of the incision, how much tension is on the skin (pulling in either direction), how many layers of stitches there are, the quality of the skin, and genetic and nutritional factors. A wide scar can occur with either type of closure. Staples can also leave "track marks" or little scars along the staple lines that can be temporary or permanent. [Just FYI, there are also absorbable staples that can be used for repairing the deep portion of the skin, which are placed below the skin surface and take the place of one layer of stitches.] In practice, I prefer to close my tummy tucks incisions in 3 hand-sewn layers, and have found this to leave an optimal scar. After surgery I like to monitor the healing and take steps to optimize the scar even further, such as silicone scar gel, silicone sheeting, or steroid injections if there is a raised scar. As you can see, the preoperative planning, intraoperative technique, and postoperative followup are all important factors influencing your ultimate scar, in addition to your own healing characteristics.

Hello, and thank you for your thoughtful question about how the closure technique — hand-stitching versus stapling — affects tummy tuck scars.

Your sister is absolutely correct in many respects. Hand-stitching usually results in a much finer, thinner, and more aesthetically pleasing scar compared to stapling. During a tummy tuck, most experienced, board-certified plastic surgeons take extra time to meticulously hand-suture the different layers — deep tissue, dermis (skin layers), and sometimes even the surface — to align the skin edges perfectly and create the cleanest possible closure.

When a wound is hand-sewn in multiple layers, the tension is distributed underneath the skin, which minimizes surface stress and helps the incision heal in a flatter, neater line. Techniques like deep dermal sutures and subcuticular closure (a buried stitch right under the skin) are very commonly used in plastic surgery because they hide the sutures and reduce scarring.

Staples, on the other hand, are faster to place but are generally reserved for emergency surgeries, trauma cases, or very large incisions where speed is critical. They can leave "track marks" or small dotted scars along the incision line and sometimes create wider or more irregular scars, especially when not removed precisely at the right time. Because a tummy tuck is an elective, aesthetic surgery where scar quality is very important, most cosmetic plastic surgeons avoid staples for skin closure in favor of hand-suturing.

You’re also right that hand-stitching takes more time during surgery — but in plastic surgery, a beautiful result is worth the extra minutes. A careful closure is one of the most important steps in getting a thin, smooth scar that matures well over time.

When you consult with your plastic surgeon, it’s perfectly appropriate to ask what closure technique they use. Choosing a surgeon who is meticulous about closure technique is key to achieving the best scar possible.

Thank you again for your excellent question. You’re very smart to be paying attention to the finer details — it shows you’re planning thoughtfully for the best outcome.

Wishing you the very best as you move forward with your tummy tuck journey!

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Be sure to thoroughly review your surgeon’s before-and-after photos, especially focusing on scar quality, and always choose a surgeon with a strong reputation for excellent closures and attention to aesthetic detail.

When consulting with surgeons, you should definitely focus on the quality of the scars left in a tummy tuck.  It is a very important aspect of a tummy tuck.  Some surgeons do use staples, but most of the time they will remove them after just a few days.  

Sutures are preferred over staples, as staples result in scarring that is generally more uneven and visible.

I agree that closure of a tummy tuck should be a hand sewn meticulous closure with subcuticular sutures. This ensures that there will be no "track marks" to the permanent scar which is an unacceptable result for an elective cosmetic procedure. You should ask to see your prospective plastic surgeon's pictures of before and after pictures to see what type of final result to expect.

I always suture the abdominoplasty wound.  It takes longer to do this but achieves a far better result in terms of the scar.  If you are paying for the procedure, you deserve the optimal scar that the surgeon has the expertise to provide.  Understand that some surgeons cut corners and others do not.  That is why it is important for you to actively participate in your care and inquire about the method of closure that the surgeon intends to use.

 

There are many factors contribute to the final appearance of a scar after tummy tuck. For  example,  some patients are prone to develop keloid or hypertrophic scars despite the surgeon's  best efforts.  Some patients will develop superficial separations of the incision line, depending on the quality of the skin present (for example, stretched marked skin may not “hold” sutures as well as skin with normal thickness dermis).

On  the other hand, the surgeon may be able to control  the quality of the scar  with attention to certain  technical details. For example,  it is important to take as much tension off the final layer of closure as possible-  if tension is taken off the superficial layer (by using deep sutures)  the incision may heal with a finer line scar. Avoiding excessive excision of skin may also help avoid tension upon closure of the suture line.

The use of silicone-based products (creams or  sheeting)  may also be helpful in achieving the best scars  possible.

I hope this helps.

Staple closure is very rare in plastic surgery except in certain situation. Tummy tuck incisions are better sutured rather than stapled.The way scars could heal is related to many factors and the way the incision is sutured is only one of them. Genetics does play a major role in scarring. We all scar in different ways! Hope that helps.

Despite the fact that any patient can develop an unfavorable scar even in the best of hands, it is pretty clear that external staples will generally leave a much worse scar.
Definitely give stronger consideration to any plastic surgeon who tells you they'll use sutures alone to close the tummy tuck wound.
Yes, it is much more time consuming and results in more expense to the facility, but the time and costs of suturing the wound together is worth it when it comes to the ultimate and final appearance of the scar.
Good luck. The results from a tummy tuck can be amazing!

Thank you for your question. Your sister is correct. Staple leave an extra external scar around the Tummy Tuck incision on either side where the staples puncture the skin.

Most plastic surgeons use internal stitches called a "Running Intracuticular" to avoid external suture marks.

As pointed out below there are many factors involved in Tummy Tuck scar, but a closure with staples should be avoided.