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.