Hand-stitching or Stapling for Tummy Tuck Incision?

I have been contemplating a Tummy Tuck for several years now, and have viewed hundreds of photos. I've seen some incredibly even, thin scars and some horrific wide, jagged scars. My sister (a nurse) said a lot (I did not understand everything) of this is attributable to whether the the incision was hand-stitched or stapled. She said hand-stitching allows a much neater, tighter scar than stapling, which creates inevitable gaps that don't heal as neatly. She also mentioned the time factor involved in hand stitching.

That led me to wonder whether hand-stitching is the exception or the rule. Any thoughts?

Doctor Answers 11

Never Use Staples to Close a Tummy Tuck Incision

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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.

Do staples or stitches give better scar after tummy tuck?

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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.

Anita Patel, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 12 reviews

Tummy tuck scars

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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.

Stitches versus staples

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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.


No staples for tummy tuck

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I do not know of a single cosmetic plastic surgeon who uses staples to close a tummy tuck incision. The vast majority of surgeons use a subcuticular skin closure which does not need to be removed and is hidden completely under the surface so that no cross hatching scars result that may occur with skin staples. The suture can be left for long periods of time and absorbs by itself. Skin staples may be faster and save time but usually will not produce as good a scar.  Always remember that everyone heals differently and some people obtain thinner and flatter less noticeable scars than others despite the technique of the surgeon. Tummy Tuck scars may take up to 18 months to fully mature.

Richard Linderman, MD
Indianapolis Plastic Surgeon

Sutures better than staples for tummy tuck

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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.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

I would not recommend staples for tummy tuck surgery.

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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.

David Rankin, MD
Jupiter Plastic Surgeon
4.9 out of 5 stars 168 reviews

The scar quality is always worse with external staples

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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!

Tummy tuck scars

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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.  

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Sututring Better For Tummy Tuck Scars

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

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.