Which procedure would help minimize the appearance of creasing vertical line after tummy tuck revision? (photos)

Question

I had a tummy tuck and 360 lipo two years ago. One year ago I had a revision surgery to eliminate a raised vertical line above my navel resulting in a long crease from my navel up. Can this be corrected to show a smooth tummy as I never had issue with above my navel. If so, how?

J. Timothy Katzen, MD, FACS · Answer

Hello,
Thank you for reaching out with your question about the best procedure to address a creasing vertical line following a tummy tuck revision. Based on your description, there are two main options to consider:
Fat Transfer to the Crease: This procedure involves reversing the effects of liposuction by transferring fat to the creased area. While this method can be technically challenging, it has the potential to effectively address the issue without creating new scars. However, there is a risk of asymmetry or the formation of a raised area, so careful consideration and a skilled surgeon are crucial.
Creating a Vertical Incision: This option involves making an incision from the belly button upwards towards the sternum. The primary benefit of this approach is the direct elimination of the crease. However, the major downside is the creation of a permanent vertical scar. While this method can offer a more definitive resolution to the problem, it's important to weigh the presence of a visible scar against the desire for a smoother abdominal contour.
Ultimately, the decision depends on your personal preferences and how much you prioritize correcting this area. It's important to carefully consider whether the potential scar from the second option is a worthwhile trade-off for eliminating the crease. Consulting with a board-certified plastic surgeon can provide you with more personalized advice and help you weigh the pros and cons of each option.
I hope this information helps guide you towards the best decision for your needs and goals.
Sincerely,

Semih Yildiz, MD, FEPOBRAS · Answer

The photos show a vertical fold or crease above the belly button with some surrounding contour irregularity. After a tummy tuck and revision, this can come from scar tethering, skin redundancy, uneven fat thickness, internal adherence, or a combination of factors. The best correction depends on whether the problem is mainly a depressed scar, extra skin, tight scar tissue, or deeper abdominal wall contour.

Possible options may include scar release or subcision, small-volume fat grafting to soften a depression, direct scar revision, limited skin excision, or a more formal tummy tuck revision if there is significant loose skin or tension. Non-surgical treatments may help texture or scar quality, but they usually do not fully correct a true fold. Since you are about one year from revision, it is reasonable to be evaluated by a board-certified plastic surgeon experienced in secondary tummy tuck contour problems, with an exam to judge skin mobility and scar tethering before choosing a procedure.

Ira H. Rex III, MD · Answer

from your photographs, it seems like the first step might be to consider liposuction. If the increase is scarred down, sometimes this can be released with liposuction. Even if this can be made significantly better, he may find the results acceptable.

Daniel Barrett, MD · Answer

Dear Izz555,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

As others have suggested, a vertical incision can be done to excise the excess horizontally. The other alternative, which may be possible, is a breast lift. Unfortunately, your breasts are not visible in your photographs. However, a breast lift will often pull the upper abdominal skin higher and may limit the need for the vertical scar. Additional photographs would be needed to give you an accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

James Knoetgen, III, MD · Answer

If you are dealing with the appearance of a creasing vertical line after a tummy tuck revision, several procedures may be considered based on the specific issues causing the concern. It's essential to consult with your plastic surgeon to determine the most appropriate course of action tailored to your individual circumstances. Potential procedures that may help minimize the appearance of creasing include:1. Revision Tummy Tuck: If the creasing is related to inadequate tissue removal or laxity in the abdominal area, a revision tummy tuck may be recommended. This procedure involves revisiting the initial tummy tuck site to address issues such as excess skin or insufficient tightening of the abdominal muscles.2. Liposuction: In some cases, creasing may be caused by uneven fat distribution. Liposuction can be used to remove excess fat and create a smoother contour. However, it's essential to ensure that liposuction is an appropriate solution for your specific situation.3. Dermal Fillers or Fat Grafting: If the creasing is due to volume loss in specific areas, dermal fillers or fat grafting can be considered to restore volume and improve skin texture. These procedures can be particularly effective for addressing depressions or irregularities.4. Scar Revision: If the creasing is associated with scarring from the initial tummy tuck, scar revision techniques may be employed. This can involve excising or modifying the existing scar to improve its appearance.5. Skin Tightening Treatments: Non-surgical treatments such as radiofrequency or ultrasound therapy may help improve skin tightness and reduce the appearance of creases. These options are generally less invasive but may require multiple sessions for optimal results.It's important to note that the suitability of these procedures depends on the specific characteristics of the creasing, your overall health, and the assessment of your plastic surgeon. Before undergoing any additional procedures, have a detailed consultation with your plastic surgeon to discuss your concerns, evaluate the underlying causes, and determine the most appropriate course of action for achieving the desired results.

Camille Cash, MD · Answer

More information is needed but it appears you have excess skin above the navel. A vertical incision in the midline of the abdomen could remove this excess skin, although a linear scar would remain. I encourage you to visit with your surgeon to discuss your options.

Daniel P. Markmann, MD · Answer

Unfortunately, when people gain weight skin gets stretched.  The same thing happens with pregnancy.   The common fix is to stretch the skin downward, which tightens the skin in the vertical direction.   However, some people have skin laxity in the horizontal direction, as is your case.   For this issue there are 2 options.  1) A vertical scar where the crease is, removing skin on either side of that scar. When this is done at the same time as the tummy tuck it is known as a Fleur de lis tummy tuck.    Or, 2) My preference is a vertical scar on each side of the body, extending from the bra strap line to the tummy tuck scar, removing skin from each waistline.  This also removes any excess fat in this area, slimming the waistline and it is a much better hidden scar.

Kenneth R. Francis, MD, FACS · Answer

Dear lzz555,
It is a little bit unclear as to what the "revision surgery to eliminate a raised vertical line" consisted of, but it appears that you have upper abdominal skin excess in the horizontal dimension.  We can presume that you either had a massive weight loss or extensive liposuction that exceeded your skin's ability to contract in that area.  You may now consider, and would have benefitted from a fleur de lis abdominoplasty to tighten your skin in that dimension.  This would create a vertical scar in your upper abdomen.  Radiofrequency treatments (Morpheus) may give some improvement without having surgery, but will not likely completely smooth your tummy.  Good luck!

Mats Hagstrom, MD (license on probation) · Answer

In order to get an accurate assessment, we probably need a bit more information.
Do you have a history of significant weight loss? If so, how many pounds? Ideally, we should always see before and after pictures when making an assessment regarding the outcome of a plastic surgery procedure.
If you don’t have a complete set of proper before and after pictures, then ask your surgeon to forward the ones they took.
 Understanding the extent of your abdominal scar for example would be helpful.
Individuals who have significant skill laxity such as those who have had a massive weight loss may need more extensive skin production surgery.
This is usually done either with a wraparound or extended tummy tuck, a.k.a. body lift. , have vertical incision can be added.
It would be helpful to understand what was done during the revision procedure.
To get an accurate assessment, I suggest scheduling a few in person second opinion consultations.
For second opinion consultations come prepared bringing with you and complete set of proper before and after pictures and copies of your previous operative reports.
These are all available from your previous providers Best,
Mats Hagstrom, MD

Which procedure would help minimize the appearance of creasing vertical line after tummy tuck revision? (photos)

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