Been to 3 dr's for a consult, each has given me a different opinion regarding the amount of skin above my belly button.

One said I did not have enough skin above it, one said I did have enough skin, and one said they would have to wait and see during the surgery. Do they just keep cutting higher and higher to see how high they can go? How is such a thing determined? I don't like the feeling of going into a surgery not knowing if I will have that additional vertical scar or not. I am 40 years old with 5 kids (natural births). I have also lost close to 100 pounds about 5 years ago with diet and exercise. Thanks!

Doctor Answers 11

Scar

You need a standard tummy tuck with a suprapubic scar. I do not think you need a vertical scar at all.An examination would be helpful


New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Tummy Tuck

Thank you very much for your question.

Based on the pictures, I think you would be an excellent candidate for a full tummy tuck with muscle tightening.  If you are left with a vertical scar, it would be a very small one, and located very low in your abdomen and easily covered by your underwear.  If after 6 months, the small vertical scar still bothers you, it can usually just be cut out and you would only be left with the low horizontal scar.

Again, this is based on the pictures alone.  Regarding the surgeons, I would pick the one that you feel has the best approach and can deliver the result you desire through that approach.  Best of luck!

Daniel Krochmal, MD
Chicago General Surgeon
5.0 out of 5 stars 19 reviews

Amount of skin for a tummy tuck

HI cfunyny,

 I think that you would do fine with a full tummy tuck and get a very nice result You also get a great benefit with the tightening of the rectus muscles. Congrats on your weight loss too.
Best,
Dr. Christine Rodgers

Tummy tuck scar

The lower the incision the greater the chance that you might need the vertical scar, usually called an "inverted T".  I find that more patients are willing to accept the inverted T in order to  get the lowest possible scar but the truth is, every human's skin has it's own elasticity and the amount removed can differ from person to person. That can only be determined once the skin has been peeled away from the muscle. At that point in the operation I typically split the flap from the belly button down and advance it as far as I can with the table in flexion. When the skin is fully stretched it just stops coming and the skin excision is defined. At that point the decision is made (for doctor and patient) and if part of the split remains, that defines how tall the inverted T will be. If the incision is a little higher above the pubus the scar will be higher but may avoid the "T". I draw this on my patients skin with a water color if it is unclear. Once you pick your surgeon you might consider asking him to do that as he may offer a choice. Some patients do prefer a higher scar option over a "T".

Gregory J. Stagnone, MD
Dallas Plastic Surgeon
4.6 out of 5 stars 38 reviews

Been to 3 dr's for a consult, each has given me a different opinion regarding the amount of skin above my belly button

Thank you for your question and photographs and congratulations on your weight loss!  It appears that you would do well with a full tummy tuck and not a fleur de lys.  The tummy tuck will tighten your stomach muscles, helping to achieve a flatter appearance, while removing excess skin and adipose tissue in a vertical direction.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Been to 3 dr's for a consult, each has given me a different opinion regarding the amount of skin above my belly button.

Based on your photos I find it hard to believe a well trained and experienced surgeon would not do a full TT with a low scar and no vertical scar. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Abdominal skin

Congratulations on your weight loss; As mentioned in previous posts, the best way to determine this is in the operating room. However, a surgeon with experience will be able to tell you the chance of requiring a small vertical incision.  I personally do not like the top down approach as the lower scar can then end up higher than optimal. Hence, you could end up with the entire scar located above your underwear line. The key to the procedure is having the final scar low such that it is well concealed; a small vertical extension to a well placed low scar will be well concealed and unnoticeable with clothing. 

Pictures can be deceptive; I have had patients who appear to have such tight skin on the photo but have not required a vertical incision(patients # 3 and 4 on my website under tummy tucks). Surgical technique to appropriately loosen the tissue is important too. With good technique a vertical incision can be avoided in many patients. 

Matthias Solomon, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 9 reviews

Inverted T incision Abdominoplasty

Dear cfunyny,

Based on the position of you belly button relative to your groin and the amount of skin from your belly button to your ribcage, I do not think it will be a problem to avoid the Inverted T scar with your abdominoplasty. Now, other surgeons may have a different opinion, as their comfort level and experience in performing abdominoplasties may vary. Additionally, there can be some confounding issues that may modify how aggressive a surgeon will feel about pulling your abdominal skin tight (eg: smoking).

Technically, an abdominoplasty is normally started from the lower incision (especially if you have an existing c-section scar), and the skin is lifted off the abdominal wall up to the rib margin. It is then stretched down to see how much can be removed. Only at this stage can a surgeon be sure that the old belly button hole can be pulled past the lower incision, thus avoiding the inverted T.

Another option (for patients with no existing scars on their abdomen) is to start with the upper incision, and then see how low the scar can be made prior to making the lower incision. This “Top Down” abdominoplasty guarantees that you will not have an inverted T scar, and can allow the surgeon to pull the skin tighter due to a better overall blood supply to the distal skin flap.

Based on the anatomy shown on your photographs, I would suggest avoiding the surgeon who does not think you have enough skin, as I question their experience level with tummy tuck operations.

Abdominoplasty (tummy tuck): Options

Dear Ms. Cfunyny,

I applaud your search and different answers.

Thank you for your question and information about yourself. Unfortunately without photos and a examination I can advise you in general terms, however I hope you will find them helpful.

Bottom line: it is difficult to give a 100% answer based on your anatomy and skin "stretch"   that can only with certainty be dtermined intraoperatively.

In general:
1) incisions are usually placed as low as possible.
personally gave the patients bring a bathing suit bottom or panties of their choice
to ensure the placement of the incision is where they want it.

2)in thin patients with long torsos and little redundant skin may require a a small vertical scar centrally located. This is where the your orginal umbilicus was located. The trade off is to have a lower horizontal scar for a temporary small vertical scar. This small vertical scar can often be resected under local anesthesia and converted/combined with the horizontal scar 9-12 months later when the skin loosens

3)there are four types of abdominoplasties. A-C All have horizontal
incisions and D has a significant vertical compotent.
A) mini- muscle tightened below umbilicus to pubic bone
B) standard- muscle tightened from breast bone to pubic bone
C) extended as in standard but incision longer to excise excess skin/fat in outer thigh
area
D) fleur de lis- same as standard but in addtion excess skin/fat excised in a vertical
direction

Please make sure your chosen Plastic Surgeon is experienced and Certified by the American Board of Plastic Surgery and in addition ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

My best wishes,

R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
wwwimagineplasticsurgery.com
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Enough upper abdominal skin?

Hello and thank you for your question. Congratulations on your weight loss. You have done a fantastic job. A full tummy tuck is needed and maybe even a lower body lift considering the 100 lb weight loss. What the Dr's that you saw are conserved with is potentially leaving you with a small vertical scar in the midline just above the pubis, because your skin above the belly button is not that loose. I don't believe that will happen but if it does that should not be a big deal. So I agree with the surgeon who said that the final determination is made at the time of surgery.  This is very common when performing tummy tucks.  I happen to specialize in post massive weight loss body contouring and have had to do this in a few of my patients who have lost over 150lb.
Go with the surgeon that you feel comfortable with and has shown before and after photos that you like, with low incisions. 
Good luck. 
Peter Fisher M.D 

Peter Fisher, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 49 reviews

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.