Is a vertical incision necessary for a Tummy tuck with a long torso? (photos)

This is very, very rarely necessary, but this depends upon the aggressiveness of undermining and removal.Kenneth Hughes, MDBeverly Hills, CA

 When a patient is very thin, sometimes it is difficult to remove enough excess skin to remove the hole  where the bellybutton attached to the skin.  You can end up with a small vertical component to the incision.  In a patient such as yourself this would generally be around an inch to an inch and a half at a guess from your pictures.  Usually the small vertical  component still ends up being hidden  below the line where most people's bathing suits end at.  You look like you should be an excellent overall candidate and would likely get a very nice result.  

What your surgeon is likely referring to is a short vertical incision that results from not being able to entirely remove the small incision around your belly button. This is more common in patients with a long torso. This scar is typically short and not significantly noticeable. It is certainly less noticeable than raising your lower abdominal scar above your clothing.

The issue is not really that you have a long torso, it is more a factor of having a high belly button and how much loose skin that you have above the belly button.In a traditional tummy tuck, an incision is made around the belly button which stays in its original position. The skin is pulled down and the incision made around the belly button is removed with the excess skin. You end up with a long horizontal incision and an incision around your belly button.In patients that do not have enough skin above the umbilicus to pull all the way down, there are basically two options.  You can detach the belly button from the muscle and not cut around it. The belly button is then pulled lower when the excess skin is removed and reattached at a lower level. This works well for women whose excess skin is all at or below the belly button. The problems occur when there is loose skin above the belly button and when you pull it down enough to make it nice and flat, it positions the belly button too low on the torso and too close to the mons-this looks weird! If this same patient had a traditional tummy tuck where you leave the belly button attached to the muscle, the hole cut around it would not pull down low enough to be cut out with the abdominal skin. When this happens, the hole is closed up with a short vertical scar extending one to two inches up from the horizontal abdominal scar.It really takes an experienced surgeon to assess your tissue and determine the best approach because once you commit to one option, you cannot change course because you have to leave the belly button attached to either the skin or the muscle for it to have blood supply to survive.I discuss these options with all of my tummy tuck patients who have a high umbilicus and minimal laxity above it. If their goal is to have the flattest tummy possible, a short T-scar with the belly button left in its original position is best. If they don't want an incision around the belly button or a short T-scar, the umbilicus can be elevated with the skin and brought lower, but they may have to accept that they will have either a low belly button or some residual skin laxity if the belly button would come down too low and it has to be left higher to look normal.I don't see any need for you to need a long vertical incision. Some surgeons do this technique, but it is rarely if ever necessary except in massive weight loss patients.

If someone is in good shape with a long torso, it is not always possible to remove all the skin between the incision and the belly button. In that case, the original incision made around the belly button cannot be removed. I will then close that with a small vertical incision low on the abdomen. Another option is to float the belly button and slide it lower on the anterior abdominal wall. This will avoid a vertical incision all together. You can see some of my small vertical incisions on my before and after photos. Good luck!

Thank you for your question.It will be very unlikely that you would require a full vertical incision in an abdominoplasty in your case. Depending on how aggressive you want to be you may require a small vertical scar which would represent the location of your old belly button. However, I would think that you would be an excellent candidate for a mini-abdominoplasty. It is always best to consider your options and seek consultation in person with a plastic surgeon that is experienced and passionate about this procedure.Best of luck!

The possibility of a vertical scar is really more of a function of skin laxity than absolute torso length. The vertical incision would be created to keep your horizontal scar at a point low enough to visually hide the scar. The trade off is making the vertical scar higher. Often in this situation, I find that these patients are sometimes good candidates for a mini abdominoplasty. If you are in this situation, I suggest you consider discussing  you options with a Board Certified PS with experience in different types of abdominplasties.

What your surgeon is probably referring to to a short vertical closure if the torso is too long and the laxity not quite enough to allow the umbilical opening to fully reach the low pubic line preferred. Some will need this adjustment, and most will prefer this sollution to a higher transverse scar which is less easily concealed.

Chances of you needing a vertical scar are small, definitively the best treatment for you is a full tummy tuck, be sure you seek the help o f a surgeon member of the ASAPS.

If you insisted on a very low horizontal incision a vertical scar will be needed since your skin will not stretch that low.  It can be avoided with a slightly higher placement of lower scar.