My doctor said I am at moderate risk for needing a small vertical incision during my tummy tuck? Is this true and why? (Photos)

I am hoping I do not need a vertical incision during my tummy tuck. My doctor says it may be necessary but he will not know for sure until after I am in surgery. He says I am moderate risk. Why would I need this type of incision? How would the outcome be impacted negatively if he did not do a vertical incision? How high would it need to go?

Doctor Answers 8

My doctor said I am at moderate risk for needing a small vertical incision during my tummy tuck? Is this true and why?

Tummy tuck would likely be the best option based upon the pictures.  In my opinion, I could give you a low scar and no vertical incision.
Kenneth Hughes, MD
Los Angeles, CA

Abdominoplasty incision

Hello,Your surgeon is warning you that he may not be able to pull on your skin enough to remove the hole in it where it was once attached to your umbilicus. This is because you really don't have a lot of skin excess above the belly button. Unfortunately, this will alter your surgeon's decision where he places your low transverse incision, and motivate him to place it too high. This is the number one reason scars are placed too high, and are mostly unfixable.  You and your surgeon should have a preoperative discussion about placing your big scar where it belongs regardless of skin excess: along the thigh/abdominal border and low across the pubis, approximately 1.5 to 2 inches from your genital commissure. He will not be able to remove enough skin to remove the old umbilical hole and will have to close it vertically, A MUCH MORE DESIRABLE SCAR THAN A HORIZONTAL SCAR TOO HIGH ON THE BELLY!!!Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

One can only speculate without an examination regarding the need for a small vertical scar.

Greetings,  When your excess skin is not adequately elastic, it is possible to close the suture line with too much tension.  Photos are not as helpful as an examination to assess this risk. Too tight a closure could compromise the blood supply in the area above the pubis resulting in impaired healing (local skin loss-necrosis).  This risk is greater in smokers, hypertensive patients and diabetic patients, among other health risk factors.   If the tissue tension, in the judgement of the surgeon in the operating room, will be too tight,  a small vertical scar can be created using the height of the belly button defect and trimming the skin and fat transversely at a slightly lower level.  If this is your surgeon's concern, just ask him (her) to further explain this variation in your incision.Best Regards,

Douglas J. Raskin, MD
Colorado Springs Plastic Surgeon
4.9 out of 5 stars 59 reviews

Abdominoplasty incision location

in general a patient who requires a "T" incision with an abdominoplasty is a patient who has minimal excess abdominal skin. In this situation the choice is to keep the incision line low and use a "T" for a portion of the closure or to keep the incision line higher. This should be a discussion before your procedure, however I find many times these patients are also good candidates for a mini abdominoplasty. In your pictures I think you are an excellent candidate for a formal abdominoplasty, and I can't imagine looking at your pictures that you would require a "T" incision. Best of luck.

Jack Peterson, MD
Topeka Plastic Surgeon
4.5 out of 5 stars 36 reviews

My doctor said I am at moderate risk for needing a small vertical incision during my tummy tuck?

Thank you for the question and pictures. Based on your photographs, I think you are likely an excellent candidate for tummy tuck surgery and should have a very nice outcome. Based on your photographs also, I think that is very unlikely that a vertical scar will result; much will depend on where the transverse incision is planned and technical execution of the procedure.

Sometimes, especially for patients with a relatively short torso and/or minimal redundant abdominal wall skin, a short vertical scar is necessary ( in addition to the usual transverse tummy tuck scar). This vertical scar results from closure of the previous umbilical opening and prevents excessive tension upon closer in the midline of the tummy tuck incision line. If this vertical incision is not used, patients may end up with wound healing problems and much wider scars.
Sometimes these vertical scars can be revised/ removed ( usually one year or more after the tummy tuck surgery).
 
I hope this, and the attached link, helps.

Small vertical incision

Hello and thank you for your question. I agree, it's because you don't have a lot of loose skin above your belly button. The only way to not have that vertical incision is to raise your horizontal incision which to me is not worth it as it looks uglier than a small low vertical scar. Peter Fisher M.D 

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

Tummy tuck

Hello and thank you for your question.  I will write this disclaimer first--the best way to determine is with a proper in-person physical examination.  However, based on your photograph, you are a great candidate for a tummy tuck with liposuction and I cannot imagine you needing a vertical incision at all.  Your tummy tuck can be done through a low and short incision, all completely below the bikini line without any need for a vertical incision.   Your muscles can also be plicated resulting in a flat abdomen.   I am not sure why your surgeon would consider placing a vertical incision because it appears in the photograph that you have plenty of skin laxity.  Once again, an in-person examination would be much more valuable in determining this.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

Incision location

If you want the horizontal scar of your tummy tuck to stay low to accommodate how you like to wear bathing suits, low rise jeans etc..then your surgical closure will be tight given that your laxity is mild.  I think a  small T will be much less noticeable than a high riding scar.  High riding scars are very difficult to fix and it can really detract from the happiness factor of a tummy tuck.  I would defer to what your plastic surgeon recommends..there's a good chance you won't need it and if you do it will be very limited.

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