Loose skin above belly button, ugly vertical scar what can be done? (photos)

Question

52 year old, mommy makeover 9 months earlier, ugly vertical scar from belly button. Sub optimal body shape after treatment.

Raffy Karamanoukian, MD, FACS · Answer

Abdominoplasty scars can be quite complex, ranging from the simple hypertrophic scar to a multiplane inflamed keloid. Pigmentation, discoloration, chronic inflammation, scar visibility can all occur in the short term. We begin each treatment with combination therapy using Yellow broadband BBL, Vbeam, fractional erbium, intralesional IIT, and scar modulation. Start with a combination of Plato's Scar Serum massaged twice daily after one week of epithelialization followed by Luminase/Exfolase. Scar consultation and revision may be recommended.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding loose skin above the belly button and ugly vertical scar and what can be done. You also said that you obtained a suboptimal body shape after your treatment. Regarding your body shape, I suggest High Definition VASER liposculpting of your love handles and possibly even fat transfer into the hips. This would give you a smaller waistline with accentuated hips. You don't have to if you don't want to transfer fat to the hips.
Regarding your belly button scar, I would suggest a scar revision. This vertical scar is where your belly button was and cannot be removed with entirety with your already tucked tummy tuck. This is the consequence of your abdominoplasty, whicht should've been outlined before surgery. There are many scar treatments, including using the Fraxel laser, injections with steroids, silicone, and even compression treatment. You may also consider a surgical revision. In regards to loose skin in the upper abdomen, if this bothers you, you will need the removal of excess skin. If the skin is the issue, liposuction should not be performed. If indeed the loose skin bothers you. I would suggest a reverse tummy tuck and an incision is made underneath the breast, and the anterior abdominal wall is lifted upward. This will help to smooth out the anterior abdominal skin. Overall,, I think you have excellent results compared to your preoperative pictures. I would be cautious about undergoing a reverse tummy tuck. The benefit of the surgery will be minimal; however, don't be lured into liposuction because liposuction does not fix loose skin. Thank you for your question regarding oose skin above the belly button and ugly vertical scar and what can be done. 
Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear RAH71,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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

Connie Hiers, MD, FACS · Answer

You can do micro-needling to help improve the scar. the scar is where your belly button used to be.  Your basic shape is somewhat straight and that is related to your bone structure which cannot be changed. Minimally invasive radiofrequency treatment with Renuvion can help tighten skin of the upper abdomen. Please discuss any concerns you have with your surgeon.

Camille Cash, MD · Answer

I'm sorry you are unhappy with your tummy tuck results.  Have you discussed your concerns with your surgeon?  The linear scar below the belly button appears to be healing appropriately.  Typically vertical scars are placed closer to the long horizontal scar.  It's difficult to tell without an examination but you may have improvement with liposuction.

Douglas Taranow, DO, FACOS · Answer

Overall, your results are not bad.  I do agree that the old umbilical scar is very long.  Usually, the retained vertical umbilical scar is inches BELOW the umbilicus and only 1 inch to 1.5 inches long.  Not sure why yours extends from the umbilicus all the way inferior??
The original markings pre-op are where the scars would be and the length.  have you asked your plastic surgeon?
Unfortunately, there is very little to do in erasing the permanent scar.  You might try micro needling.
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

In some cases, plastic surgeons are unable to give patients a low set scar without leaving a vertical scar from the incision around the belly button. I’m guessing that you’re surgeon. Mention this during the consultation. Hopefully your surgeon also showed you before and after pictures of previous patient would have a procedure done by your provider.
The outcome of your procedure is in someways quite good, but perhaps your surgeon was a bit on the conservative side.
The incision is well designed. It’s even offsides and your belly button looks natural. Those are the usual qualities we look for when judging results. I suppose you could make an argument about the length of the vertical incision and yes the procedure should’ve been more aggressive in regards to separating tissues and pulling the skin and muscle tighter. Being more aggressive during tummy tuck surgery, increase his chances for complications, and in this operation when things go wrong, they can be pretty serious. Wound healing failure can leave scars that are inches wide and take six months or longer to heal. It’s hard to blame a surgeon first thing on the safe side.
Cosmetic surgery is often a balancing act between keeping your patients safe and getting impressive results. It’s possible you had the potential of getting slightly more impressive outcomes, but doing so would’ve required the procedure to be done in the more aggressive manner.
At this point, you have to ask yourself if you’re willing to redo the entire procedure. Doing so would only lengthen your vertical scar and it’s a lot to go through for what would be a fairly modest improvement, including the lengthening of the vertices scar.
If the results bother you and have that you’re willing to go through the entire procedure again then schedule second opinion in person consultations with other plastic surgeons in your community and see what they have to say. If not, then there’s no point in complaining about the outcome. The time for being critical of plastic surgeons is during the vetting process while you are choosing providers. I recommend patients have multiple in person consultations before scheduling surgery. I generally recommend patients have at least five in person consultations before choosing a provider. During each consultation, ask each provider to show you their entire collection of before and after pictures of previous patient who have similar body characteristics to your own. Ask providers to show you examples of excellent outcomes, average outcomes, and outcomes that did not turn out, as well as they had hoped. Being shown a handful of preselected images, representing the best results of an entire providers career is insufficient to get a clear understanding of what average results look like. An experienced provider should have no difficulty showing you at least 50 sets of before, and after pictures of commonly performed procedures like a tummy tuck. I typically tell patients to judge tell me tuck results based on who gets the most natural looking belly button on a consistent basis, with a very low sets car that follows anatomic contours, naturally unevenly on both sides, torso, little ballast, appropriate and natural from all angles. Your results need those criteria. Whether the vertical scar was indicated or not, if it could’ve been made, shorter or placed slightly lower, is not worthy of a discussion without having full context.
It would be unfair and inappropriate to judge a quality outcome, especially on matters were there is a balance between patient safety versus more impressive results. 
For reference, you could do a Google search using the words “tummy tuck dehiscence” and click “images” for reference. This could potentially help reconfirm some gratitude of the improvements you did receive. 
Your surgeon did an excellent job, and while there may be surgeons who could’ve pulled you tighter it’s hard to criticize anybody for prioritizing patient safety over aesthetic perfection. 
All plastic surgeons are well familiar with the phrase “the enemy of good is better”
Best,
Mats Hagstrom, MD

Loose skin above belly button, ugly vertical scar what can be done? (photos)

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