Will I Need a Small Vertical Incision for my Tummy Tuck? (photo)

I'm a 33 year old 5'6 130 lbs mother of two. I've had 2 csections and my scar is very low. I'm getting different answers from different surgeons regarding having a "T" scar. 2 have told me that I will have to have a small vertical incision because my csection scar is really low and there is not enough skin to pull down and another has told me that he is able to do it without the vertical scar. Based on what you can see from my pictures, what do you think?

Doctor Answers 26

Will I Need a Small Vertical Incision for my Tummy Tuck?

Dear AM,
Thank you for your post.  It is probably a close call if there are multiple surgeons saying different things.  The surgeons who are saying that there will be a 'T' Scar are telling you this incase there is a 'T' scar.  They will, of course, not place a 'T' scar there if it is not needed.  I would advise you to go with the surgeon that seems the most competent and you are the most comfortable with, not just the one saying what you want to hear.  This may be the same person, but don't not choose the other surgeons because they are preparing you for a possibility. 
Best wishes,
Pablo Prichard, MD

Phoenix Plastic Surgeon
5.0 out of 5 stars 38 reviews

Will I Need a Small Vertical Incision for my Tummy Tuck?

Your examining surgeons have it all over those of us offering opinions based only on photos. I have a little disconnect with your reported height and weight and the photos, making me all the less comfortable offering advice without an exam.

Your c-section is low, but that is not an issue. Your navel seems a bit high, and the skin from chest to navel looks inadequate to reach all the way to the current scar. There are a number of ways to deal with that.  I have seen patients who went to surgeons who promised no vertical scar, and true, they don't have one, but the entire horizontal scar is so high that it cannot be hidden in two-piece swimsuits or undies.  Not a breast solution.

An alternative in some cases is a "umbilical float" where the navel is lifted off the abdominal wall (this would allow easy repair of the hernia I think I see in the photo), and repositioned a bit lower. This is a compromise, to be weighed against the benefits of no vertical scar and no umbilical scar. 

Often the best choice is to accept the vertical incision.

All the best. 

Vertical scar needed for abdominoplasty?

It's very possible that you may require a vertical incision but usually the scar heals well and is lower on your abdomen.  In women without a prior scar, the alternative would be to make the scar higher.  A higher horizontal scar is more difficult to camouflage than a small vertical one.

Quintessa Miller MD FACS
San Antonio Plastic Surgeon

Quintessa Miller, MD, FACS
Fort Walton Beach Plastic Surgeon
5.0 out of 5 stars 6 reviews

Will a small vertical scar be needed?

Its tough to answer this question just based on a photo.  I would defer the answer to the plastic surgeons who examined you and informed you they may need a lower midline scar.   This may be needed because 1) they are trying to place your transverse tummy tuck scar as low as possible and 2) you may have limited excess skin above your belly button.   Best wishes,

Dr. Basu

Houston, TX

Will I Need a Small Vertical Incision for my Tummy Tuck? (photo)

Your problem is not whether you need a vertical scar or not.  The problem I see from your photos is mainly the fact that you have intra-abdominal obesity and not the typical redundancy which responds best to TT.  It is not possible to say without examining you, but if in addition to the intra-abdominal obesity you have weakness of the abdominal wall, a standard TT may not be adequate and you may need mesh re-enforcement to prevent recurrence of this bulge.  Whether a vertical resection will improve your outcome can only be determined at the time of surgery.  So I would tell my surgeon to go ahead with the additional vertical portion if he feels it necessary at the time of surgery.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 14 reviews

Tummy tuck questions

I am aware of the issue of leaving a T scar after a tummy tuck and I agree that is would be nice to avoid it. There are very few cases in which I have found this necessary and believe your case can be done without the T scar. You C section scar may appear low, but it will migrate superiority with a tummy tuck. Many surgeons tell their patients there might be a small vertical scar to make sure they are fully informed prior to surgery, even though it is not needed in the vast majority of cases.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 22 reviews

Tummy tuck scar

As the old adage goes,"Plastic surgery is a constant battle between blood supply & beauty". Judging from the pictures you have posted, the C section scar is really low and as pointed out by the plastic surgeons you have consulted it would be difficult to pull the skin all the way down. So, in my opinion too, it would be best to go with a small vertical scar during the procedure to ensure a safe outcome (in terms of wound healing).

The vertical component will fade over a period of time and will hardly be a cause of concern in the long run. All the best with your procedure.

Small Vertical Incisions & Tummy Tucks

Thank you for your question and photos.  If two surgeons recommended that you compromise with a small vertical incision above your TT scar...I would heed their recommendations.  The have had the benefit of examining you and are interested in keeping you safe and giving you the best cosmetic result.  Base on your photos you have a long torso, high belly button and not a tremendous amount of laxity...these are observations and can only be confirmed with examination.  In this situation, leaving a small vertical scar where the original belly button exited is the safest and most prudent way of avoiding over resection and skin necrosis and wound separation.  These are all complications that you should avoid.  A small vertical scar that heals well and fades with time is a small price to pay for a safe and uneventful recovery.  All the best.

Will I Need a Small Vertical Incision for My Tummy Tuck?

There are multiple options for placement of the scar and for the type of abdominoplasty. Each option can result in a reasonable improvement, but each has their its advantages and disadvantages. A lower placement of the incision and removing the C-section scar is a reasonable option.  There is a long distance between a high umbilicus and a low C-section scar. Sometimes there is not enough looseness and excess of the skin to safely remove the old hole from the incision around the belly button (umbilicus), so a small vertical closure of that incision is performed  in order to avoid complications from an excessively tight closure of the tissues. Another option is a second horizontal scar above your C-section scar, which is usually less desirable.

Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest that you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with.

You should discuss your concerns with that surgeon in person.

Robert Singer, MD  FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.5 out of 5 stars 18 reviews

Will I need a vertical scar with my tummy tuck?

Thanks so much for your question.  Based on your photos I can see why you are getting different opinions.  You best answer will be answered by physical exam.  When you bend over and try to touch your toes you can see how much skin can safely be removed based on the laxity of skin in that position.  It also depends on your overall health and your vascular health.  What I mean by that is how well you will be able to heal if your skin is placed under tension.  This is dependent on past history (i.e., smoking, diabetes, etc.)  Hope this helps.

Shaun Parson, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 39 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.