Why do I have to have a vertical scar below my naval in addition to the pelvic scar with my abdominoplasty? (photos)

Question

As a result of about 15 lbs of weight loss, I have some loose and crepey skin on my stomach above and below the naval. I am currently 5'4" and 112 lbs. The Board Certified PS I saw said he will have to create a new belly button and the scar will come from sewing up where the old one was. I was all for it until he told me that. This is in addition to the regular tummy tuck scar. Why is this and is there another way?

Ankur Mehta, MD · Answer

Hello and thank you for posting photos along with your question...Every patient is different and I have not evaluated you in person so it is hard to say whether a vertical incision is absolutely necessary....However, I will say that I, to this day have never had to give someone a vertical incision and I have been able to keep the incision very low. My advice is that you should be evaluated by a couple of other plastic surgeons and see what their thoughts are. I combine liposuction and tummy tuck which allows me to get alot more movement of skin and fat and therefore I havent had to add a vertical scar. Just to be clear...I am not saying that you dont need a vertical scar but the only way I could personally tell is if I evaluated you in person. I have attached before and after photos of a patient that came to me who had already had a previous mini tummy tuck. I told her she needed a full tummy tuck. I told her that due to her previous mini tummy tuck I did not know if there was enough loose skin to pull down and that I may have to give her a vertical scar. Not only did I not have to give her a vertical scar but I was also able to keep her incision VERY low. Please make sure you are being evaluated by a board certified plastic surgeon. I hope this helps and I wish you the best of luck in your tummy tuck journey!

Kenneth Hughes, MD · Answer

Hello. Great question. However, a personal examination is needed to determine if you absolutely need a vertical incision. Please schedule a consultation with a board certified plastic surgeon for a detailed surgical plan to achieve your desired results.

Gary M. Horndeski, MD · Answer

With the amount of excess skin you have, it is likely that you would not need a vertical scar.  You could get by with just a scar for your new umbilicus and a low pelvic scar.Best Wishes,Gary Horndeski, M.D.

Craig S. Rock, MD, FACS · Answer

When performing an abdominoplasty, a low transverse incision is made across the pelvis and a second incision is usually made around the umbilicus (navel), leaving the umbilicus in place and attached to the underlying abdominal fascia.  When your abdominal skin is advanced toward the pelvis and the excess is removed, if the skin currently above your umbilicus does not reach the low transverse incision, the original opening from your umbilicus is sutured closed, resulting in a small vertical scar - usually close to the low transverse incision.  An incision is then made in the abdominal skin over your umbilicus, your umbilicus is brought up into the opening and sutured into place.It is generally considered preferable to create a small lower abdominal vertical scar rather than make the entire transverse scar higher up on the abdominal wall.  While most patients clearly have enough excess skin above the umbilicus to make the vertical scar unnecessary, there are times when, as the surgeon, it is impossible to be 100% certain.  In those cases, it is good surgical practice to inform the patient of the possibility in advance.Best wishes.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question and photograph.  If the skin from the horizontal incision to the top of your belly button can not be removed, you will be left with a small vertical incision, the size of which is your current belly button length.  This can be accounted for to help minimize the risk, but involves moving the horizontal scar higher to minimize the amount of skin needed to be removed.  If this does not make sense, have your surgeon draw out the scenario as this often helps patients more than a verbal explanation.  Best wishes.

Nathan Eberle, MD, DDS, FACS · Answer

surgeon is telling you in advance he will likely not be able to remove all of the skin from the low transverse(TT) incision to above your current BB-meaning you dont have enough skin/laxity, so when he pulls the skin down you will have a small vertical scar from the area where your BB used to live, this is a better alternative than bringing the transverse scar higher towards your BB, which some surgeons may suggest.

Curtis Wong, MD · Answer

and the more skin you have, the better for allowing complete removal of the skin without a vertical incision.  If you cannot pinch your belly button to your anticipated incision in your pubic area, there is a good chance a vertical scar will become necessary.  If you have very little lax skin above the umbilicus and can live with the outcome from dropping your belly button an inch, you could just have a float where your belly button is secured an inch lower (and it still looks 'normal').  Your surgeon is being honest with you and I applaud your surgeon for that.  If you find a surgeon that promises you no vertical scar with a low transverse scar, get it in writing and know what happens if your surgeon doesn't meet the agreed upon terms as there are just too many high scars on this site that cannot be fixed.

Earl E. Ferguson III, MD, FACS · Answer

It is difficult to assess from a photo, but experience tells a surgeon whether or not the laxity that is present in your abdominal skin is adequate to allow removal of the defect where your belly button was.  It is uncommon to need to do this, but I warn patients of the possibility pre-operatively so that there are no surprises.  It is better to have a low transverse scar with a small vertical component than a high transverse scar and no vertical component.  The vertical segment tends to fade very nicely and can often be removed later if necessary once the skin has relaxed.

John Dean, MD · Answer

You asked if there are any alternatives to the vertical scar and indeed there is. You can have a procedure where the umbilical stalk is floated up in order to tighten the muscles and remove fat and skin. The stalk is then reinserted at a slightly lower level to tighten the skin above it. This technique avoids a scar around the umbilicus and there is no vertical scar either. I have a journal article about this procedure,accepted for publication but as yet unpublished, that I could share with you.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.Generally speaking, 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).    In our practice planning the incision line for tummy tuck surgery is done after careful communication of patients' goals and preferences. I find that marking patients the day before surgery, as much as possible, with the help of the patient's planned swimming suit or undergarment, helps when it comes to placement of incisions.
In most cases, the tummy tuck incision can be kept very low, usually at or below  the pubic hair line (or at or below an existing C-section scar).
The use of the progressive tension relieving suture technique (sutures placed between the abdominal wall flap and the underlying abdominal wall fascia) allows us to keep the resulting scar low and relieve some of the tension upon the tummy tuck closure.  Reducing tension upon the incision line helps keep scars as far as possible.
 
 Patients should keep in mind that the lower the incision line used for tummy tuck surgery, the less skin can be removed at or above the umbilicus.  This may be especially relevant for patients who have stretch marks and/or piercings above the umbilicus.  Sometimes, patients elect to have their incision lines placed higher so that more skin and/or an existing supra umbilical piercing can be removed  during the tummy tuck procedure. 
 Always best to communicate your goals, concerns, and questions directly with your plastic surgeon, who will be your best resource when it comes to specific thoughts, advice, and/or meaningful predictions or reassurance.
 Best wishes for an outcome that you will be very pleased with.

Why do I have to have a vertical scar below my naval in addition to the pelvic scar with my abdominoplasty? (photos)

Answers (13)

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