Full TT with vertical BB closure, how common is this?

I'm scheduled to have a full TT w/lipo of the flanks in a few months and my PS told me the reason for my vertical BB closure is due to my thin frame & long torso (140lbs 5'8) and not enough skin laxticity around my BB to pull it down far enough to have my previous BB hole removed. I trust my PS, however, this was the first time I've heard of this. How common is this?

Doctor Answers 10

Yikes- that is really uncommon..

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Hello-- It is really uncommon to have the outcome you are describing.  I think it would be a good idea to get a few more opinions.  If there is not enough skin to pull down, perhaps a mini is better.Good luck.

Time for a second opinion

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Thank you for your question.  I think that you need a second opinion.  I have been in practice for 26 years and have done around a thousand tummy tucks. NEVER have I left a vertical scar from the umbilicus. I have seen several patients who have had it done by other surgeons; none of them were happy.  There are a large number of variations on the tummy tuck including full, mini, extended mini, umbilical float, etc.  I believe that it is likely that one of these is available to you so that you don't have to have the vertical umbilical scar.  If you have only seen one plastic surgeon, I would encourage you to get a second opinion. 

Full TT with vertical BB closure, how common is this?

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We warn most patients of this possibility but in my experience it is extremely uncommon even with a very low TT scar. We are able to do this because of the progressive advancement closure technique and a high dissection of the tissues over the lower ribs. Some surgeons say this can't be done safely but we having been doing it for nearly ten years without complications. If you are worried, you may want to talk to your surgeon to make sure he uses this technique or else seek out another consultant. 


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While I warn patients that this might be a possibility, I can't recall every having to do so.  It also depends upon the technique and incision pattern.

Full TT with vertical BB closure, how common is this?

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What you describe is fairly routine in a patient with your anatomy, tall with a long torso and without a lot of excess skin laxity.

If a member of my family underwent these procedures, they would be performed by an experienced plastic surgeon who is board certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery, who will fully explain what is entailed in the procedures, including both the positives and potential problems. You should be complimented on the fact that you are seeking valid information before jumping into any procedure.

Robert Singer, MD  FACS

La Jolla, California


Usually a game time decision

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Personally, I have never had to do this.  Usually this is a possibility rather than certitude before surgery.

More often than you would think

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with a long torso and placement of the final scar as low as possible, this situation does happen. It is a very short vertical scar and typically heals very well and is also concealed in the bikini line. Good luck with your upcoming procedure. 

Full TT with vertical belly button closure.

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Thanks for your question. In a tall patient is is not always possible to pull the old umbilical hole down far enough to throw it away completely. In this case the umbilicus is closed horizontally and usually winds up as a small vertical scar just above the pubic area. This small scar is usually still covered under the underwear line. Full tummy tuck is often still a better option because it allows repair and muscle tightening from top to bottom and more skin removal than a patient would get with a mini. In some cases the small vertical can be removed with a staged excision at a later date because the tissues will stretch and relax over time.

An alternative is called an umbilical float, where full tightening is performed, but the existing belly button is pulled down with the skin. Careful patient selection is required here because the umbilicus can sometimes wind up too low.

Some patients in my practice need a full muscle repair but do not have a lot of skin laxity. For these rare clients I elevate the skin like a full tummy tuck, do a full muscle repair,  put the belly button back in its original hole, but remove only a mini tummy tuck amount of skin.

By evaluating your skin laxity you PS will guide you to the best option. What you have described though makes perfect sense. I have included additional info below in the link.

Best wishes.

In-person evaluation needed

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Hello and thank you for your question. The best advice you can receive is with an in-person consultation.   My major goal of surgery is to avoid this vertical scar and keep all scarring low and below the bikini line.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  

Best wishes and good luck.

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

Vertical scar closure, How Common?

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Hi Rose and thank you for this question. This situation is actually quite common in tall individuals with a high belly button. There are techniques to advance the skin farther down such as Pollock's internal suture advancement technique. I'm glad you like your doctor, but getting a second opinion is a good idea too. I find that less than 1% of my patients require a vertical component to their scar, but I really like low incisions and advancing the skin down as far as safely possible. 

Best wishes always,


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