Why is my Pubic Hairline and Scar Being Pulled Upwards After my Tummy Tuck?

When the skin of the abdomen gets stretched out from pregnancy, usually the skin of the pubic region gets stretched out as well. If this is not compensated for by reducing the height of the pubic hairline (essentially cutting out the upper portion of skin containing pubic hair) you can end up with the pubic hairline rising up too high. Without seeing your situation, I cannot determine if this is the case with your outcome.

It is common for a tummy tuck scar to pull upward with time, even if it is correctly placed low, within the bikini line.  I use anchoring sutures to hold down the deep tissue and help prevent this upward tension, and this seems to work for me in keeping the incision line below the bikini line and preventing the upward migration of pubic hair.

If it is already too high, it is not going to go back down.  The best course of action is to allow time for the tissues and skin to relax (6 months minimum), then return for another procedure to lower your scar.  I've done this on many occasions on patients whose scars are too high.  Obviously, discuss this problem with your surgeon, as well as the cost.  He or she may be willing to waive their fee and have you just pay for the facility and anesthesia (it may also be possible to do this under local anesthetic, but I tend to recommend a short IV sedation).

If you wish to compare your scar placement with others, you can glance at examples on my website (reference attached).

The incision from a tummy tuck will rise after surgery during the healing process.  It is crucial to plan the final position of the incision during the marking.  Meaning placing the original incision lower so that the anticipated rise when the patient is completely upright the incision is still hidden in the panty line.

Thank you for your post. It is not common for surgeons to anchor the lower incision to the fascia or covering of the abdominal muscles to keep the scar low, however, I do use this technique and agree with it. All the tension on the incision is from above, not below, and thus the scar tends to move toward the area of maximal tension (towards the ribs/bellybutton). This moves the scar higher than desired. I like to keep my scars very low, and feel that anchoring the scar helps accomplish this. The following photo is an example of this.

Tummy tuck scar migration is due to one thing only, tension.  At the start of a tummy tuck the surgeon cuts around the belly button.  After the skin is pulled down the hope is that enough skin can be removed so that the top incision is made at the top of the belly button incision, thus removing it.  If not then the belly button incision can end up as a small vertical incision.  Not such a big deal.  In fact none of my patients have ever complained about it.

Some surgeons get fixated on getting out the belly button incision and will severely flex the patient on the operating room table.  Although they can then make the top incision high enough the tension that it puts on the wound closure can lead to several potential complications.  First, the tension can cause the blood flow to the skin to be severely comprimised leading to wound healing issues or at worst skin loss.  And secondly the severe tension eventually pulls up the skin in the midline, because that's where the most tension is.  Unfortunately, there's no way to correct it and it will continue to migrate until the tension is gone.

I tell my patients when I think they may have a small vertical scar because patients prefer this to a migrated scar.

Without preoperative and postoperative photos, the following answer is somewhat based on conjecture. However, it sounds like the planned incision at your pubis was initially not placed low enough. Add to this possibly a somewhat lax mons pubis (hair bearing area), mobility of this tissue and tension created by removal of the excess abdominal skin and the result was an incision that got pulled up along with the hair bearing area.

Depending on how high this has been displaced, it can be quite difficult to correct. If there is only a small amount of elevation, with time and some relaxation of the tissues, it may be able to be lowered. With a considerable elevation, the solution becomes either very complex or effectively "impossible" or imprudent.

It is unlikely that with time that the scar will migrate back down again if there is any significant elevation of it to begin with.

 

What you are experiencing is a natural outcome of many full or extended tummy tuck procedures.  The pubic area and its hairline will be raised from its preoperative position. This is because the pubic region is not a fixed area so, although most of the final skin closure comes from the upper skin flap being pulled down, a small amount of it comes from the lower skin flap (pubic region) being raised up. This is often not avoidable for many patients. Some of the potential issue can be addressed in the markings of the incisional pattern before surgery but it can not always be avoided. It may be possible as a secondary procedure to lower the level of the horizontal scar a little bit but the pubic hairline will always come right up to the scar line.

From your description I see two issues. First, the pre operative discussion was not clear between you and your surgeon. In other words, you should have requested that the incision be low enough to be covered by your bikini. Second, the experience of the surgeon, maybe he did not or does not know that the incision moves upward in a TT. Well best to allow some more healing than consider a revision. 

Hello,

Although it is difficult to know if the incision was placed in the optimum position without seeing photos of the markings I can contribute one additional piece of information in addition to what has already been answered already.  When a tummy tuck is close there is tension placed on the incision and this naturally results in a scar that migrates up from its initial location.  To prevent or minimize this some surgeons place deep sutures from the soft tissue to the abdominal wall.  My philosophy is a little different.  When laxity develops in the abdomen through pregnancy, weightloss, etc, the abdominal skin and soft tissue sag downward but so does the mons tissue.  Because of this I always place my initial tummy tuck incision into the hair bearing part of the mons since 1) I know that the incision will migrate up a little, and 2) I want to elevate the mons a little as well.

At this time I would allow ample time for healing.  The incision may fade and the tissues may relax sufficiently.  Worse case scenario you could always lower the incision a little by removing a little more tissue below the scar as in my description above.

 

All the best,

Remus Repta, MD

It sounds like your scar was placed in the correct location.  Things are probably very tight at this time.  As you heal, these tissues will relax and things should improve.  Difficult for me to say for sure since I am not your doctor and you have not posted any photos.  Give this time-about 6 months and then reevaluate the situation.  Discuss your concerns with your surgeon now.