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

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.