Is a Vertical Incision Necessary For My Tummy Tuck?

I saw a surgeon today and he said he needed to do 3 cuts: one on belly bottom, another in the horizontal c-section and a 3rd one vertically below my belly bottom. My mother says the vertical one below the belly bottom is NOT necessary. Is it true? can they use ONLY the c-section one? I am 100 lbs. and I have had 3 kids and I don't have excess fat I just have diastesis. Thank you!

Doctor Answers 19

Upload some photos as each body and abdomen has unique requirements

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Its hard to know without photos.  There are cerainly some individuals who would need a low horizontal incision, one inside the belly button and then a small one resulting from closing the prrevious belly button location.  This is particularly the case for individuals that have a medium a mount of laxity--enough to warrant a tummy tuck but not enough to allow removal of the belly button location and placement of the incision very low.

All the best,

Dr Repta

Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Tummy tuck and incisions vertical and horizontal

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Dr. Emerson has outlined the case for the vertical and horizontal scars very precisely.  I do not agree with the detachment of the belly button from its birth position and floating it down because of his reasoning.  I do think that your doctor is feeling that the 'hole" in the abdominal tissue to be redraped will not come down far enough to be taken out completely and the treatment for this is to close the elongated by the pulling down of the a straight line.  It is very acceptable to patients if it happens.  I should add that many times the upper skin stretches further than we expect and in this case, the circle would come out as with larger patients.  You are small and this is to your great advantage.  Good for you doctor in that he/she told you about this being a possibility rather than the doctor finding at the table that it would be too much to pull that circle out safely.

Need for vertical incision with tummy tuck?

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There are two situations in which a vertical incision may be required in a tummy tuck.  These two situations are very different from one another and used for two completely different reasons.  While it is true that a vertical incision is uncommonly needed for a tummy tuck, sometime the situation does arise. 

1. The first situation occurs in a patient who has lost a considerable amount of weight, often more than 100 lbs.  In this situation there is a significant amount of excess, lax skin in both the horizontal and vertical directions.  In this setting, some surgeons may elect to remove the excess skin both horizontally and vertically.   The vertical incision allow excess skin from around the patient's sides and back to be pulled forward and removed.  This is sometimes called a Fleur-DE-lis abdominoplasty.  This leaves a long horizontal and vertical scar.

2. The other situation involves the relatively small patient with more skin excess below the umbilicus than above.  These patients often weigh less than 120 pounds, have significant diastasis of their abdominal muscles, and loose skin primarily below the belly button.  There are different possible approaches for this type of patient.  Sometimes the umbilicus is detached from the muscle layer and allowed to "float" downward along with the skin.  This can result, however, in an umbilicus that is unusually low and in an unnatural position.  I also believe that it does a relatively poor job of flattening the lower portion of the abdomen.  

The other approach involves leaving the belly button attached to its natural position (like in a regular tummy tuck) and pulling the skin as far down as possible without too much tension.  In these specific cases, the skin cannot be pulled all the way down to close the incision, so a small vertical scar is creating (by suturing together the hole created by incising the umbilicus).  The vertical scar is usually small and is often a worthwhile trade-off for a very flat abdomen.  I hope that this is helpful.  Good luck.

Eric T. Emerson, MD, FACS
Charlotte Plastic Surgeon
4.7 out of 5 stars 29 reviews

Concerns about a vertical incision for a tummy tuck

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Photos would assist in better answering your question though ultimately another consultation may be in order. The only reason that you would need a full vertical incision extending from the umbilicus down to the horizontal scar is if you have extreme horizontal laxity of the skin. This would be common if you have lost a massive amount of weight, possibly on the order of 80 to 100 pounds or more. Otherwise, it is usually not be a prudent selection.

Sometimes, if there is not enough vertical excess skin to be removed in a tummy tuck, the old site of the belly button insertion would persist and, therefore, would need to be closed which is usually done as a vertical line. It may possible that this is what your surgeon had explained to you. It would be in your interest to have this clarified with your surgeon.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Vertical scar in tummy tuck

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Most full tummy tucks do not require a midline incision but each case iit's unique. You should ask your surgeon why. he feels it is necessary in your particular situation.   He may have  a good reason why it would be beneficial in your case when most of the time it is not used. 

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 31 reviews

Vertical incisions and tummy tucks

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The vast majority of tummy tucks performed in the United States are done without a vertical incision.  Most patients can plan on having a scars near or within the belly button and a horizontally often extending from hip to hip.  With that being said, there are some patients who cannot be adequately treated with this technique because of the amount of skin excess.  Typically these are massive weight loss patients who have lost a substantial amount of weight either with diet and exercise or with the assistance of bariatric surgery.  It's impossible to determine which incision pattern will be right for a patient without a physical exam.  If after one consultation a patient is still unsure about the plan, it's recommended they seen another board certified plastic surgeon in the area.  With these types of procedures, it's also often helpful to review photos of past patients.

Kelly Gallego, MD, FACS
Yuba City Plastic Surgeon

Tummy Tuck - Abdominoplasty Incisions

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The planned incisions for an abdominoplasty (tummy tuck) procedures is dependent on the amount of excess skin and surgeon experience.   

Craig Mezrow, MS, MD, FACS
Philadelphia Plastic Surgeon

Need for a vertical scar not likely in abdominoplasty procedure

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Suggesting you need a vertical scar (with your history of multiple pregnancies) concerns me. He should not need to do that. Ofcourse, your case may be the exception. Without pictures it's difficult to say. I strongly suggest you get a second opinion by at least 2 other Board Certified Plastic Surgeons. Best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Need For Veritical Incision In A Tummy Tuck

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The need for a vertical incision in a tummy tuck is almost exclusively limited to patients who have experienced extreme amounts of weight loss, either through bariatric surgery or on their own. The only exception would be in those patients who already have a vertical incision from a c-section or prior intra-abdominal surgery.  Given your 100lb weight and obvious lack of a pre-existing vertical abdominal scar, it is unlikely that your tummy tuck would absolutely need a vertical incision component.

Vertical tummy tuck incision rarely needed!

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I have been doing tummy tucks for 25 years (have done hundreds of them), and can count on one hand the patients in whom a vertical incision was needed. If your skin is so tight that a properly-designed low-incision ellipse cannot be removed and the upper abdominal skin sutured to the lower incision, then you probably didn't really "need" a tummy tuck in the first place.

As per my colleagues, without photos or direct examination, it is impossible to state with certainty, but I think the majority of us are questioning your surgeon's assessment (just as your wise mother did). Seek another consultation or two with ABPS-certified plastic surgeons who have years of tummy tuck experience, if only to reassure yourself that your initial surgeon is either correct, or perhaps "ill-informed." Look at tummy tuck photos and see how many vertical scars you see in the "afters." Now you know why we are all saying what we are! Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 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.