Skin removal - Will the scar length be reduced if skin tightening is done in two stages?

Question

This is a general question for when excess skin is removed such as a breast lift, inferior buttock lift, tummy tuck etc. To minimize the length of the final scar, can the skin tightening be done in 2 stages so that only half of the excess skin is removed each time? In this way, once healed from the first stage, then the same incision site is used to remove the remaining excess skin? Please ignore the extra cost and time it will take.

Randal Haworth, MD, FACS · Answer

While the concept of minimizing the length of the final scar by removing excess skin in two stages is theoretically plausible, it’s not a standard or common practice in many cosmetic procedures. Typically, surgeons aim to achieve the desired outcome in a single surgery to minimize patient discomfort, recovery time, and potential complications associated with multiple surgeries.

However, the feasibility of a staged approach may depend on the specific procedure and the patient’s individual circumstances. It’s crucial to consult with a qualified and experienced plastic surgeon to discuss the best approach for your unique situation.

Best of luck !

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding the possibility of reducing scar length by performing skin tightening procedures, like a breast lift, buttock lift, or tummy tuck, in two stages. While it’s a thoughtful approach, performing skin removal in stages generally does not reduce the overall scar length.

In skin removal surgeries, the final scar length is determined primarily by the amount of excess skin and the degree of skin laxity that needs to be corrected. When the procedure is performed in one stage, the surgeon can typically remove all of the excess skin in a single incision, resulting in a final scar that is tailored to the amount of tissue being removed.

If skin tightening is done in two stages, the same incision site may be used for the second procedure, but the scar will ultimately need to be just as long as it would have been with a single surgery. The reason is that no matter how the skin is removed, the body requires a certain length of incision to remove a given amount of skin. Additionally, performing the procedure in two stages may increase the likelihood of healing complications or scarring irregularities, as the tissues are being operated on more than once.

While two stages may provide more gradual results, it won’t necessarily lead to a shorter scar. The best way to minimize scar visibility is to work with a board-certified plastic surgeon who can carefully place the incision and provide proper scar care post-operatively.

I hope this answers your question and helps you in planning your procedure.

Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear Cute3330,
the length of scar will depend on the length of the incision. You can't prevent scarring but you can improve it. Also, most scars will be less visible with time. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Jeffrey M. Darrow, MD · Answer

There would be no benefit to having two stages to remove excess skin for a tummy tuck, lower body lift, breast lift, etc, and the scar would not be any shorter.  Each of these procedures can be planned so that as much skin as possible, and as tight a repair as possible is accomplished in one stage. There can always be some skin relaxation due to natural relaxation of the tissues, but this should be minimal when carefully planned the first time. Have a detailed discussion with your plastic surgeon. Best wishes.

Camille Cash, MD · Answer

In general having a procedures such as a breast lift or tummy tuck broken into two stages will not result in a shorter scar and may in fact may negatively impact the result.  When removing skin the surgeon's goal is to minimize the scar in terms of length and optimize location while at the same time give a result that includes an aesthetically pleasing contour and shape.

Mats Hagstrom, MD (license on probation) · Answer

If someone has a lot of skin laxity, then there’s no way to avoid a long scar if you want the contour and results to look good.
You can think of skin excision as a requiring afford to one ratio in order to not leave contour and regularities, sometimes called dog ears.
For example, if a surgeon removes a skin lesion, that’s half an inch and diameter to get a flat contour typically requires a 2 inch incision. Likewise, if 10 inches of skin is removed on the lower abdomen, this often requires a 40 inches scar to not create contour irregularity. There are of course variations to this theme depending on each individual. Some people have abdominal skin laxity that’s limited to the front of the abdomen only while others have laxity the continues on the side and back. There’s no advantage to having multiple skin excisions, except for very certain situation . Having two rounds of skin excision is typically only done when the right amount of skin cannot safely be removed with one operation. For example, if someone is trying to exercise a tattoo, removing the entire tattoo may create too much tension to safely heal the incision in which case it can be done in stages. Staging the surgery will not shorten the length of the final scar.
Best,
Mats Hagstrom, MD

Skin removal - Will the scar length be reduced if skin tightening is done in two stages?

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