Is a vertical cut below the belly button the best technique? (Photos)

Thank you for your question regarding a vertical cut below the belly button is the best technique for removing excess skin. Thank you for this most interesting question. There are basically two techniques to get rid of your excess abdominal skin. Both techniques would involve a horizontal excision to get rid of your excess abdominal skin. I do not think it's worth doing a vertical tummy tuck to eliminate your excess skin because the incision would extend above your belly button, which would not be aesthetically pleasing. Therefore, your best solution would be a horizontal excision for your tummy tuck. The question is where to place this horizontal incision, precisely, whether it should be placed high or low. If the incision is placed so the incision can be hidden underneath your underwear pant line, then the area of skin from the incision to the top of your belly button will not be eliminated. With this technique, an incision would be made around your belly button hole will be closed. The second technique places the incision higher and maybe above your underwear line. With this technique, the skin and fat from the incision line to the belly button would undoubtedly be removed and there would be no need for a vertical belly button scar. However, the giant horizontal scar may be under your underwear line and be less visible. The trade-offs are a low incision with a vertical belly button scar or a higher incision, perhaps more visible without a vertical belly button scar. I would opt for option 1 with a lower incision and a vertical scar where your belly button has previously been. In my opinion, this would be the best aesthetically pleasing look. I hope I've helped to answer your question regarding a vertical cut below the belly button is the best technique for getting rid of excess skin.
Sincerely,
Dr. Katzen

Given the fact that your muscles are tight without obvious diastasis, I would recommend a skin only tummy tuck option. As is always considered in the discussion, there may be a vertical scar extending from your low horizontal scar where the umbilical hole does not stretch all the way down to the horizontal scar. That may be the trade-off for maximum tightening of the tummy skin and making for a tighter, cleaner belly button with no hooding of skin over the top. An in-person consultation with an experienced body plastic surgeon will help in decision making. See attached case for reference. Thank you.

A vertical cut below the belly button is not the best technique. You have enough skin, particularly above the belly button, to most likely go with the 2nd option where there is no vertical cut.

Best Wishes,

Gary Horndeski, M.D.

Dear Lindaw.,
based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because 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

It is quite possible that your BB may be released from abdominal wall attachement and pulled down. Once excessive skin is resected, BB can be secured to abdominal wall in a new position, 2-3 cm. lower but still within normal BB range. Only on the basis of in person consultation a surgeon can make decision whether this technique is good for you. Hope this helps.

thank you for your question and posting appropriate pictures. It looks like you are a good candidate for a lateral tension abdominoplasty tummy tuck technique. In this procedure, you can avoid having a vertical scar as you seem to have adequate skin to avoid this. Best to have a virtual consultation to discuss options of course.

The small vertical segment will allow the tummy tuck s at the be lower down. In many cases it’s worth a smal two inch vertical scar to maintain a low incision

An exam to be certain, but I think the horizontal scar would do well for you and could avoid the vertical scar. If you are Ok with the small amount of loose skin above your belly button, then just do the mini tuck. You will have a fair amount of scarring around the mesh.

What you are describing is a standard tummy tuck, not a mini. In a mini tuck the skin excised is below the belly button so there is no hole around it. What you described is a new hole being created and the small vertical scar would represent the old belly button. This is typically preferred in order to keep the long incision low.

A mini tummy tuck by definition only treats, the lower abdomen, and does not include repositioning of the belly button. If you’re having repositioning of your belly button, then you are having a full tummy tuck. Perhaps they are not doing muscle tightening in which case it would be a skin only full tummy tuck.
An individuals who have moderate or slight skin laxity, it may be challenging to remove all the skin between the incision around the belly button, if the incision or scar is placed low. The alternative is to either add a small, vertical scar representing the incision made around the umbilicus or raise the scar position higher on the lower abdomen. In my opinion, tummy tuck scars should be kept as low as possible, especially on individuals who don’t have thick layers of subcutaneous fat. Plastic surgeons with sufficient experience should have no difficulty showing you before and after pictures of previous patient who had different variations of the procedure. Ask them to show you previous patients who had the procedure they describe or are recommending. An experienced plastic surgeon and should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures like a tummy tuck.
Ask providers to show you as many pictures as possible of a previous patient who had the procedure who have similar body characteristics to your own.
Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider. Sufficiently experienced providers should have Enough before and after pictures to clearly show you what your results should look like. Highly experienced surgeons should have hundreds if not, thousands of before and after pictures of commonly performed procedures.
Judge tummy tuck results based on who gets the most natural looking belly button on a consistent basis, as well as a very low set scar that follows anatomic contours naturally and evenly on both sides.
Patients should recognize that there are significant variations in skill and competency for all plastic surgery procedures, and being board-certified and plastic surgery with years of experience does not mean that somebody has mastered any one single procedure. A full tummy tuck is a permanent and irreversible operation. You get one shot at doing this procedure correctly. Poorly done procedures are very difficult to improve upon.
In my opinion, patients should be far more selective than they think necessary when it comes to the vetting process and choosing the best provider. Presently I recommend patient start by having at least five in person, consultations and consider scheduling more unless they feel very confident they found the best provider. Providers who have sufficient skill and experience and confidence should have no difficulty showing you a variety of outcomes, and should have ample numbers of before, and after pictures to make it clear what their results look like on a regular basis. I suggest asking providers during the consultation to show you a variety of outcomes, especially a patient will have your body characteristics. Ask providers to show you examples of excellent outcomes, average outcomes, and outcomes that did not turn out, as well as they had hoped. I asked them specifically what the revision rates and revision policy is. Ask each surgeon about complications and which complications they’ve personally had, the frequency, and how those patients were managed afterwards.
Take notes during each consultation, especially regarding the quantity and quality of before and after pictures showing it. You should not have been left not understanding the concept of the need for a small, vertical scar, representing the incision around your belly button.
Personally I place great importance and allows that squire and then some individuals. This may require adding a small vertical scar. Most plastic surgeons should be able to make a small incision around the umbilicus leaving that vertical scar fairly insignificant. The scar usually ends up right above the primary incision, and is usually the correct way to do the procedure compared to placing the scar higher on the abdomen which is undesirable. There are certainly times when surgeons cannot accurately predict if a small vertical scar will be needed while still setting the scar low. Sometimes the decision needs to be made in the operating room.
I recommend patients take their time and not rush into scheduling surgery. Especially major operations like a full tummy tuck.When, in doubt, slow down and schedule more consultations. The more consultations you have the more you’ll understand your candidacy for the procedure, and have the best chance at finding the best provider.
Take an active role during the consultation, recognizing it is your responsibility to vent to each provider regarding skill and experience. Ask them specifically to show you as many before and after pictures as they are willing to. If the collection of results is limited, then ask the provider why they do not have more pictures for you to see. It’s completely reasonable to ask a provider how many tummy tucks they performed in their career. They should have a collection of before and after pictures that is representative of the number of cases they’ve done.Quality plastic surgeons should be detail, oriented and thorough both during surgery and during consultations.
Based on your pictures, it doesn’t look like you have significant muscle separation. This is generally the case for women who have not had previous pregnancies. The women who have not had children doing a skin only tummy tuck. If sometimes I preferred procedure. Muscle tightening makes the recovery significantly more challenging and longer lasting compared to a skin only tummy tuck. A tummy tuck primarily treats skin laxity, and muscle separation. A mini tummy tuck typically treats skin laxity only of the lower abdomen.
Best,
Mats Hagstrom, MD