What is the Reason for Needing an Abdominoplasty AND the Vertical (Inverted T) Incision? (photo)

I just had my pre-op appt and the doctor recommended I also the the vertical T incision with my abdominoplasty. I wanted to do a little research prior to then. How it will improve my look? Just a little extra info about me. I've had two viable pregnancies. I had twins a year ago. I'm 4 ft 11 in and was as round as I was tall. I have a severe diastasis that had to be checked for a hernia (which was negative). Thank you for any feedback.

Doctor Answers 10

Reason for Needing an Abdominoplasty AND the Vertical (Inverted T) Incision

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A standard tummy tuck removed any vertical excess of tissue that is present. Some patients have enough horizontal laxity that a vertical excision of excess skin is needed for a full correction of the abdomen. The upside is that there is a tighter abdomen. The downside is that there is a long vertical incision in addition to the standard lower abdomen TT incision.


Nothing beats an in person exam, but from these photos I would be inclined to recommend a standard TT. What I can't tell from the photos, and what an examining surgeon can tell is whether there would be enough improvement from a vertical excision to justify the addition incision.


From my perusal of other responses, it might be well to consider a second opinion from another surgeon. 


Thanks for your question, and for the attached photos. Best wishes. 

Seattle Plastic Surgeon

T incision

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Based on your pictures, I don't think you would need a Fleur-de-lis or T incision. The vertical component is for reducing horizontal tissue excess. Based just on your pictures, I would think your excess tissue could be treated with a horizontal scar alone. 


You should see a different board certified plastic surgeon for a second opinion. 



Asif Pirani, MD, FRCS(C) 

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

A vertical incision is designed to reduce the laxity width wise.

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Thank you for the photos.  A horizontal incision is designed to reduce the skin laxity that exists in a vertical direction while a vertical incision is designed to reduce the skin laxity in a horizontal incision .  I your case I do not think that you will need the vertical incision but this of course depends in the results that you would like to achieve and the examination .

All the best,

Dr Remus Repta 


Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Vertical Incision with Abdominoplasty

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There are two indications for a vertical incision in combination with the horizontal incision of an abdominoplasty.  The more common is a relatively short incision in the lower abdomen that is the result of releasing the navel.  This incision will end up somewhere between the new navel position and the horizontal scar and is usually about 1 inch in length.  The other, less common, vertical incision is called a fleur-de-lis pattern and is used to address very significant skin laxity, usually in patients that have had massive weight loss.  Check with your plastic surgeon to get a better understanding of what he is recommending and why.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 81 reviews

What is the best approach for a Tummy Tuck?

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A tummy tuck (TT) or Abdominoplasty is a surgical procedure that addresses the skin, fat and muscle of the abdominal wall.  It traditionally includes the removal of excess skin in the lower abdomen (usually between the umbilicus and pubic bone) removal of the fat in the abdomen and hips, and tightening the muscles of the abdomen. Nowadays, because of women's fashion changes (low riding jeans) tummy tucks include not only the abdomen, but the flanks/hips all the way into the back.  In fact, when I perform a TT now, I am basically treating all the skin, fat and muscle from the pubic bone to the ribs and the entire back from the buttock to the bra line.

Every woman is built different, therefore every TT is different and customized for each particular patient. Some general categories of tummy tucks that I perform are:

  1. Standard full TT
  2. Mini-TT
  3. Extended TT
  4. Circumferential TT (or lower body lift)
  5. TT with umbilical float
  6. TT with T-incision
  7. Modified TT

Again, all of these TT's include some form of skin/fat removal and muscle tightening with or without a hernia repair.  The woman should be sterile or finished with child-bearing, you do not want to have a TT and then become pregnant, it would ruin the TT.  You need to be in good health and a non smoker and willing to trade the new shape for a long scar.

To decide which TT is best for you, a detailed exam with multiple photos and exact measurements is necessary.  Based on the photos you submitted I would recommend a standard TT  This would be a low riding horizontal incision, no vertical or T incision would be necessary.  You have a very large diastasis recti and a major portion of your procedure will be fixing your abdominal muscles.  Without seeing your back or lumbar area, I can not give you recommendations on the best approach for addressing this area.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 83 reviews

Tummy Tuck Options: When is a Vertical Incision Needed?

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A vertical incision is needed in tummy tuck for two reasons.   First, if a patient has a high belly button and desires a low scar, closure of the belly button hole may be needed.   This requires a short vertical scar, usually low on the abdomen.  The other indication is if a patient has a tremendous excess amount of skin in both the vertical and horizontal direction.  A vertical scar is needed to remove some of the horizontal skin excess.   From the photos you show, I think it is unlikely that you will benefit from a horizontal scar.   Feel free to get a second opinion from a board certified plastic surgeon to confirm my thoughts.  Best wishes!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

Vertical T Incision for Abdominoplasty

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A Vertical T incision, also known as a Fluer-de-Lis, is most often used in abdominoplasty when addressing a tremendous amount of excess skin on the sides and is usually in patients who have had massive weight loss of greater than 75 pounds.  Also, in occassional situations, a small vertical T is used just over the standard horizontal incision if the belly button is very high.   In that case the vertical component is only an inch or two.


Although an exam in essential to confirm what is best for you, based on your photographs, most of your extra skin is located in the front. This is not more than would be expected from pregnancy with twins and, it does not look like you need the vertical incision to get good results.

Adam Hamawy, MD
Princeton Plastic Surgeon
4.8 out of 5 stars 57 reviews

Inverted T incision for tummy tuck

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The usual reason for a vertical scar with a tummy tuck is a belly button that is so high that the hole in the skin from where it was cannot be included in the skin that is removed. From your pictures, your belly button does not appear to be that high. The other reason is to remove extra skin from around a tummy (in a vertical plane) not just extra in a horizontal plane that can be pulled down. Without an in person exam it is hard to tell if that would be necessary for you but from looking at you pictures, it would seem that a standard tummy tuck would be beneficial for you. You might want to seek a second opinion from another board certified plastic surgeon. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Tummy tuck without verticle incision

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From your photographs I see no reason to suggest an inverted "T" type tummy tuck.  You ahve a very lax abdominal wall that will require tightening and it also appears that you have an umbilical hernia.  This could be fixed at the time of the tummy tuck.  I would suggest that you seek another opinion regarding your abdominal issues.

Daniel H. Kane, MD
Miami Plastic Surgeon

Vertical incisions on tummy tucks

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From your pictures, I would not anticipate that you would need a vertical incision.  The only patients I have ever used it on have been massive weight loss patients where the weight gain was very centrally located around the torso, making a "boxy" appearance of the excess skin.  And even in this situation, I find that approach is rarely needed.  I would consider a second opinion from a second board certified plastic surgeon to confirm the proposed approach.  In my opinion, you do not need this extra scar.

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.