Thin Skin Above Belly Button my Require Vertical Scar for Tummy Tuck? (photo)

Question

I saw a ps regarding Tt and she said that since my bb is high and the skin right above the bb is thin that i might require a vertical scar. My question is, is there any think I can do or use in that area to thicken the skin to avoid the vertical scar? I am not scheduled for surgery until mid June.

Robert F. Centeno, MD, FACS · Answer

The vertical tummy tuck scar is not required because the skin is thin, it is required  because you do not have a lot of excess skin.  If too much skin is removed the incision will be closed under too much tension causing wound healing problems and too high of a scar.  By placing the incision below the belly button and leaving a short vertical scar you can make the procedure safer and a better cosmetic outcome as the final incision will be lower.  This is a very good compromise to make.  Avoiding the vertical incision is not a good idea in your case.  They do very well over time.  Better safe than sorry!

Larry S. Nichter, MD, MS, FACS · Answer

In your particular case one of your photos suggest that you may have an umbilical hernia (the bulge). If so discuss the pros and cons of its repair. There is nothing to thicken your skin to prevent a vertical scar. On the brighter side is that if there is enough laxity of your skin you many not need one and secondly, if you do it is usally quite small and would be located near your pubic hair. Most important is making sure you find a qualified board certified plastic surgeon.

Sean Younai, MD, FACS · Answer

As a Board Certified Plastic Surgeon who specializes in tummy tuck surgery and body contouring it is rare to see a patient that would need a vertical scar tummy tuck. You are an excellent candidate for a regular tummy tuck or the type that I perform- High Tension Abdominoplasty. Your umbilicus is not high, and you have plenty of loose skin that can be removed.

	A vertical tummy tuck is usually reserved for patients who have had massive weight loss of 100-200 lbs! You are not in that catagory. I recommend that you do your research prior to proceeding with your tummy tuck.

Kenneth Hughes, MD · Answer

From your photos, this is something that your plastic surgeon should have pointed out as she or he did. During the surgery, that decision will be made, and you may not need this maneuver. This depends upon skin laxity and aggressiveness of surgical technique. There is nothing you will be able to do to help the skin. Kenneth Hughes, MD Los Angeles, CA

Tom J. Pousti, MD · Answer

Thank you for the question.

Sometimes, especially for patients with a relatively short torso and/or minimal redundant abdominal wall skin, a short vertical scar is necessary ( in addition to the usual transverse tummy tuck scar). This vertical scar results from closure of the previous umbilical opening and prevents excessive tension upon closer in the midline of the tummy tuck incision line. If this vertical incision is not used, patients may end up with wound healing problems and much wider scars. Sometimes these vertical scars can be revised/ removed ( usually one year or more after the tummy tuck surgery).   I hope this, and the attached link, helps.

Joseph M. Perlman, MD · Answer

From the position of your belly button, I would think that your plastic surgeon would have to pull dangerously tight on the abdominal flap in order to remove all the skin from the belly button down, so you will have a vertical scar. Most vertical scars are not noticeable and they are within the panty line. Discuss these concerns with your plastic surgeon. I explained patients that some procedures require the patient to accept a trade-off of a scar for the ultimate result of a flattened tummy.

Richard J. Brown, MD · Answer

The vertical scar is totally reliant on whether or not your surgeon is able to get all the skin out up the current belly button or not. It is purely an intra-operative day of the procedure decision. I, and your surgeon correctly warn patients of the possibility of this scar. It really is not that big of a deal. The scar is usually just above the pubic bone. You do have a more flattened mushroomed out belly button. You may have a hernia beneath there which I could only tell on direct exam. Don't stress about the scar. It is standard of care to mention it at consultation as your surgeon did.

Ralph R. Garramone, MD · Answer

In some patients, a vertical scar just above the horizontal primary scar is necessary to close the circular incision made around the belly button.  In most patients this opening is removed with the skin that is removed.  The skin will only stretch so much and if this area cannot be removed the vertical scar results.

	I have not found this to be a problem in my patients.  The overall results from the tummy tuck are pretty significant and a short visible scar has not been a problem for the patients in who it is necessary.  I do not believe there is anything you can do to the skin to change it.  In my experience, the problem in this area is a prior piercing.  The thin skin bridge created by the piercing then gets over stretched by the pregnancy.  

	Best of luck.

C. Bob Basu, MD, MPH, FACS · Answer

Based on your photos, I would tend to agree with your PS.  Because of your anatomy (meaning your belly button is positioned fairly high on your torso and you have limited excess skin above your belly button), you will likley need a lower midline scar.   One way to eliminated this lower midline scar is to raise your transverse tummy tuck scar much higher.   But I really would NOT recommend that.   In my opinion, its better to keep your transverse scar as low as possible and accept the lower midline scar if you are looking for an improved abdominal contour.   Remember, in the end, when it comes to tummy contouring, the basic principle is that you must accept some degree of scar to achieve that better form.   Best wishes.

	Dr. Basu

	Houston, TX

Ronald V. DeMars, MD (Retired) · Answer

There are no shortcuts to good results. I am sure your surgeon will try to remove the bad skin, but if she feels it would harm the healing, then let her do the vertical scar. It will be very low and should not be a problem. There is nothing you personally can do to thicken or strengthen the skin.

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