Will a Tummy Tuck Scar Drop over Time?

Tummy tuck scars are more likely to drift in an upward direction rather than downward. This is due to the upward pull on the scar from the upper abdominal flap. It's possible your surgeon feels the postoperative swelling is making the incision placement appear displaced, and once it goes down it will be in a slightly different location. I'm not sure that will happen, but in any case, 3 weeks after surgery is too early for any revision. I would recommend allowing time for your incision to heal and the swelling to subside. I would suggest giving it at least 6 months before any revision.

It is unlikely that your scar will drop.

However, as it fades it will be less of a problem for you. Most patients make a few clothing adjustments to keep the scar concealed, and I rarely hear any complaints about the scar.

Remember that the final scar location is determined by the 'tug-of-war' between the tissues above and below the incision. It is not always possible for the surgeon to guarantee its final position.

I doubt the scar will drop much .  It has been my experience that they tend to rise some as the patient straightens out. In general,  I like to see at least 4 inches between the umbilicus (belly button) and the top of the scar - more if possible.  Scar position is one of my 3 "keys" to a good tummy tuck.

Tummy tuck scars tend to stay where the surgeon placed it or it might rise. If the scar is too high now, it will not drop. Depending on the tension across the incision, the scar usually tends to rise. I place my suprapubic scar 6cm above the convergence of the labia majora and also use suture fixation internally to prevent the pubic area being pulled up into the lower abdomen.

If your scar is too high now, it will not 'drop' into a better position over time. It was likely placed too high to begin with, and the tension created by TT closure promotes an upward 'drift' of TT scars. I try to place my TT scars as low as possible, relying on the zones of adhesion along the groin area to limit the migration of the scar upward.

Scars for a tummy tuck will end up roughly midway between the upper incision (usually just above the umbilicus) and the lower incision.  Sometimes if the upper abdomen releases more than anticipated, the scar will be a bit lower, for example if the patient has had a lot of scarring from a prior liposuction procedure, or has a great deal of upper abdominal looseness.  But generally, the incision ends up slightly higher than midway between the umbilicus and the lower incision.

So why wouldn't every doctor just make a really low incision, therefore ending up with an ultimately lower final scar?  Because it is not always possible to take out everything between the very low scar and the umbilicus, especially in fit women who do not have have a lot of loose skin.  A highly reputable doctor will do everything possible to get a low scar.  A lazy or unqualified one may not; I have seen many cases where doctors do not do a sufficient dissection on the upper flap, and therefore the downward mobility is limited, raising the ultimate scar.  A wise doctor will also not close things too tightly:  this will lead to a wide, unsigtly scar.

In fact, ironically, fit patients end up with higher incisions when they have a conventional tummy tuck!

Location of incisions is important, so doctors and patients should discuss frankly where the incisions will end up.  Scar position generally does not change, but scars usually lighten considerably, especially with laser therapy, creams, etc.

Now, there are many in-between short scar procedures that can be used that are neither mini tucks nor full tummy tucks that can allow lower placement of the incisions but still enable full tightening of the fascia.

Thank you for your post. It is not common for surgeons to anchor the lower incision to the fascia or covering of the abdominal muscles to keep the scar low, however, I do use this technique and agree with it. All the tension on the incision is from above, not below, and thus the scar tends to move toward the area of maximal tension (towards the ribs/bellybutton). This moves the scar higher than desired. I like to keep my scars very low, and feel that anchoring the scar helps accomplish this. The following photo is an example of this.

Once the horizontal tummy tuck scar is set at the completion of the procedure, it largely is not going to change after it heals. It most certainly will not drop and may slightly raise up a bit. (although not much) Although tummy tuck closure appears to depend completely on the upper skin flap being brought down to the lower incisional edge above the pubis, it is not really a complete unidirectional tissue shift. Depending on whether it is a mini- or a full tummy tuck and what the quality of the remaining abdominal skin is like, tummy tuck closure is a bidirectional tissue shift that may range anywhere from 95:5 to 85:15 ratio between the shift of the upper and lower abdominal skin flaps. This has to be factored into the initial incision marking and where the patient can accept the final tummy tuck scar location. Unfortunately, the lower abdominal skin flap (incision to pubis) is not a fixed structure and it will move upward to some degree as the final closure is done.

Picking a location for the tummy tuck incision site take s some practice and experience.  In general its nice to have the incision as low as possible because then it can be hidden in nice lingerie, undergarments or swimwear.

If your surgeon based the incision on the underwear location and didn't  take into consideration displacement of the skin with the procedure then sometimes it will end up riding higher than anticipated.

If there is still ( hopefully) some redundant excess skin in the tummy /abdominal area , some surgeons can lower an abdominoplasty incision by creating an incision lower than the  the initial incision and remove  the skin in between the first incision and the new lower incision.

Good Luck to you.

 

Kimberly Henry M.D.

San Francisco, CA

Many changes do take place over the first three months after surgery and maybe even some "drift" of the scar, but not much.  Everything is still tight and swollen now and as this decreases you will have a much better idea of the final result.

After things have completely relaxed a few months down the road there may be enough looseness to move the scar down some more.

Interestingly in marking the tummy tuck incision line it is important to pull the skin up tight in the area and then make your mark, because all of that area is going to pull up at surgery just like the skin in the upper abdomen will pull down.