Scar outcome after tummy tuck. How can someone get a thin scar vs. a scar that has widened and stretched?

A thin scar in a tummy tuck starts out with a meticulous closure consisting of bringing the deep layers together with some tension so there is no tension at the skin surface. Then the skin is sutured with small bites of rapidly absorbable suture as precisely as if it were a facelift closure, resulting in a perfectly pencil thin line.
Because tension is the primary contributor to unfavorable, thick, or wide scarring, it is necessary to prevent tension at the skin surface. I prefer to do this pre-emptively by advancing the upper flap and suturing it to the abdominal wall with "progressive tension sutures". This is what is done during a "drainless" tummy tuck. To close off the space where fluid can accumulate, the flap is progressively sutured to the abdominal wall with barbed sutures, like closing a zipper, and each suture fixes the flap in place so no tension can be transmitted to the flap in an upward direction, away from the incision (scar) line. Where the closure terminates at the incision line, the top and bottom are just sitting there, kissing, without any tension on the skin. Then I place sutures in the deep layer, the superficial fascia, that is a layer with a fibrous network that can hold tension, and snug this up, so the flap and lower side are brought together resulting in a little hill. That removes all tension on the skin. The incision hill relaxes over the next two months, the time that the scar is forming. During that time, there is minimal tension on the skin layer, so the scar can remain as thin as it was when it was closed in surgery.
Genetics can defeat the best , tension-free closure, and give a raised scar or hypertrophic scar. However, setting up the conditions for optimal scar-healing allows every patient their best chance at favorable, fine-line healing. There is a commercial device called Embrace that works on the principal of removing tension from the skin during the first two months post-op. It is a stretched, sticky piece of silicon that is applied along the tummy tuck incision, starting 2-3 weeks after surgery. It grabs the skin above and below the incision and pulls it toward the incision, relieving the tension on the healing incision. It helps, according to the pictures they show. However, it has been my idea that relieving tension on the skin with the method described above, is better, and makes it unnecessary to use an after-the-fact treatment. My patients may want to enhance their scar quality even more by adding embrace, but before embrace, I never saw wide or stretched scars, so I don't know if it is adding anything.
The problem with the way tummy tucks are usually done, is that after the excess skin is trimmed, the flap is pulled down and sutured with the maximum tension to smooth out the skin. All that tension is then focused on the closure with only the attachment of the belly button acting as a tension-relieving point half way between top and bottom. Naturally, all that tension, exactly where you do not want it, will lead to unfavorable conditions for healing with a fine scar. If the surgeon can use the deep layer, the superficial fascia in such a way that most of the tension is taken up there and the tension at the skin layer is minimal, then there is a chance that the scar will heal well.
Since I like to make things more predictable, I just relieve all the tension on the skin before I close it, then do as careful a job as I can to make it very even and flat from end to end.

Hello and thank you for question! There are a number of ways to optimize post-op wound healing. Resting in a flexed position for 2-3 weeks post-op helps to ensure tension free wound healing, and thus better scar outcomes. Additionally, silicone tape or Biocorneum scar gel are both effective ways at helping achieve maximum aesthetic healing potential. Also, avoiding strenuous activity, properly utilizing the abdominal binder and compression garments, and avoiding sunbathing for 1 year post-op are also all good techniques to try and achieve best scar outcomes. As always, making sure to listen to your surgeons instructions will be of the utmost importance. Hope this helps!

Your question addresses a crucial aspect of tummy tuck recovery – scar healing and management. While it's impossible to "guarantee" a perfect scar, there are several ways we can optimize the chances of a satisfactory outcome.

Tension Management: Excessive tension on the incision can contribute to a wider or thicker scar. Skilled surgical technique can minimize this tension, and patient behavior, such as avoiding standing fully upright too soon, can help.

Individual Healing Factors: Each patient's body heals differently, and genetics play a significant role in scar formation. While this is out of our control, we can still use techniques to optimize healing.

Scar Care: Postoperative scar management is vital. This includes avoiding sun exposure, massaging the scar once healed, and potentially using silicone sheets or gels.

Healthy Lifestyle: Maintaining a healthy lifestyle can improve healing. This includes proper nutrition, avoiding smoking, and moderating alcohol consumption.

Follow Up and Intervention: Regular follow-up visits are crucial. If a scar appears to be healing poorly, early intervention can help manage the situation.

In short, achieving a thin, minimal scar is a combination of skilled surgery, careful post-operative care, and a healthy lifestyle. A frank discussion with your surgeon about these factors can help set realistic expectations about your scar outcome.

Sincerely,

Dr. Katzen