Can I Get A Full TT With No Vertical Scar?

I am 5'4 and weigh 120lbs. I have had 3 babies and a very disciplined workout regimen. I want a tummy tuck since I have some loose skin and relaxed lower abdominal muscles. I am a candidate for a full TT. I had two surgeons say my insicion would be hip to hip w/a vertical incision. However, one surgeon says he would give me a full without the vertical, and although my scar may be initially higher, he would bring me back in 6 months later to do a revision and lower my scar. Is this true?

Doctor Answers 25

When you have little excess skin, a tummy tuck requires a short vertical scar.

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1)  You do not have much loose skin.  Your main problem is muscle separation that needs to be repaired.  To expose the muscles, you need to make a little belly button incision.  When there is a lot of skin, that incision is simply pulled down and removed.  But in your case, it will have to be closed as a short (one inch) scar above your pubic area.

2)  Whatever you do, do not have a "mini" tummy tuck.  This will not correct the upper muscles, and you will be unhappy.

Manhattan Plastic Surgeon

Tummy tuck without vertical scar

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The components that need to be addressed and taken into considerations in a tummy tuck are the following:

1. Amount of excess skin
2. Degree of abdominal muscle diastasis (muscle separation)
3. Excess abdominal skin
4. Location of abdominal scar, if any
5. Location of belly button

Although without a physical exam I cannot give you a final recommendation, your main problem is diastasis of the muscle. I cannot tell if the excess skin is in the lower abdomen or around the belly button  based on the picture. If the excess skin is around the belly button and you want to have a low scar, then, the only way to do this is by leaving a small vertical scar between the belly button and the horizontal scar of the tummy tuck. This vertical scar results from the closure of the previous location of the belly button. If the excess skin is in the lower abdomen, then, you do not need to have a full tummy tuck scar. Basically a horizontal incision is done to access the abdomen wall and plication (suturing of the muscle) is done through this incision. Excess skin is removed and the end result is a horizontal closure without a vertical incision. Now, for this to work you cannot have excess skin above the belly button.

Different patients require different approaches. A thorough physical exam will provide the answers to your questions.  The truth is that each procedure has it pros and cons.

Tummy Tuck with or without a vertical scar

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From your photos, you appear to have very little excess skin below the belly button.  A traditional tummy tuck ususally removes all the skin between the belly button and the "bikini line".  That would not be possible with your anatomy.  However, your tummy tuck could be completed without a residual vertical scar by not cutting around the belly button, and freeing its stalk from the abdominal wall.  The muscles could be repaired (if needed) and the excess skin could also be removed.  Your belly button would placed be approximately 1-2 inches lower, and still give you a natural looking abdomen with the final incision in the bikini line.

Ricardo Izquierdo, MD
Oak Brook Plastic Surgeon

Tummy tuck scar and making it as small as possible

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In the majority of the tummy tucks I do, there is only the lower horizontal scar and not a vertical one. I try to make as few cuts as is necessary and achieve the best result. With vertical scars, it would be difficult to wear a two piece bathing suit. 

Abdominoplasty incision choice

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A tummy tuck is not a one standard procedure.  Every patient requires a unique approach.  You do have a rather unique situation, namely high umbilicus, more loose skin in lower abdomen than upper abdomen, relatively thin body habitus and loose abdominal muscles.  You are an ideal candidate for a modified abdominoplasty with “umbilical float”.  This is not a mini-tummy tuck.  It involves repairing all the muscle damage, tightening your loose skin and still allowing for a low bikini incision.  Ask your surgeon about this approach.

Tummy tuck scar

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It is difficult to determine if a vertical scar would be necessary without it fizzles emanation. In general, however, with your body type the options are:

1.No surgery.

2. Abdominoplasty with higher incision to avoid vertical scar (with 2nd stage lowering of scar if desired).

3. Abdominoplasty with lower incision and use of vertical incision (to close umbilical  opening).

I hope this helps.

Full tummy tuck with no vertical scar

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This is a very difficult question to answer with just photos, as the question comes down to how much extra skin you have and how lax it is .  Having said that, there are several points to consider. First of all it is imperative to keep the abdominoplasty scar as low as possible.  Your first operation is the best chance to get this correct.  As for the possible vertical scar- two of the plastic surgeons who did examine you felt that they could remove enough skin so as to avoid the vertical scar.  i would believe them as i find that it is extremely unusual in my hands to end up with a vertical scar.    Dr. Brown 

Donald M. Brown, MD (retired)
San Francisco Plastic Surgeon

How to avoid the vertical scar and risks of too high a transverse scar

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Most of the revision tummy tucks I have done are due to the original transverse scar being too high, and often accompanied by an umbilicus that is too low. This is a situation that is hard to correct, and can be due to an effort to remove the umbilical donor site that would otherwise be closed as a small vertical scar. It is better to have a small vertical scar than a transverse scar that is too high and visible.

There has to be at least 10-12 cm between the umbilicus and the lower incision to look right and that lower incision has to be just above the pubic hairline in order for it to be covered by underwear and bikini.

If there is sufficient laxity with skin pinch above the umbilicus of 8-9 cm before surgery, it is usually possible to remove the donor site hole of the umbilicus with all the skin that is removed, thereby having no hole to close as a short vertical scar in the lower abdomen above the pubic area.

The most important part of the planning is making sure that the transverse scar will end up hidden by the bikini or underwear. The planning has to take into account that the tension pulling upward on the closure will elevate the scar into a visible area of the lower and lateral abdomen unless the pubic area and anterior thigh are first pulled up and then the future scar line marked in the underwear/bikini line.

Once the surgery is done, the distance from the umbilicus and pubic area is usually fixed, since all the laxity has been removed.  This makes it difficult to go back later and remove more skin, including a vertical scar. All you can do then is shorten the distance from the pubic area to the umbilicus which is cosmetically unattractive and undesirable.

Bottom line:  accept a small vertical scar if it is really necessary because there is just not enough laxity in the abdomen to allow removal of the umbilical donor site. Secondary revision to remove the vertical scar is only possible if there is enough residual skin laxity which may develop over a period of months to remove the scar without shortening the visible distance from pubis to umbilicus.

With the high-lateral, high-superior tension technique I use and taking into account upper abdominal skin laxity pre-operatively it is highly predictable which patients will be able to have a closure without a vertical scar.

TT without vertical scar

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From your photos it doesn't look like the skin at the top of your navel os going to make it down to your lower abdimnal crease (suprapubic crease). If it doesn't than you have a few options. 1. Accept the lower vertical scar. 2. have the surgeon raise the whole horizontal scar. Not my preference since now your entire scar will be too high. 3. have a modified tummy tuck. this is where the entire skin can be lifted, the muscles tighted and the belly button either lowered or "disconnected" and put back in its original place. Hope this helps.

Tummy Tuck Scar

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In agreement with the surgeons you saw, because of your relatively short xiphoid to umbilical distance and longer umbilical to symphysis (pubis) distance, and the type of string bikini you like (which demands a lower scar), your situation is not routine, and begs for a less conventional solution. There are always trade-offs. I agree with Dr. Khoobehi that floating your belly button to avoid the vertical scar may be the best choice.

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.