What Type of Tummy Tuck Surgery Necessitates a Vertical Scar As Well As a Horizonal One?

Question

I have seen pictures of tummy tuck after photos and been concerned by the small vertical scar I see in some along with the expected horizontal scar. Are these scars a normal part of the procedure or due to some other type of repair? Also, are there always scars around the belly button and why are these so hard to see in the after photos while the horizontal ones are so pronounced?

J. Jason Wendel, MD, FACS · Answer

Thank you for your questions.  The small vertical scar that I think you are referring to is the vertical scar that is closed where the skin used to be around the belly button. Depending on how long or short someone's torso is and the amount of extra skin, not all of the skin between the belly button and pubic region can be removed.  A short vertical scar is sometimes necessary to close this area.  This is not common but does happen at times.

	The horizontal scars are more noticeable than the belly button scar because of scar length and location.

	I hope this helps.

Brent Moelleken, MD · Answer

The tummy tuck with a vertical incision is a good method for treating patients and avoiding a hip to hip incision.

	It allows the surgeon to lower the incision and make it shorter.  The tradeoff is a small vertical incision.

Nicholas Tarola, MD · Answer

Thank you for your question.  For most people, the standard tummy tuck scars iinclude a horizontal scar at the lower portion of the abdomen and a circular scar around the belly button.  However, when a person does not have a significant amount of excess skin of the abdomen and/or has a very short torso, the surgeon is not always able to remove the whole cut in the skin around the original position of the belly button.  That hole is pulled down and moved to the lower portion of the belly and is ultimately closed as a small vertical scar.  Whenever patients consult with me to discuss a tummy tuck, I always mentioned the possibility of a small vertical scar even if I think they will likely not have one following surgery.  It is always best to discuss all possibilities so that our patients are not surprised following surgery.  I hope this information has been helpful.  As always, consult with board certified plastic surgeons to discuss your options.  Best wishes!

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.

Barry L. Eppley, MD, DMD · Answer

There are several indications for the use of a vertical scar in a tummy tuck. There are useful after large amounts of weight loss usually after baristric surgery, when there is a pre-existing vertical scar from a prior ob-gyn procedure and in some forms of a mini-abdomioplasty when the desire it to keep the scar very low or avoid a horizontal scar altogether. It is not common after most forms of a tummy tuck but has a role to play when the benefit of extra skin removal provided by the vertical dimension is more valued than the vertical scar.

Peter E. Johnson, MD · Answer

The very small vertical scar you occasionally see after tummy tuck indicates there was not enough skin laxity to bring the skin from around the 'old' belly button down to meet the low closure line above the pubis. To avoid this something must be compromised, the scar must be raised, or the closure too tight. We prefer to keep the transverse scar low, without too much tension over the pubis.
	Best of luck, Peter Johnson, MD.

Stephen Delia, MD · Answer

Most tummy tucks (abdominoplasties) will result in a horizontal scar, usually concealed within the underwear garment as well as a scar around the belly button. Sometimes there may not be enough skin laxity to remove all of the skin below the belly button. In these cases, part of the closure may be vertical in the midline (in addition to the horizontal closure) in an effort to avoid an exessively tight closure and wound healing problems. This small midline scar can sometimes pucker in and extend beyond the undergarment.

Ronald H. Stefani Jr, MD (retired) · Answer

When a full tummy tuck is performed, the primary goal is to remove all loose skin and fat from the level of the belly button down to the pubic hair area which is where the final scar will be. If there is enough laxity the original opening of the belly button can stretch down to the level of the final scar. If there is only mild laxity of the lower and mid abdomen then the circular opening from the original circle cut around the belly button may only make it part way down. If that is the case then the final scar will be a lower abdomen horizontal scar with a small vertical scar in the midline, resembling the shape of an upside down T. The vertical scar addition may be determined to be more favorable then trying to over stretch the abdominal skin downwards as too much tension can lead to wound healing complications. I hope this information is helpful.

E. Anthony Musarra II, MD (in memoriam) · Answer

A standard tummy is done to remove excess skin and tighten the abdominal muscles.

	Understand the problem is a 2 dimensional one with the skin being loose horizontally

	and vertically.  A standard tummy tuck removes the excess skin that is horizontal.  Usually

	there is not enough vertical laxity to worry about, except in patients who have large amounts

	of skin in both directions.  We usually see this is massive weight loss patients.

	That will require a vertical incision to remove the vertical excess in addition to the

	horizontal excess.

	There is usually a scar around the belly button because the belly button usually is not moved

	itself, only the skin.  In the ideal tummy tuck, the opening in the skin that is the result of cuttng

	around the belly button comes out when the excess skin is cut out.  Sometimes this is not possible

	so the opening has to be sewed up leaving a small vertical scar between the belly button and

	the low horizontal scar.  In some cases there is not scar around the belly button because the belly

	button is separated from the muscles and move downward about an inch and reattached to

	the muscle.

Margaret Skiles, MD (retired) · Answer

I am assuming that you are referring to a vertical scar in the middle of the lower part of the tummy that is connected to the horizontal, hip-to-hip scar and there are two possible reasons for this. The most common is that there was not enough skin to be able to pull the site of the old belly button down to where it would be removed. This usually leaves a small approximately 1 inch scar in the midline. The other reason is to remove excess skin in the side to side direction. The horizontal scar is from removing skin in the up and down direction (that extra roll that you can grab when you sit down). If you can grab a lot of extra skin up and down in the middle ( think one hand grabbing above the belly button and one below), this extra will not be removed with a horizontal incision but only vertical. This is usually only necessary after large weight loss, for example 50-100lbs. I hope this helps you understand and answers your question.

What Type of Tummy Tuck Surgery Necessitates a Vertical Scar As Well As a Horizonal One?

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