How Much Vertical C-section Scar Can I Remove? (photo)

Question

I'm 2 yrs after final C-section (low transverse-pfannenstiel) & later: midline scar). I really don't want a hip to hip scar. My priority, in order: 1. Flat stomach, so clothed I don't look pregnant 2. remove vertical scar as low as possible (I hope to wear a bikini, or at least low shorts) 3. remake a nicer belly button, which was once nice vertical slit. My skin is fairly tight-how much of the vertical scar can I get out? Full vs mini tuck with internal plication? How to do the umbilicus? Thx!

James E. Chappell, MD · Answer

As you are quite thin and there is not alot of redundant skin, AND you have a vertical midline scar that goes from the Pfan. incision up around and above the umbilicus you have several options:

	1. Do nothing

	2. Mini lower abdominoplasty/liposuction to flatten/tighten

	3. Full abdominoplasty to flatten/tighten skin/tighten muscle/remove laxity above umbilicus and remove at least a portion of the scar around the umbilicus.

	 

	All of these should be discussed at length between you and your BCPS.  You will always have a midline vertical scar of some length, it cannot be "removed".  Whether or not you wear a bikini depends only on you.  I don't make money telling my patients they are "vain," and you do have "things" that can be improved, so I would say things could be improved.  But please realize that except for the scars you have an abdomen (even after 2 pregnancies/C-sections) with which MANY women would be pleased.  Best of luck to you.

Raffy Karamanoukian, MD, FACS · Answer

A tummy tuck can reduce the majority of the scar.  The other option would be to undergo liposuction plus staged surgical scar revision of the vertical scar to reduce puckering and scar indentation.

Ronald J. Edelson, MD · Answer

The best option for you would be a full tummy tuck. that would remove all of the scars you currently have and replace them with one lower a abdominal bikini line scar. On my web site, if you look at my tummy tuck photos, the first case shows a woman who had a vertical scar and how much a tummy tuck was able to I prove it. Good Luck!

Steve Laverson, MD, FACS · Answer

Your abdominal scar is similar to one or more in the photo gallery of San Diego plastic surgeon Dr. Steve Laverson. Not only will you see how much scar can be removed by tummy tuck, but you will see that your fear of a "hip to hip" scar may not be justified.

Erez Sternberg, MD · Answer

First of all, let me commend you on your research, education and photos. This "pre-surgical research" is really important for a highly effective consultation when you meet with a plastic surgeon to discuss your options.

	From reading your concerns and evaluating the photos I truly believe that you will be unsatisfied with anything short of a full TT with revision of the umbilicus and removing as much skin as possible.  This will not eliminate all of your vertical scar, but will allow for creating a new smaller, nicer belly button and revising the vertical scar that will stick out slightly above your pant or bikini line.  All the other scar length (horizontal) will be below your clothes and you will find that your apprehension about the scar may be unnecessary.

	This will afford you the best opportunity to address all of your concerns (tight flat abdomen, new belly button, and removing as much vertical scar as possible) with one surgery.  You just have to have reasonable expectation for the resulting lower abdominal scar.  It will be long, but you can get it lasered afterwards to improve cosmesis even further.  Hope this helps. Good luck.

Curtis Wong, MD · Answer

Thank you for providing photos as they speak volumes of what can be done... and not done.  As mentioned earlier, you cannot remove your entire vertical scar due to your lack of redundant skin as you demonstrate with your tummy relaxed and bending at the waist. 

	You can consider  a mini-abdoiminoplasty that would at least allow lowering of your scar your belly button and liposuction (part of a mini-tuck) can remove the fullness of the lower abdomen and the transverse scar would be removed wtih whatever vertical redundancy you have.  A muscle plication can easily be done with a mini-tuck. Lowering of your scar could allow you to wear a high waisted bottom to cover it, and if your scar heals well enough, you may even feel confident enough to wear a bikini again.

	I encourage you to discuss your concerns and goals fully with your chosen surgeon.

Steven Turkeltaub, MD · Answer

Your photos are helpful but an examination can more definitively provide you with accurate information. It appears that a full tummy tuck with a limited lateral extent of the scar may be a reasonable approach as you already have the vertical scar and given your concerns regarding your belly button and the separation of the muscles. Lowering of your scar is a must and liposuction will further improve your results. (The vertical scar will not be removed though it may be reduced in length and position from above the belly button!)

	A mini tummy tuck will not really provide you all that is needed particularly since you would like an improvement of the belly button and plication of the muscles.

Sean A. Simon, MD · Answer

first of all, I must complement you for photos and analysis of the issues that concern you. After reviewing your pictures, it will not be possible to remove all of the vertical scar (without replacing at least a portion of it with a new scar), as it extends superior to your belly button and as you noted, you do not have a significant amount of skin laxity to work with. A type of mini- tummy tuck may be your best option along with scar revision of the remaining portion, and liposuction to further contour the abdomen. The final decisions will be made after a thorough physical examination by the consulting plastic surgeon.

Vincent D. Lepore, MD (retired) · Answer

Since your vertical C-section scar extends around and above the belly button, it probably won't be possible to completely remove it with a tummy tuck. However, the resultant vertical scar will be lower on the abdomen and I don't believe the horizontal scar will be significantly longer than the one you presently have. Also, the horizontal scar can be placed lower and the contour improved. Given the position of your present scars, I would suggest a full tummy tuck with muscle plication. Best wishes.

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