Vertical scar along with horizontal scar?

Question

I was so excited about getting a consult today in regards to a tummy tuck. The surgeon mentioned that because my belly button tends to be on the higher side, I may have a vertical scar along with the horizontal scar. Has anyone had this before? How big is the scar? Is it visible? Why would a vertical scar be needed? I plan on contacting my surgeon for further clarification, but was wanting to get some insights. Please break it down in layman’s terms.

J. Timothy Katzen, MD, FACS · Answer

Thank you, a777749, for your question regarding the vertical scar your surgeon mentioned in addition to the horizontal scar from your tummy tuck. It sounds like what your surgeon is referring to is the scar that can sometimes result from where your belly button used to be before it is repositioned during the procedure.

In a traditional tummy tuck, the surgeon removes excess skin from the lower abdomen, and the belly button is usually repositioned. The vertical scar you’re concerned about is likely from the old belly button site, which is often closed as a small vertical scar after the procedure. This scar typically isn’t very large, as it’s only necessary to close the area where the belly button was moved from, and its size depends on how much skin is being removed.

Is the Vertical Scar Noticeable?
This vertical scar is usually small and fades over time. Many patients find that with proper scar care, such as silicone scar treatments or laser therapy, the scar becomes less noticeable as it heals.

If you have concerns about the visibility or size of the scar, I recommend speaking with your surgeon for further clarification and to discuss potential options for minimizing its appearance.

Sincerely,
Dr. Katzen

Ira H. Rex III, MD · Answer

A vertical scar may be needed if you have a high bellybutton or good skin tone.  If you pull the skin flap too far downward, you can have circulation and healing problems and even dead tissue.  Your plastic surgeon makes the decision on how much they can stretch the flap safely.  If it stretches far, the bellybutton donor site is removed with the extra skin.  If it does not stretch far, the bellybutton site remains as a vertical closure.  This usually heals to look like a stretch mark or thin white line.  It often will not even show above a bikini line.  You have the right idea to return to your surgeon so you understand this better.  The extra small scar is usually very small trade-off for the major improvement you can usually expect from a tummy tuck.

Daniel Barrett, MD · Answer

Dear a777749,
it is hard to tell for sure without an examination. Generally speaking, if you don't have much loose skin then you might need vertical incision. If you are considering surgery, you need to discuss all this in details with your plastic surgeon.. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Jeffrey M. Darrow, MD · Answer

First, some facts. Some peoples bellybutton sits slightly higher on their abdomen than others. Second, some people seeking a tummy tuck do not have that much loose skin to remove.  Third, ideally when evaluating somebody for a tummy tuck, the thumbs are placed just above the top of the pubic hair, and the fingers placed just barely above the TOP of the belly button and pinching the fingers together should be relatively easy. If it is, this means that everything between the fingers can be removed, and this means that the skin from the upper abdomen will stretch downward to the lower portion of the abdomen. During a tummy tuck, an incision is made around the belly button, and the bellybutton stock is left in place. This means that there is now a hole in the abdominal skin.  If the skin at the top of that hole can easily be brought down and sutured to the skin just above the top of the pubic area, this skin hole can be removed because it lies within the excess skin that will be removed and, once the incisions are sutured closed, you would only have a lower abdominal incision, and your belly button would be brought out through a new opening created in the upper abdominal skin which has been pulled downward. However, if the opening created in the abdominal skin by cutting around the belly button CAN NOT be removed when the abdominal skin is pulled downward, it must be closed as a small (3-4 cm) scar which is positioned some distance above the lower horizontal scar.  Choosing this option allows the horizontal scar to be placed as low as possible.  For patients who do not wish to have the small vertical scar above the horizontal scar, and they are not fully intent on having their horizontal scar as low on their tummy as possible, it is possible to shift the position of the lower horizontal scar upward so that the skin just above the belly button could be approximated to skin lower on the abdomen without too much tension.  One final option is an “umbilical float“. In this procedure, no incision is made around the bellybutton, but when the abdominal skin is elevated and pulled inferiorly, the stock of the belly button is cut underneath the skin, where you can’t see it, and the belly button is moved lower as the upper abdominal skin is pulled downward and sutured back at a slightly lower position.  I hope this increases your understanding. Best wishes.

Gary M. Horndeski, MD · Answer

If you do not have much excess skin then when the skin is pulled down vertically, the site of the previous belly button will end up slightly above the new closure line. The scar is usually in the order of 1/2 inch to an 1 inch at most. Unfortunately, you have not provided photographs but there may be another way to do your surgery without the vertical scar. I would need a front view & both side view photos of your abdomen to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

Sometimes when a patient has a long torso a small vertical incision is needed in addition to the horizontal scar.  The vertical scar represents the incision that was made around the existing belly button.  This incision is short in length and will be pulled as low as possible.  I encourage you to discuss it further with your surgeon.  She/He should be able to demonstrate approximately where the scar would be located based on your anatomy.

Darryl J. Blinski, MD · Answer

Since you did not post photos, very difficult to give an accurate answer, but usually when this is told to a patient, they have a deficiency of the amount of skin to be removed in the tummy tuck thereby a small vertical scar in the midline area above the horizontal scars placed or an island Skor Virtual consult fees for the surgery range from $8000-$20,000. Again, best of virtual consult with.

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