Scars are, in a sense, the price you pay for a tummy tuck. A tummy tuck surgery can tighten your abdominal muscles, remove loose skin, decrease stretch marks, and rejuvenate your belly button. But the trade-off is visible scars that may remain after healing. Each patient has to decide if that scar is worth it for them. This blog post will explain everything you need to know about tummy tuck scars - where they’re located, what they look like, and how to minimize them. Keep reading and learn if a tummy tuck is right for you.
Where Will My Tummy Tuck Scars be Located?
The first step in understanding tummy tuck scarring is knowing where your scars will be. This depends on which of the several types of tummy tuck your plastic surgeon performs.
Standard Tummy Tuck
A standard tummy tuck incision is made low on the abdomen, just above the pubic mound. This horizontal incision allows your surgeon to tighten your abdominal muscles and remove excess skin. The length of this incision will depend on how much skin needs to be removed but a standard tummy tuck scar will usually extend from hip bone to hip bone.
A second circular incision is made around your belly button. This allows your surgeon to free the umbilicus from the surrounding skin and fat leaving it attached only to your abdominal muscles at its base. The skin is then pulled down over muscles, and any excess is removed. The belly button is brought out through a new opening in the skin and is sutured into place without changing its location. This step leaves a second standard tummy tuck scar around the belly button.
Modified Tummy Tuck
A modified tummy tuck is a slightly less invasive version of the standard tummy tuck. This surgery is ideal for patients with localized fat and excess skin below the navel and above the pubic area. The modified tummy tuck scar is the same as the scar made in a standard tummy tuck but may be two to six inches shorter. There is no incision or scar around the belly button. The belly button is raised with the rest of the abdominal skin and moves downward toward the pubic bone when the skin is tightened.
This technique only works when the loose skin is limited to the lower abdomen. If the skin excess extends to the upper abdomen, tightening it via a modified tummy tuck won’t work. Stretching the excess skin of the upper abdomen forces the surgeon to lower the belly button to an abnormal position.
Mini Tummy Tuck
A mini tummy only requires a six to nine inch scar across the lower abdomen below the bikini line - the same as a C-section scar. No belly button or other additional incisions are needed.
Though a mini tummy tuck procedure does leave the shortest, best scar, it produces the least improvement of all tummy tucks. Because of the short scar, only a small amount of excess fat and skin can be removed. The belly button can't be improved and only the lower abdominal muscles can be tightened.
In our experience, most patients benefit from a more extensive procedure even though the standard tummy tuck scar is longer.
Extended Tummy Tuck
Following pregnancy, a woman’s skin mainly stretches in the abdomen. But with significant weight loss, the loose skin can extend past the hip bone and onto her back. Tightening the lower back skin requires an extended incision. The scarring is like that from a standard tummy tuck incision but continues across the back just above the buttocks.
Though the extended tummy tuck removes excess skin from both the front and the back, it has several drawbacks. The surgery takes significantly more operating room time than other types of tummy tucks. The healing process is lengthier and tougher. It has a higher complication rate and limits how much skin your surgeon can remove from the abdomen or the back. Most patients are better off with a standard abdominoplasty followed by the removal of excess back skin later.
Fleur de Lis Tummy Tuck
The fleur de lis tummy tuck comes from the French emblem, a stylized lily or iris. The three “petals" of the fleur de lis represent the incisions in this type of abdominoplasty. One scar runs vertically from the pubic bone and rises as high as the belly button or lower breastbone. This vertical incision leaves a visible scar that cannot be hidden by a two piece bathing suit.
Because of the unavoidable and visible vertical scar left by a fleur de lis tummy tuck procedure, we rarely use it. We find it occasionally helpful on patients who have lost substantial amounts of weight and sometimes for women who have had multiple pregnancies. These patients have so much loose abdominal skin that it can be impossible to remove it via a standard tummy tuck incision. With the vertical scar, a plastic surgeon can excise far more loose skin leaving a flatter tummy.
Though more effective, the trade-off of having a long scar on the abdomen that cannot be hidden by a bikini bottom or panties makes this procedure preferable only when no other option works.
How Long Will it Take my Tummy Tuck Scars to Heal?
It often takes six months to a year for scars after a tummy tuck to be fully healed. The scar tissue can appear red and raised for the first few weeks but gradually fade and flatten over time. Some tummy tuck patients may need to wait several years before their incisions are barely visible, but most scars start to fade within a few months.
Types of Tummy Tuck Scar Problems
Your tummy tuck scar will typically heal to be a thin pale line. But sometimes, one of the following tummy tuck scar issues can occur.
Hypertrophic Scars
A hypertrophic scar is raised and darker than the surrounding skin (a red scar in patients with light pigmentation and brown scars in those with darker complexions). They occur when the body creates too much collagen during wound healing, often in response to excess inflammation. The thickened scarring can usually be treated with steroid injections or silicone scar creams.
Keloid Scars
A keloid scar is also caused by too much collagen production in a healing surgery incision. They are also raised and deeply pigmented. Unlike a hypertrophic scar, an actual keloid scar will grow beyond the edges of the original incision or injury. They can be disfiguring and challenging to treat.
Keloids usually need to be surgically removed along with steroid injection and, occasionally, radiation treatment. Fortunately, keloids are much less common than hypertrophic scars.
Atrophic Scars
Atrophic scars are sunken and often pale. They occur when insufficient collagen is produced during healing or when the underlying fatty tissue is damaged or separated. Atrophic scars can sometimes be improved with fat injections or dermal fillers, but they usually need to be cut out, and the resulting wound re-closed.
Widened Scars
A tummy tuck scar can sometimes widen when the incision heals under too much tension. This usually occurs when the stitches are too tight and hold the wound edges together with excessive force.
In tummy tucks, this can happen if the plastic surgeon removes too much skin. The remaining abdominal tissue needs to be pulled too hard to close the gap, and the lower incision heals with excess tension.
Dark Scars
Dark scars can occur when the tummy tuck scar is exposed to too much sunlight during healing. The UV rays increase melanin production in the healing scar. This hyperpigmentation is not caused by an excess of collagen and will not respond to steroid injections or creams. Bleaching creams or laser treatments can fade these, but these must be done cautiously, or they can leave an even worse unpigmented scar.
The second type of dark scar happens when too much blood supply remains after the surgery scar heals. This leaves a pink or even red scar. The blood vessels can be removed with laser treatments to reduce redness. Red scars will not respond to scar cream or other topical treatments.
How to Minimize Scarring After a Tummy Tuck
Surgical Technique
Scar Positioning
Though you can’t predict what a scar will look like after the wound healing process, a surgeon can control where he places it during the surgery. Careful scar placement will make it visible in the fewest possible situations and allow for the most clothing choices after healing.
Our first rule for scar positioning is never to create more incisions than are necessary. Avoid fleur de lis tummy tucks if at all possible. Use modified and mini tummy tucks where they will work.
We position our lower abdominal incisions so that most bikinis will hide them. And we avoid angling the scar upward as we approach the hip bone so it won’t rise above low-cut pants.
We have also modified our umbilical closures to minimize the scar and hide it within the belly button.
Tension Control
A core plastic surgery principle is that too much tension on a healing wound creates a more prominent scar. For tummy tuck surgery, the amount of skin removed from the lower abdomen is critical. Taking too little leaves laxity that compromises the result. But taking too much invites a widened or hypertrophic scar.
There is no formula for determining the perfect length of skin to remove. So, during surgery, we carefully assess the tension at each point across the incision and customize each patient’s excision pattern accordingly.
However much tissue is cut off, a surgeon can reduce tension on the remaining skin by first closing a deeper layer in the fat (Scarpa’s fascia). We do this with a row of buried dissolvable sutures that bring the wound edges together, allowing the tummy tuck scar to heal with less tension.
Drain Avoidance
Suction drain placement is a common plastic surgery practice with tummy tucks. But drains are uncomfortable and annoying for many patients. They also leave scars where they exit the skin.
There is a way to close a tummy tuck that eliminates the need for drains. We use this method and avoid drains (and their scars) in 90% of our tummy tucks.
Aftercare
Your tummy tuck scar will mostly depend on your genetics and your surgeon’s technique, but you need to care for the healing incision properly to get the best possible scar. Here are the dos and don’ts of scar care following abdominoplasty.
Dressings
After plastic surgery, the best wound care consists of keeping the incision clean and covered with a dressing. Your first surgical dressings were applied by your OR team with your incisions still sterile. Leave them on unless you are told to do otherwise. If they get bloody or soiled, let your surgery team know.
Cleaning
Keep your incision clean. Change your dressings according to your doctor's instructions. Avoid dirty environments. The first weeks after abdominoplasty are not the time for gardening.
Do not shower after your procedure until you're told it is safe. Since we don’t use drains, most of our patients can shower around day four after their procedure. If you have drains, showering may have to wait until they are removed. Baths usually aren’t safe for 6-10 weeks after an abdominoplasty.
Tanning
Avoid tanning your tummy tuck scars for at least six months after your plastic surgery. Ultraviolet light can turn a scar brown. Protect your scars with sunblock as they heal.
Activity
Activities that stress the incision or increase tension on it cause more scar tissue. No sit-ups, stretching, bending over, or twisting of your body for six weeks or longer. Wait for your doctor to tell you it is safe to resume such activities.
Diet
Your metabolic rate rises as you heal from surgery. Your body needs adequate calories to recover, and your early post-op phase isn’t the time for intentional weight loss. Eat a nutritious, balanced diet and maintain a healthy lifestyle for the best tummy tuck scars.
Summary
If you’re considering a tummy tuck, it’s essential to understand that scars are a trade-off for the benefits of this surgery. The type of tummy tuck, your surgeon’s technique, and your genetics affect how well your scar heals. Most patients find their scars becoming much less visible with proper care.
If you want to learn more about whether a tummy tuck is right for you, call or text us today. We’d be happy to answer any of your questions and help you make an informed decision about your treatment options. We can also help with problem scars from a previous tummy tuck.
