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One of the main concerns of tummy tuck patients is the scarring involved.  And indeed, there is no such thing as a minimally scarring abdominoplasty operation when one is talking about the length of the scar, however strategies can be employed to minimize the visibility of the scar.

Is a scar necessary?

The tummy tuck operation involves a direct excision of the lower abdominal tissues to remove excess skin by pulling it downwards. The more skin is removed, the longer the scar. Therefore, by the time you are deemed a candidate for a tummy tuck, a scar becomes necessary to remove the extra tissue that bothers you.

Can I get a mini tummy tuck or laser lipo instead to minimize scarring?

Opting for a mini-tuck will often get you “mini” results, and therefore this is rarely a feasible option if your abdomen needs a regular tummy tuck. You can read more on the mini-abdominoplasty section. Laser Lipo is a great option for many people, but beyond a certain point of skin stretching, or if muscle stretching is present, this won’t be a good option.

In short, a consultation with Dr. Khalifeh will help you explore options other than a tummy tuck, however, once you are deemed a better candidate for a tummy tuck, it is best to accept the length of the scar for the results that a tummy tuck can give you and the other options cannot give you.

Shape of a tummy tuck scar

The shape of the tummy tuck scar is determined by several factors:

  • Initial planning/drawing: Generally speaking, we will start by drawing a midline point in the pubic region, 6-10 cm away from the genital region. From that point, we will start with a gentle curve outward. When the pubic area ends and the thigh/abdomen region begins, Dr. Khalifeh will assess factors such as: skin thickness in abdomen and thigh/lower abdomen region, existing skin folds, amount of skin resection necessary, exsiting bony structure, and clothing fitting on the patient to try to determine the best course to take.
  • Needless to say, there is a wide variety on the optimal course of planned incision between one patient and the other. Dr. Khalifeh is very experienced at maximizing results while minimizing the downside of scar positions. During the initial consult, you may ask him to draw your planned scar, and he will discuss your body’s specific with you while doing so that you can see your planned incision.
  • Skin Tension: The tummy tuck scar shape will then be affected by skin pulling. A tummy tuck involves resection of a good amount of skin, and there will be upward skin tension that can pull the scar upward. This tension can be minimized by some strategies (see below). Finally, in some patients tension can be different from one side to the other based on the patient’s anatomy, resulting in slight asymmetry in some cases.

Minimizing abdominoplasty scar part I: Surgeon strategies

  • Planning the incision to keep it low, avoid large step-off due to different skin thickness, using the patient’s folds where possible.
  • Proper tension by the planning of the resection to create pleasing results, maximizing flap blood flow, creating as even of transition of fat thickness between upper flap and lower skin incison.
  • The incision is closed in layers to minimize the tension, which minimizes the final scarring. Recently, I have favored using knotless-barbed sutures such as quill or stratafix during the layered closure. These knotless sutures can provide a more even spread of tention and they minimize the need for knots, which at the most superficial levels can sometimes contribute to foreign body reaction and be a detriment to the scar.

Example of a knotless suture, which helps tummy tuck scars

Minimizing abdominoplasty scar part II: Patient factors

Some factors depend on patient compliance. For example, smoking or beeing around second hand smoke can be a detriment to healing during a tummy tuck scar. Proper nutrition is also required for optimal healing. It is recommended that one eats plenty of fresh fruits and vegetables during the healing period. Take your prescribed antibiotics. Follow the instructions on incison line care.

Incision line care: the initial period

My recommended incision line care:

  • Day one—Day three: leave initial surgical dressing on.
  • Day three—Day seven: you may change dressings on the long incison site, but redress with Neosporin or triple antibiotic ointment and a thin layer of unfolded gauze. Minimize the use of tape/adhesive, especially on the abdomen. Try to hold the dressings on with either compression garment, undergarment, or tape, but tape to the thigh rather than the abdomen and use as little as possible.
  • Day seven—day 14: use dry gauze only, unless instructed differently at your follow up visit.

Incision line care for optimal scarring: the intermediate period

At after two weeks, we generally recommend:

  • Scar Guard or Scar Away silicone gel strips which can be found on Amazon or at your local CVS
  • Mederma gel around the belly button scar
  • In rare cases of advanced therapy need, Embrace Scar Therapy is recommended. This is reserved for complex cases because of the added cost and difficulty in dressings.

Ethnicity and scarring

Scarring will also differ based on ethnicity.

  • Caucasian scars may stay initially red for a period of one year.
  • African american scars heal with a darker surrounding color, and, although rare, have a higher risk of hypertrophic scar or keloid formation.

M.R. Khalifeh is keenly aware of the importance of the scar and keeps the incision as low in the bikini line as possible while employing the latest surgical techniques to maximize the chance of a perfect scar.

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