Low Abdominoplasty Scar
Typically the c-section scar is removed with the excess skin at the time of the abdominoplasty (tummy tuck).
While your scar is not visible in the pictures provided, let’s assume it is at the top of your pubic hair.
In that case, the distance between the location of your belly button (umbilicus) and the scar will determine if you need a short vertical scar to close the old umbilical site which could not be removed along with the rest of the excess skin.
A lot of it depends on the degree of skin laxity you have and whether or not you have loose, poor quality skin above the belly button.
In the situation where the skin above the belly button is not too bad or loose, then I recommend a possible mini-abdominoplasty with floating the umbilicus.
This way the transverse scar can be very low and there is no scar around the umbilicus. The muscles can still be tightened (plicated) to give you a flatter abdomen.
Typically I liopsuction the flanks at the time of the tummy tuck to create a narrower waist and it is especially noticeable when you are walking away from someone. Furthermore, it can eliminate the muffin top if you have one. (Douglas L. Forman, MD, Bethesda Plastic Surgeon)
Tummy Tuck Scar Placement
I would suggest placing your tummy tuck scar at the level of your previous C-section scar rather than below it. This is the usual placement.
I cannot tell for certain without an examination, but you appear from your photos to have sufficient excess skin that there would not be a need for a vertical scar. (John Whitt, MD, Louisville Plastic Surgeon)
Tummy tuck low scar below c-section scar
I usually make my incision below an existing c-section scar, unless the c-section scar is extremely low. The tummy tuck scar needs to be 6-8 cm above the top of the vagina. I cannot tell from your picture where your scar is. (Vishnu Rumalla, MD, Dallas Plastic Surgeon)
Low location of tummy tuck scar
Most plastic surgeons try to make the scar at the c-section or below the c-section scar. On your photo, I cannot see your c-section scar. If you have to have a vertical component to the scar, it will be fairly short. In most cases, I do liposuction to the waist and flanks at the time of tummy tuck. Liposuction will give you a better waist line. (Sugene Kim, MD, FACS, Houston Plastic Surgeon)
Horizontal tummy tuck low scar
In your photos, your C-section scar is not visible, however, it is customary to excise the pre-existing C-section scar and to replace it with a low horizontal scar that should be hidden by your underwear. About 85% of my patients receive liposuction along with a tummy tuck. However, you appear to be quite thin. If, indeed you do have liposuction, it will improve the flanks. Abdominoplasty alone does not improve the flanks. (Jason R. Hess, MD, San Diego Plastic Surgeon)
Tummy tuck scar by c-section scar
I always try to remove the c-section scar and place the tummy tuck scar as low as possible to keep it low and hidden in the underwear. This usually can be acccomplished. (Steven Wallach, MD, Manhattan Plastic Surgeon)
A tummy tuck scar can often be designed so as to include the C-section scar, that is the C-section scar would be removed with your tummy tuck and you will be left with a new tummy tuck scar. In some cases, depending on how much excess skin there is, you may also have a small vertical scar. This scar is usually low on the abdomen and may be concealed with a bathing suit bottom. Some limited liposuction of the “love handle” areas may be of benefit in your case. (Andrew P. Giacobbe, MD, Buffalo Plastic Surgeon)
Can c-section scar be included in tummy tuck scar?
The vast majority of the time, the scar for the tummy tuck is what you describe, a horizontal incision. It is usually possible to include the old c-section scar within this. Each patient is different. Best to see a couple board certified plastic surgeons. They should be able to guide you through the process. (Jeffrey Roth, MD, Las Vegas Plastic Surgeon)