Vertical incision in tummy tuck
There is a variation of the standard tummy tuck which introduces a small vertical scar in the midline between the pubic hairline and the belly button.
This is occasionally required when you are physically unable to remove all of the skin between the belly button and the hairline. The vertical scar is actually the opening where the original belly button was.
The other variation is to simply lower the belly button on the abdominal wall but you must be careful with this choice as a very low position of the belly button looks unnatural.
A small vertical scar at the hairline is a far better aesthetic compromise than a low belly button.
Some individuals will raise the position of the horizontal scar to get the skin out and avoid the vertical tummy tuck but I think this is problematic. A small low vertical scar can still be concealed in a bathing suit, a high horizontal scar can serious impact your wardrobe.
Seek out a board certified surgeon in your area to help you with your decision. (Robert W. Kessler, MD, FACS, Corona Del Mar Plastic Surgeon)
Vertical tummy tuck incision rarely needed!
I have been doing tummy tucks for 25 years (have done hundreds of them), and can count on one hand the patients in whom a vertical incision was needed. If your skin is so tight that a properly-designed low-incision ellipse cannot be removed and the upper abdominal skin sutured to the lower incision, then you probably didn’t really “need” a tummy tuck in the first place.
As per my colleagues, without photos or direct examination, it is impossible to state with certainty, but I think the majority of us are questioning your surgeon’s assessment (just as your wise mother did). Seek another consultation or two with ABPS-certified plastic surgeons who have years of tummy tuck experience, if only to reassure yourself that your initial surgeon is either correct, or perhaps “ill-informed.” Look at tummy tuck photos and see how many vertical scars you see in the “afters.” Now you know why we are all saying what we are! (Richard H. Tholen, MD, FACS, Minneapolis Plastic Surgeon)
Vertical incision and tummy tucks
You should definitely get a second opinion if you are uncomfortable with your PS plan. Yes it is sometimes necessary to have that vertical incision but I have found them to be quite rare as most people have enough loose skin to reach without the need for the vertical tummy tuck. (Delio Ortegon, MD, San Antonio Plastic Surgeon)
By all means get another opinion if you are not comfortable with the answers you are getting. Although it is rarely necessary to have a lower vertical scar it does happen sometimes. You can eliminate this need by putting the long trransverse scar higher but that just doesn’t make sense if you are trying to minimiZe visible scars. (Ronald V. DeMars, MD, Portland Plastic Surgeon)
Is a vertical scar necessary for my tummy tuck?
Unfortunately, without photos, it is difficult to give you any accurate idea of what you may need. The lower abdominal horizontal incision is the standard tummy tuck incision required for either a full or a lower (mini) tummy tuck. If the skin is only loose below the belly button, that is all that is required.
If the skin is loose above the belly button, the only way of tightening it is to release the belly button so this skin can be pulled down and tightened. A new hole is made in the skin pulled down over the belly button, the belly button pulled through and sewn in and so there is a scar around the belly button. If there is not enough loose skin above the belly button to allow the OLD belly button hole to move down far enough to remove it with the extra skin, then it is closed as a small vertical scar.
Whether you require this small vertical scar is dependent on how much loose skin you have above the belly button to start with, and how long your torso is.
Some plastic surgeons try to avoid this by elevating the main, long tummy tuck incision into a much higher position so the old BB hole does not have as far to travel down and therefore avoid this vertical scar, but I think this is a poor choice. The scar may be too high, the pubic hair may be pulled up too far, etc. (Robert M. Grenley, MD, Seattle Plastic Surgeon)
Vertical Scar Necessary for Tummy Tuck?
Occasionally, a vertical scar is necessary when performing tummy tuck surgery. It becomes necessary if the patient has a relatively short torso or a relatively small amount of “excess skin”. The vertical tummy tuck results from closing of the umbilical opening. The vertical scar allows for closure of the abdominoplasty incision line with less tension and less potential for opening/wound healing problems.
With all due respect to your mother’s opinion, if you wish to gather other opinions I would suggest meeting with board certified plastic surgeons. Every patient’s anatomy is different; your mother’s experience may be based on a small number of “subjects” compared to well experienced board-certified plastic surgeons. (Tom J. Pousti, MD, FACS, San Diego Plastic Surgeon)
Vertical scar with a tummy tuck
If you are not happy with the answers given to you by your surgeon, I suggest that you get another opinion. I generally only add a vertical scar in patients who have had a huge weight loss and have a tremendous amount of excess skin. It is impossible to tell what is best for you without an examination and no photos, however, I virtually never create the scar that you have described. There are a variety of different tummy tucks including full, extended, mini, extended mini, etc. An experienced board certified plastic surgeon who has performed tummy tucks on a wide variety of patients should be able to find a tummy tuck that will work for you assuming that you are a good candidate for the procedure.
Horizontal incision as well?
Since you don’t post any pictures, it would be difficult for me to determine if you need the “third” incision or not. I would say that we, as surgeons, would rather not have to do a vertical incision unless we really needed to. The two general categories refer to massive weight loss patients and those patients with a relative high belly button. The massive weight loss patient has a significant skin excess and generally poor skin tone that a vertical incision is needed to remove all the excess skin. This is called a fleur-de-lis abdominoplasty. The latter category refers to the high umbilicus and the inability to remove enough skin to hide the umbilical scar. Therefore, there may be a small vertical extension to the usual scar. So I would guess that if this is the recommendation by your surgeon, then you fit into one of the above situations. (Tito Vasquez, MD, FACS, Southport Plastic Surgeon)