Scarless Tummy Tuck - Not!

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


July 09 2008

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Loose abdominal skin and fat – it's not a pretty combination. Sometimes flabby abs may be genetic, or they may be the result of a substantial weight loss or pregnancy. Luckily, there's an operation called abdominoplasty that can create a flat, taut tummy, but not without at least some tummy tuck scars. Fortunately, there is treatment available for surgical scars.

The closest one can get to a scarless tummy tuck is endoscopic abdominoplasty. Like all endoscopic surgeries, this least-invasive technique uses a small camera called an endoscope that allows the plastic surgeon to tighten muscles, suture, and perform liposuction through two or more small incisions in the abdomen. This procedure is reserved for individuals who have weakened lower abdominal muscles and excess abdominal fat, but relatively tight abdominal skin; it cannot tighten loose skin on the stomach. Although the endoscopic procedure is far less invasive than a full tummy tuck, it still requires recovery time. Like a full tuck, surgical drains are inserted in the incisions to prevent a build-up of fluid. Drains are usually removed a few days after surgery. There is some evidence that endoscopic abdominoplasty is more beneficial for men with rectus abdominal diastasis (a gap between the two vertical muscles of the abdominal wall) than for women.

A full abdominoplasty is the most invasive of the tummy tuck procedures and is used for people with very lax muscles, excess amounts of loose skin, and extra fat. There are variations in the full tummy tuck technique, but they generally involve a low horizontal tummy tuck incision just within or above the pubic hair that extends out laterally toward the pelvic bones. Its length depends on the amount of skin to be removed, and the surgeon usually tries to place it within the lines of the patient's preferred undergarment or bathing suit. Skin and fat are separated from the abdominal muscles to a point just below the rib cage, and an incision is made around the navel. Usually the skin and fat below that point are removed. The surgeon sutures together loose underlying tissue and muscles along the centerline to tighten the abdominal wall, similar to lacing up a corset. The skin is redraped, the skin is reattached to the navel in a procedure called umbilicoplasty, and the incision is closed.

If the patient has a minimal amount of loose skin and fat below the navel, a less invasive technique called a partial abdominoplasty, or mini-tummy tuck, often suffices. This requires a short, low horizontal incision and no repositioning of the belly button. A mini-tuck usually does not include any muscle repair.

A relatively uncommon type of abdominoplasty – the reverse tummy tuck – is often performed in conjunction with a breast reduction. This technique uses an inverted V incision just under the breasts. The skin is then pulled up, excess skin and fat are removed, and the incision is sutured.

The vertical scar abdominoplasty, uses a horizontal incision across the lower abdomen and a vertical incision up the center of the abdomen that resembles a fleur-de-lis. This technique is performed on people who need substantial amounts of skin removed and considerable tightening around the waist.

Patients who have lost a great amount of weight through diet or bariatric surgery often end up with lots of excess skin. A dermolipectomy removes the skin and fat and also repositions the belly button, but does not tighten muscles. This technique is for people who have more sagging skin than a mini-tummy tuck is designed to handle. Another option is a panniculectomy.

Following any of these surgeries (as you can see they can't be referred to as "scarless"), patients are told to wear a special garment for several weeks to help support the abdominal area and reduce swelling. The drains are usually removed within days, depending on the amount of accumulated fluids. Stitches generally come out within a week or two. Numbness is common and can continue for months. Tummy tuck incisions fade over time, often to a faint line, but will always be visible to some degree. It may take months for the swelling to subside and for the final results of the tummy tuck to emerge.

Recovery varies from patient to patient and depends on a number of factors, including the technique used and the patient's general physical condition and healing history. Non-strenuous activities are usually acceptable within 1 to 3 weeks of surgery.

The tucked tummy should remain firmer and flatter for many years to come, unless the patient gains or loses a significant amount of weight or becomes pregnant. Eventually, gravity and aging will have their effect, and future corrections may be necessary.