Board certified plastic surgeon, S. Larry Schlesinger, MD, FACS, explains how a skilled surgeon can perform a tummy tuck resulting in a near-invisible scar below the bikini line. By starting the incision well below the pubic hair line, the scar will still lie below the bikini line when abdominal tissue is pulled down. S. Larry Schlesinger, MD, FACS employs a three-layer suturing system which results in a flat, thin scar healing without redness.
Hi, I’m Larry Schlesinger and I’m a board certified plastic surgeon from Honolulu, Hawaii and the question of the day is “Where is the abdominal incision scar from a tummy tuck?”
Well, first of all, we have to talk about how do we get to that and normally, when your tissue of your abdomen gets stretched out from pregnancy, it not only stretches out the skin above the pubic hair, but it stretches out the pubic hair, too. So if the incision is made at the top of the pubic hair, then what happens is, that scar ends up pretty high, pretty close to the belly button. Not a good thing.
So you want to take anywhere from one inch to even two-and-a-half inches below the pubic hair scar, given that you may or may not have pubic hair, but where it should have been, down to probably about an inch-and-a-half above the separation of the labia, the vertical line that goes down to the labia. At that point, about an inch-and-a-half to two inches above the labia and two sometimes three inches below the top of the pubic hair, there’s where you want to start your incision.
As you go out to the side, the surgeon will keep that incision below what’s called the anterior superior iliac crest. These are your hip bones that you can feel in thin people. So if the scar is kept below that, if the incision is kept below that and the tissue is pulled down tightly, normally if you don’t have too much loose skin below, you’ll keep that scar well within the bikini line.
The whole idea in Hawaii of doing a tummy tuck is to be able to wear a bikini. So we want to pull the tissue down, the loose skin down from above the belly button as well as below the belly button and keep that scar low so patients can go the beach and feel really good about the way they look. Scars are as long as they need to be. We don’t care how long it is, we care how wide it is.
So if you can’t see it, it doesn’t matter how long it is. The whole idea is that the edge to avoid what we call a dog ear where it sticks up and looks bad, to do that, the surgery is done with multiple layers of closure. We close the bottom layer with thread as big as kite string and we’re sewing in the SFS: Superficial Fascial System. Ted Lockwood of Kansas City, unfortunately now deceased, taught us about the Superficial Fascial System. Above that, we use a dissolvable staple, above that we use another dissolvable suture.
And then a lot of guys will just put superglue on them above that. I’m a little bit more cowardly, so put stitches and staples in which come out at 3 days. So that suture line is free of stitches and staples after 3 days. Then we start taping that suture line for about 3-4 months and that gets a flat scar and get rids of the redness very quickly. And that scar is well-hidden below a reasonable bikini.
String bikinis, I can’t guarantee you, but a reasonable bikini for sure would hide the scar well. And we keep it thin. I’m Larry Schlesinger, I’m a board certified plastic surgeon from Honolulu, Hawaii. Thank you very much.