According to the American Society of Plastic Surgeons, tummy tucks are among the top five most common cosmetic surgeries among women. As telling as the statistics are, what they don’t share is just how much scarring can occur as a result of the of this surgical procedure. For that reason, we chatted with a few plastic surgeons to determine what kind of scarring you should expect from a tummy tuck. So, if you’re seriously considering going under the knife or if you’re already on the other side of the procedure, keep reading to learn what type of scarring to look out for.
Meet the Expert
- Dr. Suzanne Trott is a double board-certified, Beverly Hills-based plastic surgeon.
- Dr. Steve Fallek is a board-certified plastic surgeon at BeautyFix Med Spa in Manhattan.
- Dr. Farah Naz Khan is a Dallas-based, board-certified plastic surgeon.
- Dr. Bryan G.Forley is a board-certified plastic surgeon specializing in plastic and reconstructive surgery.
What Kind of Scarring Should You Expect Following Tummy Tuck Surgery?
As Trott puts it, “A tummy tuck, like a breast lift or reduction, is trading a shape for a scar.” This is to say that, if you’re planning on getting a tummy tuck (or if you’ve already completed the procedure and are embarking on the healing process), you should expect (and prepare for) scarring. Of course, the type of scarring you experience will depend on the placement and technique of your procedure. With that in mind, keep reading to learn which type of scarring to expect for each tummy tuck area: belly button, lower abdomen, and pelvic area.
If the most you know about tummy tucks is that they shrink your lower abdomen area, you may be unsure how belly buttons have anything to do with it. As it turns out, however, they’re often one of the focal points of tummy tuck scarring.
“In a traditional tummy tuck, the belly button (still attached to the deep abdominal wall) is brought out and inset through a new opening created in the skin flap, directly over its location,” Trott explains. As a result, she says that the patient winds up with a scar surrounding the belly button—in addition to scarring between the lower abdomen and pelvic area. That said, she reassured that the belly button scar is usually not visible thanks to being "tucked" or "pulled in" by the tightening of the abdominal wall, and it usually winds up on the inside.
That said, not all tummy tucks feature belly button scarring. In mini tummy tucks—think: less fat and skin, and smaller incisions—belly button scars can be avoided altogether.
“Usually when I am doing a mini tummy-tuck—where less skin is removed—if the patient has a high [navel], I do something called ‘floating’ the belly button where it stays attached to the skin flap and is re-connected a little bit lower on the abdominal wall.” When Trott performs these procedures, she says the belly button is still the same as it was before and, as a result, there’s no scar around it. “This is also a good time to fix an umbilical hernia, which is not uncommon after pregnancy,” she adds. “Since there is not a lot of tension on these scars, mini tummy tuck scars usually heal thinner and faster with less discoloration.”
Here’s the area that most people think of when they think of tummy tucks: the portion of the belly laying between the belly button and pelvic area.
“No matter what type of tummy tuck you have (full, mini, etc.), you will be left with a scar running horizontally across the lower abdomen between the hips, a couple of inches beneath the belly button,” says Fallek. “The length of the scar varies from a couple of inches to the entire length of the abdomen, sometimes extending up and over the hips to the back.”
Given the expansive scarring potential, Khan says to really evaluate whether a tummy tuck is necessary or if another treatment may prove more effective and less invasive. “The tummy tuck scar is a big scar so if patients simply have a little bit of excess skin with primarily excess fat on their tummy, I recommend they undergo liposuction with BodyTite by InMode,” she says. “Liposuction removes the excess fat and BodyTite allows for intense skin tightening so patients get both fat removal and skin tightening with just a couple of small (less than one centimeter) scars that are easily hidden.”
Given most surgeons will give their patients the opportunity to place their scars as low as physically possible, oftentimes tummy tuck scarring primarily resides in the pelvic region. This way, the scar can be fairly easily concealed beneath underwear and bathing suits. If you're concerned about the visibility of your scar, ask your surgeon if a pelvic scar is an option for you.
Tummy Tuck Scar Healing: What It Looks Like and How Long It Takes
Regardless of the locations of the scarring, healing remains roughly the same. It’s a continuous process that takes at least a year to see real progress.
Trott says that tummy tuck scars—regardless of their location—usually heal really well and are barely visible by a year. “However, if your scar is still red at a year, give it more time!” she encourages. “My experience is that the scar fading process can last up to eighteen months.
“The scars start out as what looks like nothing—invisible!—because they have just started healing,” Trott continues. “They don't start thickening or turning red or brown or discolored until about a few months postoperative.” While this might be initially alarming, Trott says that the color change occurs due to the scar knitting together over time, which is an inflammatory process. “At six weeks they are usually about 50 percent normal skin strength, and at a year 80 percent normal skin strength,” she adds, noting that scars are usually their reddest/most discolored from a few months to about six or seven months postoperative.
Trott says that the amount of tension placed on a scar while it’s healing can play a role in its appearance. For that reason, ultra-tight clothing and intense stretching following a tummy tuck aren’t always advised.
Since scars typically start out lighter and then get darker before fully healing back into a lighter state, Trott says that patients often feel quite dismayed because “It looked so good before!” But Trott says that once the scars are fully healed—which typically takes place a year to a year and a half out—they can appear almost invisible. That said, she notes that folks who experience thicker scarring may never reach that invisible state.
According to Trott, the main determinant in how a tummy tuck scar heals is really dependent on how the patient heals. “Usually, patients who develop keloids or hypertrophic scars already know that they don't scar well from other scrapes or surgeries,” she says. Darker skin tones tend to be more at risk for thicker scars, and light skin tones tend to be more prone to red-toned scars, so be sure to ask your surgeon to be extremely frank about the type of scarring you specifically should expect.
At the end of the day, Forley says that given tummy tucks are elective surgical procedures, the scars are designed to be as favorable as possible—as opposed to a scar resulting from an uncontrolled traumatic injury. “A favorable scar is characterized by a fine line that is flat, non-tender, and not discolored,” he says, acknowledging that in the initial stages of healing, discoloration is normal. All this is to say, the overall outcome of the scarring is largely dependant on the healing capacity of the individual patient. “This is genetically determined and plays a role in the final appearance of the scar,” he concludes.
The Healing Stages
- Closure. Whenever your skin is broken, as is the case with incisions made during your tummy tuck surgery, Fallek says that your body creates collagen fibers to fill it in and close it. This closure process takes about three to four weeks.
- Establishment. Once the wound completes the closure phase, Fallek says the collagen continually builds up at the wound site, which protects and strengthens the affected area. “To support its formation, blood supply to the area increases,” he explains, noting that both factors cause the new scar to become darker, thicker, and prominent. This phase lasts for three to six months.
- Maturity. Once enough collagen has formed at the wound site, Fallek says that some of it breaks down, and, subsequently, blood supply decreases. “The scar becomes lighter, thinner, flatter, and less palpable as well as visible,” he explains. “This process can take one to two years, at which point they are considered fully mature.” As a general rule of thumb, Fallek says that you should always expect your scars to look darker, textured, and generally worse before they get better. “You may notice that they look particularly bad a couple of months after your surgery,” he warns, noting that it’s not necessarily a concern.
When to Be Concerned About a Scar
The three main things to worry about with tummy tuck scars are if the scar unhinges and opens up, turns blue, and/or if it starts to develop drainage and excessive redness from the wound site.
Trott says that the only time she worries about any scar, let alone tummy tuck scars, is if they open up. “The way to prevent this is to make sure the deeper tissue has good sutures in it to take the tension off the skin,” she says.
Additionally, Trott says that your scar turning blue can be a sign that it doesn’t have quality blood supply. “This is usually something you would see in the OR and is extremely uncommon,” she adds. “Oftentimes patients develop small eschars or scabs in the center area of the scar where it is the tightest, and as long as they don't open up it's not a big deal and we just leave it like a natural band-aid while the skin heals underneath.”
Then there's the chance of drainage and redness. “Redness of the skin surrounding the scar or drainage that develops from the wound site can be signs of an infection,” Forley says.
Other than those instances, consider your scarring normal and be patient until it starts to truly mature.
How to Treat and Reduce Scarring
As always, you should only follow the course of treatment that your surgeon discusses with you. This list is merely a collection of common treatments that surgeons tend to encourage with patients.
Try a Weekly Dressing Change
Trott points out a product called Embrace, which some of her patients have used and found to be helpful. “It is basically a weekly dressing change—you buy the kit online—that takes tension off the scar,” she explains. “It's a little expensive but totally worth it if you want to do everything possible. I know that my patients who have used it have been very happy with their scars, but so is mostly everyone, so it's hard to compare.”
Try Laser Therapy
“With patients with Fitzpatrick I and II skin types (think: super pale), I will usually start to laser the scars with a Cutera 532 wavelength (it's like a photofacial) to try to get rid of any red and brown pigment faster,” Trott says. “With darker skin tones, I do a test spot first because this kind of laser can [discolor] skin on a Fitzpatrick III to VI.”
Wear Silicone Strips
Once you’re a few weeks post-op and your incision is completely closed, Khan recommends using silicone strips. “The strips and gel create a protective layer over the scar and promote healing by reducing inflammation,” she says.
Apply a Silicone Scar Gel
According to Forley, topical silicone gel has been shown to improve hydration of the outer layer of skin cells, which benefits the healing process by reducing different aspects of scarring, including thickening and discoloration.
If a scar starts to appear particularly thick, Trott says that you can get steroid injections to thin it out. “This can also help when scars are itchy,” she adds. “However, you have to be careful to ONLY inject the scar because if you inject the normal tissue around it, you will get tissue atrophy.” This should of course only be performed by a board-certified surgeon or dermatologist, preferably the surgeon who performed your tuck and is familiar with your specific case.
Try Morpheus8 by InMode
Dealing with thick, dark scars? There’s a solution. “Using both microneedling and radiofrequency, this technology can help break up a scar (so it’s not as thick) and lessen its appearance,” Khan explains. “This is great to use even a couple of months after surgery to prevent the scar from thickening over time.”
You should avoid direct sunlight for three months post-op to prevent any enhanced scarring. However, once the three months is up, it’s important to still protect your scars. For this reason, remembering to apply a high SPF (30 or higher) is essential.
Consider Scar Revision
If your tummy tuck scarring is severe, Forley says you may want to start the process over. “In some cases, a scar may benefit from excision and starting the wound healing process again,” he explains. “This may be especially indicated when conditions at the onset of the initial healing process, such as an infection or impaired blood supply, may have led to an unfavorable result.”
All tummy tucks are met with some type of scarring. The visibility and permanence of scars will depend solely on the way your body heals—so long as you go to a trained and board-certified plastic surgeon and follow the prescribed post-op protocol, that is. The way any past or existing scars from falls or scrapes have healed is a typically a solid indicator as to how your tummy tuck scar will heal.