Avoiding thick Tummy tuck scars

Many patients are afraid of the Tummy tuck procedure because they have seen friends’ scars or pictures of scars on the internet and they think such scars are unavoidable. Still others, including Hispanic, Asians, or African Americans think they are bound to get thick scars simply based on their ethnic background. This is just not so. Thick or unsightly scars following abdominoplasty can be easily avoided.

What are the causes of thick or unsightly Tummy tuck scars?

The scar from the tummy tuck procedure is a function of the surgical technique used. Techniques which can cause thick Tummy tuck scars include:

  • Too much tension

    The surgeon tries to tighten the skin by cutting out too much skin and then closes the superficial layers of the wound with sutures under too much tension (too tightly). The body then lays a lot of collagen fibers to hold the wound together. The bulky collagen fibers make the wound look thick. With too much tension on the top layers, the scar can also spread and become thick.

  • The skin edges have little blood supply

    Not having good blood supply is a bad thing. The ‘traditional tummy tuck’ surgical technique is to lift up (dissect) all the skin of your abdomen up to the rib margins and stretch it down to your pubis. The problem is that a lot of the blood supply coming from the abdominal muscles is cut. The cells that produce collagen go into overdrive when they don’t have a great blood supply.  This creates more scarring and can compromise healing during the postoperative period.

  • The scar is placed too high up, ‘at the bikini line’

    The scar will always migrate upwards towards the belly button in the months following a tummy tuck. If the incision is placed ‘at the bikini line’ instead of ‘below the bikini line’, it will move up above the bikini line post operatively and be noticeable.

How do we prevent thick abdominoplasty scars?

The Lockwood Technique takes care of all 3 problems at once.

An illustration showing the Tummy tuck Lockwood technique.

The differences between the Lockwood Tummy tuck technique and the standard Tummy tuck technique are illustrated in this diagram on the left.

The pink area represents the amount of dissection which is done in each technique. The Standard technique is shown on the left hand side, the Lockwood technique on the right hand side.

You can see that the Lockwood technique has much less dissection of the tissue.  This is a good thing. Notice that the Lockwood technique lifts only the skin along a central tunnel in the middle of the abdomen. The sides stay attached.

The Lockwood technique has the following positive influences on the surgical outcome:

  • Less tension at the surface, more tension at the deeper layer

    This refers to the closure of the incision with sutures.  When suturing the wound closed, the technique puts the most tension on the Scarpa’s fascia, which is the deeper layer of the tissue. When the deeper layer is closed with more tension, the skin at the surface can be closed with minimal tension. This type of closure will prevent the scar from getting wider.

  • Better blood supply means faster healing

    By having less dissection of the tissues with the Lockwood technique, the skin flap preserves most of its blood supply.  With more blood supply, the healing is better, faster, and with less scarring.

  • Better scar placement, better results

    I place the incision well below the bikini line to allow for the fact that it will migrate up. Because we do not have to worry about tension or blood supply, we can place the scar lower in the abdomen, closer to the pubis. Since there is little tension at the surface of the scar, there is less tendency for the scar to rise up as tissues relax. In summary, the scar stays well below the bikini line.

A collage of photos of a patient, from different angles, before and after a Tummy tuck procedure.

As if this were not enough, the Lockwood technique also has fewer complications than the traditional method.  I use the Lockwood technique for all of my Tummy tuck and Body lift procedures. I have written about the use of the Lockwood technique in the Body lift procedure previously. You don’t need to have a thick scar following your Tummy tuck.

Can the Tummy tuck scar be hidden way below my panty line?

This patient’s set of photos, before and after her Abdominoplasty, provides a good example of how a tummy tuck can help repair a separated rectus abdominis muscle, tighten the stomach area, and get rid of loose or wrinkled skin

…without having to deal with an unsightly scar.

Please view my gallery of Before & after Tummy tucks to see that my patients do not have thick scars!

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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10 thoughts on “Avoiding thick Tummy tuck scars”

  • Judith L Jimenez says:

    I need to have hernia repair and wanted to do a tummy tuck at the same time. I have already consulted with a general surgeon who's willing to do a combined procedure. Do you work in conjunction with other doctors in this manner. Also his long would I be out of work?
    • Dr. Ricardo L Rodriguez says:

      Judith: I only have operating privileges at GBMC hospital in Baltimore. If your surgeon operates there it will be no problem. In any case I would appreciate the chance to evaluate you in person because sometimes hernias can be corrected during the course of the Tummy Tuck muscle repair itself. We do this often. I will let Kelly at kelly@cosmeticsurg.net know of your interest
    • Dr. Ricardo L Rodriguez says:

      Sue: I'll have Kelly contact you, she usually takes care of those details. She's at kelly@cosmeticsurg.net Thanks!
  • Zan Lapps says:

    I have had mutliple abdominal surgeries. In the 70's the USN cut across the bikini area of the abdomen leaving the muscles hanging. I also got a belly buton hernia that has never been repaired from that excursion. Six years ago I lost my left kidney and adrenal gland due to cancer. This left an area that apparently the intestines moved into and there is a lump. At almost 61, 5'51/2 and 175 lbs. I would like to have the abdomin repaired. As a Kaiser paitient, they don't do cosmetic surgery and warn against me doing it because of more scar tissue forming. Your opinion?.
    • Dr. Ricardo L Rodriguez says:

      Zan: It all depends. I'd have to review your medical status, and take a look at pictures. We can do a virtual consult and I would recommend you contact Kelly at kelly@cosmeticsurg.net if you want to do that. In the end, the answer to this has to come after a detailed consideration of your individual case, but we have done many cases similar to yours.
  • Lucia Crisp says:

    Dr. Rodriguez, Love your site & your You Tube video! Very informative & made me feel like I was listening to an educated old friend. Would like to know your opinion on a couple of things. First, visceral fat and tummy tuck. Can someone who has visceral fat, almost no loose skin, have a successful(significant body change), & a long-lasting tummy tuck? Second, do you preform tummy tucks, liposuction & breast augmentations on non-insulin diabetics?
    • Dr. Ricardo L Rodriguez says:

      Lucia: Thanks for the kind words! As for the question of visceral fat, I would have to see pictures of you and talk a little before I could form an opinion. In general, if you have no loose skin, the problem may just be a combination of visceral and subcutaneous fat. Then there is the muscle in the abdomen. You may just have a split rectus diastasis. As for your second question, we do perform surgery on non insulin dependent diabetics, as well as some insulin dependent diabetics after consultation with their endocrinologists. You should contact Kelly at kelly@cosmeticsurg.net to arrange a virtual consult and I can give you an opinion that makes sense to your particular case. Again, thanks for the kind words, it makes all this effort on the blog worth it.