Q: Dr. Eppley, I am considering getting a tummy tuck but am somewhat concerned about the scar. I know the scars can look quite good in some cases but not in everyone. Since I have a c-section scar I am wondering if this is a good ‘test’ as to what a tummy tuck scar would look like on me. I had a c-section about 3 years and the scar is still red, raised, and uneven. I remember right after my c-section I could feel my skin above and below the sutures overlapping. My question is will my tummy tuck scar be same way or will the scar be a thin line with no raised areas?
A: Your question is a good one and, in theory, how one incision on the body heals (particularly the same body area) should be an indicator of how the next one would heal. But the reality is that many factors go in to how an incision heals and they can dramatically affect how the final scar can look. C-section incisions, if closed well, should always look good because there is no tension on the wound closure. Lack of wound tension usually predicts a very narrow scar. Conversely, a tummy tuck incision is always under considerable tension which is why plastic surgeons use a meticulous multiple layer closure technique with most sutures under the skin to obtain a narrow scar. Tummy tuck scars are almost always a lot longer than that of a c-section. One of the key elements in this closure technique is to get a good leveling of the tissue layers so the skin edges are even across the scar line. Based on how you describe your c-section scar, I strongly suspect you will get a better looking tummy tuck scar.
Dr. Barry Eppley
Q: I am interested in getting a tummy tuck. I have had two children and do not want any more. I can not get rid of this lower stomach pouch no matter what I do. A tummy tuck would do the trick but I am concerned about the scar. I am Hispanic and I am afraid I might scar badly. My c-section scar looks great so I seem to scar well. Will my tummy tuck scar look the same? I know it will be longer but will it look so fine and narrow?
A: While there are many factors that influence how a scar will ultimately look, one of the most important is that of tension. How tight is the wound on closure. A wound closed under tension will usually develop a scar that is somewhat wider than one that is not.
The concept of wound tension is what differentiates the c-section vs an abdominoplasty scar. C-sections are closed under absolutely no tension. They literally fall together loosely because of the expanded abdominal skin. This is why they usually look so good no matter how or by whom they were closed. A tummy tuck, however, is quite a different story. It is closed under considerable tension and requires the closure skills and training of a plastic surgeon to get a scar that may approximate that of a c-section. A good c-section scar is not necessarily a good predictor of what a tummy tuck may look like.
While scar outcomes are not always predictable, darker pigmented skin may widen and hyperpigment more than skin with less pigment. This is the risk of an abdominoplasty scar in one of Hispanic origin. Always remember that a tummy tuck is a trade-off, getting rid of that loose skin and fat with a better waistline for a scar. A scar is still an imperfection but, hopefully, one that is more tolerable.
Dr. Barry Eppley