The secret to a great tummy tuck scar is understanding the factors that go into scar healing, so you aren’t left with a mark that makes you feel self-conscious.

Hope isn’t Lost

Although all surgery involves a scar of some kind, plastic surgeons are trained experts in minimizing their appearance as much as possible.  For some people thinking about getting a tummy tuck, their number one concern is that their scar will look terrible. In reality, a well-designed tummy tuck scar is usually smooth and well hidden.

The Healing Process

Your body starts the healing process immediately following an injury. It doesn’t distinguish between accidental injuries and an elective surgery like a tummy tuck, so the healing process actually starts while you’re still in the operating room.

Why Does Your Body Form Scars?

Any time your skin is cut, your body works to close that wound because your skin is your first line of defense against infection and foreign materials. This closure is called a scar. Scars are formed in the last stage of the healing process, which is called “remodeling”.¹

What Your Surgeon Can Do To Minimize Your Scar

Choosing the correct plastic surgeon can make a big difference when it comes to the appearance of your scar. It’s important to keep these things in mind when you’re looking for a plastic surgeon to perform your tummy tuck.

Correct Placement Of Scars

Where your surgeon places your scar will have a tremendous impact not only on healing, but also in how easily your scar is covered. A low scar can be more easily covered in underwear and swimsuits. Placing the scar in the correct location will also allow your surgeon to contour it properly and manage the tension that will be placed on it during your recovery process.

Closure Technique

Your tummy tuck incision is closed by pulling the top edge of your incision down to the bottom edge, and suturing both edges together. If that incision line is under a lot of tension while its trying to heal, that high tension can leave you with a wide scar. Your surgeon can minimize that tension with the appropriate closing technique.

Your surgeon should use a multilayer closure technique that brings your different tissue layers together, and distributes tension evenly across the scar. Generally, it entails closure of your deep, dermal, and subcutaneous layers. The suture in the deep layer is where your scar’s shape and contour is determined. The dermal suture adds strength to the closure. The subcutaneous suture will also help determine the appearance of the scar. Your subcutaneous layer should be closed with what’s called a “buried suture”, which means that the knots are hidden below the skin’s surface.  That way you aren’t left with “track mark” scars along the incision line. Also, your surgeon should avoid using metal staples to close your incision since those will leave those same track mark scars. 

Sometimes you will see surgeons who are not plastic surgeons using these suboptimal techniques.  A plastic surgeon can usually see this from a mile away.

Experienced, Board Certified Plastic Surgeon

An experienced, board certified plastic surgeon has been extensively trained in the best way to create as minimal a scar as possible. They have literally written the book on wound healing. They will have knowledge of appropriate closure techniques and experience with contouring the scar so it is easily hidden. 

Frequent Post-Op Visits

It’s important for your surgeon to be involved in your recovery, and that means scheduling appropriate post-op visits. When you’re in regular contact with your surgeon, they can keep a better eye on how you’re healing, and catch potential problems early.

What You Can Do

When it comes to minimizing the appearance of your tummy tuck scar, what you do after your procedure is just as important as what your surgeon does during your surgery.

Follow Your Post-Op Instructions

The most important thing that you can do to minimize the appearance of your scar after your tummy tuck is to follow your plastic surgeon’s post-op directions. You might feel like jumping into your old routines right away, but you need to give yourself time to heal.

Avoid Placing Tension On The Scar

Although you should start walking as soon as possible after your tummy tuck, definitely avoid doing anything more strenuous than that. If you have an active job, you should plan to take a few weeks off during your recovery. Avoid exercise, sex, and any other vigorous activity until your plastic surgeon gives you approval to do those things again.

Placing your scar under too much tension by being too active can not only cause it to widen but it can also lead to your incision to open up, a condition called “dehiscence”.  In addition, it can increase your risk of infection by exposing your scar to sweat, bacteria, and irritation. Developing an infection will lead to worse scarring and prolong your recovery time. 

Avoid UV Rays

As your scar is healing, the new skin that is formed is especially vulnerable to damage from UV rays, like those from the sun or tanning beds. UV radiation can cause your scar to thicken and darken. To avoid that, keep your scar out of the sun and avoid tanning until your scar is completely healed. Even if your tummy tuck scar is covered by your underwear or a swimsuit, you should also use a cream with SPF as added protection, if there is potential that your scar will be exposed to UV rays.

Use A Scar Cream

Your plastic surgeon will also advise you to apply a scar cream or to massage your scar at a certain point in the healing process. 

Topical silicone can help improve scars. Plastic surgeons have been recommending silicone sheets for years. The problem was that the sheets had the problem of coming off.  These days, silicone gels or silicone scar creams have been developed as a more convenient way use silicone on your incision. While the process by which silicone works is not completely clear, one theory is that silicone prevents your body from sending excess collagen to the newly formed skin. When your skin is healing from a wound, there is a signal from the new scar that collagen is necessary. This seems to have something to do with dehydration. Silicone gels or creams can keep your new skin hydrated at the same level as the surrounding skin, which prevents the release of that collagen to the scar. Some scar creams also have an SPF component to protect your skin from UV radiation.²

Massage

When your body is ready for it, you can massage your scar. This helps mechanically break up any thickened tissue and helps prevent it from becoming raised. 

What Can’t Be Helped

Unfortunately, there are some things that you and your surgeon just can’t control when it comes to scarring.

Your genetics

Good scars are:  1) flat, 2) thin, and 3) flesh colored.  A not-so-good scar is: 1) raised, 2) wide, and 3) usually dark, but sometimes, in darker skin tones, the scar can be white and obvious. 

Just as many health conditions have a genetic component, so it is with scars.  Some ethnicities are more prone to poor scarring.³

In general, darker skin tones tend to fall in this category.  However, we sometimes see even very fair people develop poor scarring.  That may be because they’ve inherited genetic traits from an ancestor that had poor scarring.  We’ve also seen darker skin have excellent scars. Many Americans are a mixture of different backgrounds, which makes it difficult to predict exactly how you will scar.  

Does the part of the body affect scarring?

The answer is “yes”.  Certain parts of the body are known to have poor scarring.  Examples are the breastbone (called the “sternum”), outer part of the upper arm (over the deltoid muscle) and the back. So if you have a “bad” scar in these problem areas, it does not mean that your tummy tuck scar will also be bad!  In general, the tummy tuck incisions tend to scar well, compared to these areas.  

What’s the difference between a “hypertrophic scar” and a “keloid”?

Some people are predisposed to forming large, thickened “hypertrophic scars,” and some people are predisposed to forming what are called “keloid” scars. These two terms are often confused.  The difference is that while hypertrophic scars are typically dark and raised, they don’t extend past the borders of your original scar. Keloid scars, on the other hand, are large, puffy, raised, and extend past the borders of the scar. Keloid scars are typically found in people with darker pigmentation.  If you’ve had keloid scars in the past, you are more likely to get it again. Be sure to discuss the possibility of keloid formation with your plastic surgeon.⁴

Make the right choices

Don’t be afraid of a tummy tuck scar!  They usually heal well and can be well concealed. Although you can’t control your genetics, you can take steps to minimize the appearance of your scar.  Start with the right plastic surgeon who will talk with you about the concerns you have and how you can work together to make the outcome look as good as possible.

1. Martin, Paul. “Wound healing–aiming for perfect skin regeneration.” Science 276, no. 5309 (1997): 75-81.
2. Bleasdale, Benjamin, Simon Finnegan, Kathyryn Murray, Sean Kelly, and Steven L. Percival. “The use of silicone adhesives for scar reduction.” Advances in Wound Care 4, no. 7 (2015): 422-430.
3. Tuan, Tai-Lan, and Larry S. Nichter. “The molecular basis of keloid and hypertrophic scar formation.” Molecular Medicine Today 4, no. 1 (1998): 19-24.
4. Tuan, Tai-Lan, and Larry S. Nichter. “The molecular basis of keloid and hypertrophic scar formation.” Molecular Medicine Today 4, no. 1 (1998): 19-24.