Tummy tuck scar is almost always positioned within the groin and pubic hairline so it is well concealed by the patient’s panty or swimwear. Nonetheless, it remains imperative to apply surgical techniques and postop care that aim to encourage the scar to heal into a faded, thin line.
Orange County plastic surgery expert Dr. Tarick Smiley has recently posted Snapchat videos demonstrating an African-American patient who asked for tummy tuck. Due to her previous C-section surgery, she had keloids across her lower abdomen.
The patient’s keloid scar is caused by her previous C-section surgery. During tummy tuck, Dr. Smiley removes it together with the loose skin and fat.
Since the patient has a previous history of keloid, Dr. Smiley says she is at an increased risk of unfavorable scar after tummy tuck, which typically uses a hip-to-hip incision to remove the hanging skin and fat. Another incision made inside the navel’s rim is created in order to remove any excess skin from the upper abdomen.
Dr. Smiley says that tummy tuck and keloids risk is closely tied to genetics and darker complexion, although several risk factors can be controlled or at least minimized to help patients achieve the most favorable scar possible.
During surgery, Dr. Smiley created a hip-to-hip incision to remove the excess skin, together with the C-section keloid scar. Then, he closed the wound line and ensured that it is positioned very low that even low-rise jeans and panties have no problem concealing it.
Dr. Smiley says he always closes tummy tuck wound in multiple layers, with the deepest layer receiving most of the tension, while the skin is spared from unnecessary tautness, which is the key to favorable scar and fast healing.
To further minimize risk of keloids, the celebrity plastic surgeon uses surgical tapes to hold the skin edges together until the wound is considered clinically healed (about three weeks).
Around three weeks postop, new skin tissue forms over the wound; for patients with a strong history or propensity to aggressive scarring this is a precursor to keloids.
Hence, for the said patient Dr. Smiley says he recommends steroid injection right after the tummy tuck wound is considered clinically healed, instead of waiting for it to become established.
“For this particular patient, I would use early steroid injection as a preemptive measure,” says Dr. Smiley.
To further promote the best scar possible, the surgeon also recommends silicone sheets, sun protection, and scar massage.
The ideal tummy tuck scar is hidden in the groin crease and thus it is covered by most swimwear designs and panties. About 1-2 years postop, the scar generally turns into a faded silvery line that blends into the background.
Most patients will need an incision line that goes from hip to hip, allowing their surgeons to remove a significant amount of loose skin and fat. Concurrently, a round incision inside the navel’s rim is created to improve its shape and size, which of course leads to a more cohesive and natural appearance.
The patient’s tummy tuck scar lies low and is hidden by her underwear.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that tummy tuck scar usually falls within the pubic hairline, although sometimes it is positioned slightly below it; this is particularly true for patients who need a simultaneous pubic lift.
A concurrent pubic lift is particularly common in massive weight loss patients who often experience sagging mons pubis that may also appear “unusually full.” This additional procedure also ensures a smooth, natural transition between the pubic area and the lower abdomen.
Almost all the tension on the incision line comes from above, leading to risk of high-riding scar and over-elevated pubic hairline. To counteract this effect, Dr. Smiley says the mons pubis is lifted and attached to the deep fascia.
Recently, Dr. Smiley has performed revision tummy tuck to correct a high-riding and indented scar. (Note: The actual surgery was shown on Snapchat.)
The celebrity plastic surgeon created a new incision that was lower than original scar. This resulted in a well-concealed scar that is expected to fade into a thin, flat line, thanks to meticulous suturing techniques in which most of the tension on skin was removed.
While the aforementioned technique can also help patients with over-elevated mons pubis or visible pubic hairline, sometimes a better approach is to perform laser hair removal.
Nonetheless, for the vast majority of patients the risk of visible scar and pubic hairline can be avoided with meticulous surgical techniques, says Dr. Smiley.
Many people are curious about tummy tuck results after one year, particularly pertaining to issues such as scar appearance, flatness of the anterior abdomen, and over all contour of the midsection.
Renowned Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted videos on Snapchat showing one female patient who had tummy tuck about a year ago. Upon closer inspection, the scar has healed and faded nicely into the background.
Tummy tuck after one year
At one year postop, the tummy tuck scar has faded and flattened out considerably. However, some patients may notice that it looks a bit pink or slightly darker than the surrounding skin, which typically improves over time.
After two years, most scars have fully matured that they appear thin and silvery in color and thus barely imperceptible.
Tummy tuck scar after one year
Meanwhile, Dr. Smiley says tummy tuck renders lasting results provided that the patient has maintained a stable weight through healthy diet and exercise.
Patient commitment before the surgery also plays a critical role in the final results. For instance, avoiding tobacco products at least three weeks before tummy tuck and another three weeks thereafter is one of the keys to promote favorable scar and optimal healing.
Studies have shown that smokers are not just at an increased risk of poor healing and skin necrosis (death of skin tissue), but they are also susceptible to poor scarring.
Of course, the long-term results of tummy tuck also depend on how meticulous the doctor is during surgery.
Dr. Smiley says he almost always performs muscle repair at the time of tummy tuck. This involves the use of permanent sutures to tighten the fascia overlying the separated pair of muscles that runs between posterior sternum and the area above the pubis.
The celebrity plastic surgeon says the suture right above the navel must be extra strong to prevent breakage, which can lead to unsightly bulge that can detract from the flat tummy.
Despite the use of permanent sutures, Dr. Smiley says that patients can nonetheless enjoy a safe pregnancy because the abdominal muscle will simply expand to accommodate the growing baby.
Most patients want to know the ideal BMI for a tummy tuck, a body contouring surgery that removes the redundant skin and fat caused by large weight loss or pregnancy.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted videos on Snapchat to explain why he doesn’t always go by BMI and other “strict number-based guidelines” but instead depend on the patient’s actual physical fitness.
Dr. Smiley has shown a female patient who had tummy tuck six months ago. Her “before” photo appeared that she had high BMI readings, prompting some followers to ask why the surgeon nonetheless considered her a good candidate for the surgery.
Dr. Smiley said that BMI is supposed to estimate the amount of body fat based on a person’s weight in relation to her height. BMI readings below 18.5 suggest that one is underweight, while the 18.5-24.9 range is considered normal, and the 30 or higher is qualified as overweight and obese.
However, the celebrity plastic surgeon has argued that “BMI is sometimes misleading” because it does not take into consideration that different types of fat have varying metabolic effects on health. For instance, the visceral fat that develops around liver and other abdominal organs has a more deleterious effect than the superficial fat that sits beneath the skin.
“The patient had lots and lots of excess skin and fat over the muscle, thus we were able to remove it. In fact, she shed around 35 lbs. right after surgery due to the significant amount of hanging skin,” said Dr. Smiley on Snapchat.
The surgeon added that BMI should only be seen as one of the possible criteria when determining each patient’s candidacy for tummy tuck or other forms of body contouring surgery.
“Instead of relying solely on BMI readings, we require patients to send their current photos or, better yet, be examined,” said Dr. Smiley.
Revision tummy tuck is generally more complex than the initial surgery due to the presence of old incision lines and scar tissue. Oftentimes, the patients also have some type of navel deformity, contour asymmetry, and residual excess skin, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted a series of Snapchat videos to demonstrate revision tummy tuck performed on a male patient.
A few years ago the patient underwent tummy tuck performed by a different surgeon. But instead of achieving a more masculine physique, the surgery left him with unnatural-looking navel (too big and round), visible asymmetry along his flanks, and high-riding and indented scars.
Aside from revision tummy tuck, the patient also asked for a simultaneous breast reduction to make his chest area congruent with the abdomen.
To conceal the high-riding tummy tuck scar beneath the patient’s underwear, Dr. Smiley created a new incision line (hip to hip) that was positioned very low that it settled within the groin and pubic hairline.
Through the new incision placement, he was also able to eliminate the appearance of indented scar by removing the residual loose skin. Furthermore, he removed more skin along the right flank to eliminate the contour irregularity.
Meanwhile, the celebrity plastic surgeon also performed navel repair, particularly with the intent to reduce its size and change its shape. He said that a natural-looking belly button has a more vertically oriented contour, as opposed to having a perfectly circular shape.
During navel repair, he placed the incision inside the belly button’s rim so the scar will remain imperceptible.
Afterwards, all the incisions were closed by multiple rows of stitches to promote the best scar possible. The skin, meanwhile, was not picked up by any suture and instead a surgical tape held its edges together to reduce superficial tension.
“The key to faded and favorable scar is to eliminate most of the tension on the skin,” says Dr. Smiley.
Dr. Smiley also injected Exparel directly into the abdominal muscle; this is a long-acting numbing medication that works for up to four days, thus allowing the patient to avoid or at least limit his use of narcotic pain relief.
Tummy tuck final shape: Can every patient enjoy a more hourglass figure?
It depends, says leading Orange County plastic surgeon Dr. Tarick Smiley who has about 7,000 tummy tuck surgeries under his belt.
Recently, Dr. Smiley performed tummy tuck on a female patient with loose skin and lots of stretch marks that extended above her navel due to previous pregnancies. However, she had very little fat thanks to her commitment to healthy and active lifestyle.
(Note: Her surgery was recently shown on Dr. Smiley’s Snapchat.)
The celebrity plastic surgeon was able to remove up to 90 percent of stretch marks with meticulous skin incision in which the resulting hip-to-hip scar was hidden beneath the patient’s underwear.
Meanwhile, some Snapchat followers wrote to the surgeon asking why he was not able to deliver “curvier results” as compared to his previous patients with remarkably defined waist line following their surgery.
“While I make every effort to reshape the midsection and adhere to the classic hourglass figure, we cannot simply go past the muscle and bone,” he said.
“We have to put in fillers on the side to give her a more S shape curve,” he further explained.
Fillers, which can be in the form of fat grafts or Sculptra (a type of dermal filler), can help reshape the hips to achieve a more hourglass figure, which is traditionally believed to be the hallmark of female fecundity and beauty.
In general, Dr. Smiley prefers fat graft or fat injection because of the additional contouring effects provided by liposuction, which is the method to collect fats from multiple donor sites.
Despite some limitations in term of the tummy tuck final shape, the surgery nonetheless created significant improvement over the patient’s previous appearance. Aside from removing the loose skin and eliminating about 90 percent of the stretch marks, Dr. Smiley also repaired the enlarged navel.
Navel repair was done by making an incision around its inner rim to conceal the scar. Afterwards, the surgeon reduced its size and made its shape slightly vertically oriented, leading to a more athletic appearance of the abdomen.