Tummy Tuck Revision
Tummy tuck revision, also referred to as abdominoplasty revision, is a procedure designed to improve cosmetic issues that may occur when a previous tummy tuck surgery was performed by an inexperienced and/or unqualified surgeon, or if the body heals in a way that was unexpected. Some of the most common of these aesthetic concerns that can be corrected with abdominoplasty revision include unsightly scarring, an undesirable scar location, and a disproportionate or unnatural-looking belly button size and position. Regardless of the reason for seeking tummy tuck revision, it is critical that prospective patients choose a board-certified plastic surgeon who has extensive experience in correcting unsatisfactory abdominoplasty outcomes, as this procedure is typically considered more complicated than the original operation.
Correcting Unsightly Abdominoplasty Scars
Like any surgery that involves an incision, it is important to understand that there will always be a scar with tummy tuck surgery (though this is not to say the scar will always be extremely prominent and unsightly). In the event abdominoplasty scarring is unsightly, however, the best way to correct the issue is to excise the scar and re-sew the wound. This may involve using a skin expander beforehand if there is insufficient skin to allow for closure after the scar tissue is removed. Fraxel® laser resurfacing can also be used to “blend” the scar tissue into the surrounding skin and make it less visible.
Lowering the Tummy Tuck Scar
The only way to lower a tummy tuck scar that is too high is to make an incision just above the scar, elevate the skin all the way to the ribs, stretch it down, remove the skin below the scar that is now overlapped, and close the wound in its lower position. Often, placing a skin expander under the skin above the scar will be necessary in order to help stretch the skin in preparation for this. The skin expander is filled over a period of several weeks or months before the skin is fully stretched and ready to be brought down.
Improving Belly Button Location and Size
I have found that cutting the edge of the belly button from the skin, pulling the skin down, and making a new hole in the skin to sew the edges of the belly button results in a visible scar that can often thicken and even contract, leading to difficulties in cleaning the interior of the belly button. At best, the belly button will resemble a morning glory. For these reasons, I have changed my management of the belly button in all my tummy tucks. I cut the smallest circle of skin that I can to release the belly button and sew the edges of the belly button to the fascia. After I have pulled the skin down and begun closing the tummy tuck incision at the pubis, I determine the new position for the belly button and make a “U” shaped incision in the skin. I remove the cylinder of fat in the skin that is directly under this incision and sew the skin to the edges of the belly button so that the scar now lies at the bottom of the new belly button. All the stitches are absorbable, so there is no need to remove stitches later on. Since there is no scar on the outer edge of the new belly button, the appearance is much more natural.
Occasionally the belly button is located very high and, if you cut a circle around it to release the skin, the resulting hole will not be removed with that skin. The choices are to close the skin as an up and down, midline scar in the lower abdomen or to release the belly button from its attachments to the muscle/fascia, allow it to be pulled to a lower position as the skin is drawn down, and accept a slightly low new position for the belly button.
Recovery and Results
Recovery following abdominoplasty revision will depend on the specific technique(s) employed as well as each patient’s unique healing process. During a consultation at my practice, the most appropriate approach for one’s specific concerns can be discussed in full detail, including what can be expected in regard to the length and extent of any downtime.
Ultimately, the new size/location of the belly button can be made to look much more proportionate and natural (when applicable), and although some degree of scarring will still be evident after tummy tuck revision, its appearance can be significantly improved for the majority of women and men. Overall, my patients have been very satisfied with the final results of their revision surgery.