Photo by Kyle Smith on Unsplash
Shape-shifting alterations that occur within the confines of an operating room, tummy tucks are among the more transformative experiences in plastic surgery. But sometimes the stark absence of fat and flesh in an abdominoplasty “after” photo can veil the subtler aspects of the procedure – the meticulously crafted details that are crucial for superior outcomes.
While skin customization and muscle firming have long characterized the traditional tummy tuck, plastic surgeons of yore seldom focused on the proportions of one’s navel or the discreet contours of the abdomen, our experts aver. Over time, this collective disregard for specifics gave rise to the telltale signs of the surgery today: “A large, round, mouth-like belly button and an overly taut tummy – these are clear indications of the procedure,” asserts Dr. Jacob Unger, a board-certified plastic surgeon in Nashville.
In recent times, research has shed light on ways to safely enhance the results of a Tummy tuck. Surgeons have refined their approaches. They’ve finessed incisions to minimize scars. And as a result, the Tummy tuck has evolved significantly, “becoming much more of a 360-degree treatment of the entire trunk,” says Dr. Nina Naidu, a board-certified plastic surgeon in New York City.
So the next time you’re perusing the before and after photos on a surgeon’s board or in their collection, feel free to be amazed by the broad results but be sure to notice the finer points as well – particularly these three, which surgeons insist are the hallmarks of a modern Tummy tuck.
A low and inconspicuous scar
“An ideal scar heals as a slender line low in the undergarment – typically just above or slightly within the pubic hair,” explains Dr. David Sieber, a board-certified plastic surgeon in San Francisco. The aim, naturally, is for it to be out of view when the patient dons a not overly revealing pair of underwear or a standard bikini bottom – which is no easy feat, considering the average Tummy tuck patient is sliced from hip bone to hip bone.
Just how low can surgeons go when making the incision? “Here’s the tricky aspect,” says Dr. Naidu: “If you make the incision too low, you risk having difficulty closing it or applying excessive tension on the pubic area and exposing the clitoral hood, which wouldn’t be the most pleasant situation for most patients. There truly is a fine line.”
To guide their incisions, surgeons will at times have patients bring in what they hope to be able to wear in the future – a specific style of underwear or swimsuit bottom – so they can compare its placement with their pre-operative markings.
According to Dr. Unger, a well-positioned scar is not only concealed but actually enhances the overall outcome. “The Tummy tuck is a surgical art of geometry – it involves pulling, shaping, and angling – and by creating that low scar, we alter the appearance of the sides and the abdomen itself,” he elucidates. An abdominoplasty scar, he adds, “should also be balanced and symmetrical, which is more challenging [to achieve] than it sounds, since most people’s hips and backs are not perfectly straight and even anatomical landmarks aren’t overly helpful in every instance. It truly requires an expert to consistently come as close as possible to symmetry.”
A natural-looking belly button
Surgeons have come to view the belly button as the crowning achievement of an artful abdominoplasty.
When your abdominal skin is stretched during surgery and a considerable amount is removed, your proportions shift – and your original belly button is lost in the process. Plastic surgeons then create a new aperture for your existing umbilical stalk.
“So many articles have been written about how to create an ideal belly button,” says Dr. Melissa Doft, a board-certified plastic surgeon in New York City. “But when there are so many writings on a single topic, that often implies there is no single perfect method.”
What surgeons can concur on is this: For a belly button to seem as if it has always been there, it should be oval in form; it should be neither too large nor too small, nor too high nor too low; and its upper portion should have a somewhat hidden appearance, “so the umbilicus appears as if it’s tucked in a bit more and not just like a circle on the abdomen,” explains Dr. Naidu.
Attaching the umbilical stalk to the abdominal fascia, or the connective tissue covering the muscles, provides the most natural appearance while helping to hide the belly button incision. “That’s the element that truly makes the belly button look most natural,” adds Dr. Sieber – “inverting the scar so that it’s not visible externally.”
Of course, how well an incision heals after surgery is partly dependent on a patient’s biological scarring response. But “we truly pay a considerable amount of attention to it, offering laser treatments or injections if the scar ends up a little raised or obvious,” says Dr. Naidu. “Whereas 20 years ago, surgeons were more inclined to say, ‘Well, it’s just your belly button – don’t fret about it.’”
A contoured abdomen
“When performing a Tummy tuck, you don’t merely aim to create a flat, featureless abdomen or a straight surface – which was the traditional approach,” says Dr. Unger. Not only does an overly taut tummy tend to scar poorly due to tension, he adds – it also doesn’t look natural. The 2024 standard is softer and more shapely, with delicate curves and depressions. Which is why “liposuction is almost always incorporated into my Tummy tucks,” adds Dr. Sieber. “There’s simply no other way to achieve that three-dimensional shape that women desire.”
Yet for years, plastic surgeons were cautioned about the risks of combining an abdominoplasty with liposuction. “When I was in training, it was strictly forbidden to do that,” notes Dr. Naidu. It was the long-held belief among leaders in the field that when you’re already restricting blood supply during surgery by lifting the abdominal flap to access muscles and remove skin, it would be unwise to further disrupt it by liposuctioning the same area of tissue.
“Surgeons were concerned that adding liposuction would cause a reduction in blood flow to the skin and lead to poor wound healing or scarring,” says Dr. Doft. “But there have been numerous papers recently published that describe how to safely integrate liposuction with a tuck, so surgeons are now more confident [about carrying out the two procedures together].”
Today, in addition to removing fat from the hips, flanks, and back during a Tummy tuck, many surgeons like to meticulously sculpt the area above the belly button to “provide that nice little vertical groove that we observe in a youthful abdomen,” says Dr. Naidu. Our experts are cautious to distinguish this deliberate and targeted action – “extracting fat centrally to obtain a more athletic and alluring contour,” as Dr. Unger describes it – from the more extensive shaping of a six-pack via high-def lipo, which is potentially more risky to do in conjunction with a Tummy tuck.
Ultimately, notes Dr. Sieber, “our patients wish to look and feel wonderful without others knowing they underwent any procedures” – and the most meticulous surgeons strive to deliver precisely that.
