Background: The vast majority of tummy tucks can and are performed through a curved horizontal lower abdominal incision. (as well as around the umbilicus) There are, however, alternatives to this traditional excisional orientation in the right patient. A handful of patients may benefit from a vertical excisional approach.
When a vertical tummy tuck is typically thought of it is part of the ‘fleur-de-lis’ type. This is a tummy tuck where a vertical excision is combined with a horizontal one because there is too much side-to-side skin excess in the upper abdomen that cannot be addressed by a standard tummy tuck. This type of tummy tuck is almost exclusively used in massive weight loss patients.
Besides the fleur-de-lis pattern, there are other variations in which the vertical tummy tuck is completely vertical with no horizontal component.
Case Study: This 65 year-old female wanted to improve the shape of her stomach but did not want to commit to a traditional full tummy tuck. She asked if there was anything else that could be done. Her loose abdominal skin did not bode well for liposuction alone. But with her existing vertical scar from prior abdominal surgery decades ago, the concept of liposuction combined with some limited tissue removal became possible. This would allow liposuction to be performed and also deal with the skin laxity problem that would ensue.
Under general anesthesia, power-assisted liposuction was performed on her whole abdomen as well as out onto her flanks. Over 700ccs of fat aspirate was obtained. Then a vertically oriented ellipse of skin and fat was removed from the belly button down to the pubis incorporating her existing indented scar. Muscle plication was not deemed necessary at her age and desire for a short recovery. No drain was used.
Her recovery was uneventful with full return to all activities by three weeks after surgery. While she was still left with a vertical scar, which is how she started, the scar was no longer indented and smoother with the surrounding now flatter abdominal skin surfaces.
The vast majority of tummy tucks can be performed safely and effectively through a curved horizontal lower abdominal incision (and an incision around the umbilicus). However, there is a limited subset of patients for who may benefit from a vertical incision. This is certainly the case in someone who has an existing vertical incision.
Case Highlights:
1) Excessive skin and fat on the abdomen is not a one-dimensional tissue problem.
2) A vertical tummy tuck removes skin and fat down the midline of the abdomen, most typically from the umbilicus down to the top of the pubis. (a mini tummy tuck)
3) A vertical tummy tuck works best in women who have an abdominal shape that is longer than it is wide.
Dr. Barry Eppley
Indianapolis, Indiana