In short. Where the abdominoplasty scar sits, how it matures over a year, why drains are used, and how to look after both without doing harm.
Key points
- Patients who know this in advance tend to leave the scar alone and let it mature.
- Patients who do not often spend that period buying products that cannot help a scar that is still in its active phase.
Two things about a tummy tuck are unavoidable and both are discussed less than they should be: the scar, and the drains. Neither is a reason not to have the operation, but both are things patients should understand before rather than after. Knowing where the scar sits and why the drains exist makes the first weeks considerably less alarming.
Where the scar sits and why
The incision is planned to run low across the abdomen, typically from hip to hip, in a position intended to fall within the line of underwear. It is agreed with you before surgery, with you standing, because the way skin falls when you are upright determines where the scar will actually lie. In some patients an existing scar, such as a caesarean scar, can be incorporated into the new incision. In others it sits above or below it, which is one of the reasons previous surgery is discussed at the assessment.
How it matures
For the first weeks it is a healing wound. From around six weeks to six months it becomes red, firm and often raised, and it may look considerably more prominent than it did at one month. It then softens, flattens and pales over the following six to twelve months, and it never disappears. Where the skin is under tension, particularly at the ends of the incision, the scar is more likely to widen or to form a small dog-ear that can be revised later.
The scar looks worst at three months, not at three weeks
Patients who know this in advance tend to leave the scar alone and let it mature. Patients who do not often spend that period buying products that cannot help a scar that is still in its active phase.
What drain are for
Removing skin from the abdomen creates a space between the skin and the muscle layer, and fluid collects in that space. Drains remove it while the tissues seal, which reduces the chance of a seroma forming. They are usually removed within the first few days, once the output has fallen. Some surgeons use techniques that secure the tissue layers instead, or in addition, which reduces the space in the first place. Either approach is reasonable, and the choice is made around your operation.
Drain and wound problems worth reporting
- A drain that stops draining suddenly, or starts to drain much more, or becomes dislodged.
- A drain site or wound edge that becomes red, hot, painful or starts to discharge.
- Fluid collecting under the skin after the drains have been removed.
Looking after both
Keep the wound clean and covered while it heals, avoid pulling on the incision, and protect the scar from sun for at least a year because ultraviolet light darkens it permanently. Wear the binder as instructed. Report any swelling rather than waiting to see whether it settles. And give it time: the scar you have at three months is not the scar you will have at two years, and the difference is mostly a matter of patience.
Frequently asked questions
How low will the scar be?
It is usually planned to sit low across the abdomen, within the line of underwear, and the position is agreed with you before surgery with you standing. Where it ends up depends on how much skin has to be removed and on your own anatomy. It is worth discussing the planned position explicitly, because it is the part of the result you will live with permanently.
Do the drains hurt?
They are uncomfortable rather than painful for most patients, and they are usually removed within the first days. Having them taken out is brief and generally not distressing. If a drain site becomes sore, red or starts to leak, that is worth reporting rather than enduring.
Will the scar fade completely?
No. It fades, flattens and softens over twelve to eighteen months, and it remains visible. What scar care can influence is how it matures; what it cannot do is make a scar disappear. Any product that promises that should be treated with scepticism.
Risks & Limitations
- Seroma — fluid collecting under the skin — is the complication this operation is best known for. It is common, and it may need draining, sometimes more than once.
- Deep vein thrombosis and pulmonary embolism. Uncommon, serious, and the reason clot prevention is planned in advance rather than decided afterwards.
- Wound healing problems and infection, which are more likely in smokers and in patients with diabetes. A wound that opens can take weeks to close.
- Skin loss at the edges of the excision, which is uncommon but possible and higher in smokers.
- Bleeding or a blood collection that may require a return to theatre.
- Numbness of the lower abdominal skin, which is common and often does not fully recover.
- A scar that may widen, thicken or form a small dog-ear at the ends that can be revised later.
- A result that changes with further weight loss or gain, in either direction.
- No operation can guarantee a specific contour or a flat abdomen.
When to Seek Care
- A swelling under the skin that is new or increasing, or fluid leaking from the wound.
- Fever, or redness, warmth, pain or discharge that is spreading from the incision.
- Pain, swelling, warmth or redness in one calf — or sudden breathlessness, chest pain or a fast heartbeat, which needs emergency care.
- An area of skin at the wound edge that turns dark.
- Abdominal pain, vomiting or a lump that has not been assessed.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — patient safety and surgical guidance
- International Society of Aesthetic Plastic Surgery (ISAPS)
- Cochrane Library — systematic reviews of surgical care and wound management
- Chinese Medical Association Plastic Surgery Branch — national specialty guidance
- National Institute for Health and Care Excellence (NICE) — venous thromboembolism prevention guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.