Tummy tuck, large segment being removed

Body Contouring Scars: Is Tighter Always Better?

General, Surgeries

In cosmetic procedures such as tummy tuck, arm lift, thigh lift, and breast lift, it is generally true that more excess skin removed during surgery translates into a tighter, firmer, and more desirable result from a body contouring point of view. However, when larger sections of skin are removed, an increase in tension on the skin closure is usually the result which carries with it an increased risk for hypertrophic, keloid, and wide-spread scars as well as other wound healing complications. Body contouring scars and flatness, tightness, and firmness can therefore be conflicting goals to some extent when it comes to these popular surgical procedures.

Surgical Scars: Role Of Tension

One of the most critical technical factors that contribute to scar quality from surgery is the tension (tightness) on the wound after it is closed by stitches, staples, or other techniques. It is believed that increased tension on a closed wound provokes an inflammatory reaction at the wound edges that can lead to increased collagen production and heavier, thicker scarring. Increased tightness on wound closures can also lead to wide-spread scars as the skin edges that were drawn in tightly to close the wound are naturally inclined to stretch back to their original position over time (due to skin elasticity) and widen the scar in the process.

body contouring scars may be exacerbated by increased skin tension
Removal of a very large amount of skin in body contouring surgery such as a tummy tuck optimizes flatness but creates a larger void, so stitching the wound closed requires bridging a larger gap and creates increased tension (red arrows). Less skin removal closes under less tension (green arrows) but sacrifices flatness and tightness.

Scars From Body Contouring: Training Matters

An experienced surgeon will use her or his judgment when deciding how much tissue removal will optimally balance the desired outcome of increased tightness, flatness, and shapeliness with the potential for the undesired outcome of heavier scarring. Board-certified surgeons will keep the issue of minimizing tension on wound closures at the forefront of their surgical plan as they are keenly aware that hypertrophic, keloid and wide-spread scars can severely degrade an otherwise excellent cosmetic surgery result. Overcoming issues of tension on wound closure in body-tightening procedures is a critical element of the surgical procedure and is achieved by the use of multiple layers of sutures, progressive-tension suture techniques, and post-operative wound support with taping and compression garments.


  • For body-tightening surgical procedures such as tummy tucks, thigh lifts, arm lifts, and breast lifts, the goals of increased tightness, firmness, flatness, and shapeliness may conflict with the goal of fine scarring due to increased tension on wound closure. Consider this when discussing your surgical goals with your doctor.
  • Follow post-operative instructions carefully. Body tightening procedures have, by definition, incisions that are closed under significant tension that are more prone to opening which will lead to delayed healing and poor scarring.
  • Don’t tempt fate by exercising or returning to work too soon, as this can lead to incisions opening, delayed healing, and poor scarring. 
  • Choose a board-certified surgeon who understands the issue of skin tension and mitigating techniques to optimize scar quality.

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