Residual scar after abdominoplasty can be relatively long or highly leveled. Complaints on resultant scar can be exaggerated despite the scar being actually fairly well. Most of the time, this results from inadequate preoperative informing of the patient or selecting a patient with high expectations who does not accept mentioned possible surgical results. If the patient is cooperating with the surgeon during preoperative period and understands the needs of her body habitus, most of the time, a longer incision shaping the abdomen, flanks, and inguinal areas well enough is welcomed.

Asymmetric abdominal scar is another aesthetic complication almost always resulting from inadequate preoperative planning and intraoperative tailoring. Correction of dog ears should be performed with utmost precision. This can be accomplished with liberal use of liposuction laterally and excision of redundant skin step by step comparing both sides [7]. This is especially important in high-lateral-tension abdominoplasty where lateral excision is fundamental. This outcome is usually caused by a poor marking design with either an overestimation or underestimation skin redundancy below the incision. If there is significant excess below the incision, the resultant scar might be high riding. If there is no excessive redundant skin below the incision, the scar might be too low if too much skin is excised. As always in plastic surgery, the remaining volume is more important than the resected volume. Thus, remaining skin flaps must ensure a final scar shortly above the anterior superior iliac spinae. If the technique used is high-lateral-tension abdominoplasty, then some degree of thigh lift will be provided, and the final scar will be a longer one extending laterally above the anterior superior iliac spinae. Most of the patients, if the scar is thin enough and the operation gives good shaping of the flank and thigh areas, do not complain much about the length of the scar. Prevention of dog ears is a must during closure since, although the length of the scar is not a major patient complaint as described before; any skin excess especially in the lateral aspects of the scar can potentially end up with an unhappy patient.

One of the main reasons for a patient seeking abdominoplasty is ptotic mons. Abdominoplasty should also correct the position of the mons pubis at least to some degree. Placing the incision so close to the symphysis pubis, which is closer than 6 cm, results in a stretched and heightened pubis. Besides being a cosmetic deformity, this might lead to localized lymphedema of the area which may not resolve in long time. To place the incision too far from the symphysis pubis, which is further than 8 cm, avoids significant shaping of the pubis resulting in redundant pubic skin and soft tissues. Liposuction of the pubic area is a critical procedure which should be reserved for a very few number of patients. Besides being seemingly straightforward, overtreatment of this area with liposuction might result in permanent lymphedema and/or neurovascular damage of the clitoris. If any residual volume problems of the pubic area exist after abdominoplasty, this can be addressed with secondary partial excisions, limited liposuctions, and/or fat injections. In patients who have a highly positioned umbilicus, the mons pubis can migrate superiorly with closure of abdominal flap. This potential complication can be prevented by closing umbilical defect with a purse string suture or a T-shaped scar which may end up like a fleur-de-lis scar.

The quality of scar can be questioned by the patient. Patients should always remember that as plastic surgeons we cannot predict 100 % how a final scar will appear. This is very important to be addressed to the patient before the surgery since the final quality of the scar is multifactorial and includes endogenous patient conditions, surgeon´s operative techniques, and patient aftercare. Bad scars can be either hypertrophic or atrophic. Preoperatively, the patient should be questioned and examined about the quality of previous scars, if present. A history of hypertrophic scar or keloid is predictive of the quality of central transverse scar after abdominoplasty. Widened atrophic scars can be seen in patients with Caucasian origin. Atrophic scars are often the result of inadequate reapproximation of the superficial fascial system. The final status of a scar can be determined at 1 year postoperatively, and bad scars can be revised thereafter. Steroid injections often help to soften hypertrophic scars. Ablative laser procedures can also improve cosmetic result of a hypertrophic scar [8]. Keloids should be addressed with core excision combined with steroid injections.