A tummy tuck (abdominoplasty) is a surgical procedure designed to remove excess skin and fat while tightening the underlying abdominal muscles. While the goal is a smoother, contoured midsection, a common post-surgical concern is the formation of “dog ears.” This term refers to small, localized bulges of tissue that appear at the ends of the horizontal incision line. Although not medically concerning, these puckered areas can detract from the final result. Understanding their cause is the first step in effective prevention and treatment.
What Dog Ears Are and Why They Form
Dog ears are distinct, triangular-shaped mounds of excess skin and fat that develop at the lateral edges of the tummy tuck scar. They are a form of tissue bunching, typically becoming noticeable three to six months post-procedure as swelling subsides. These protrusions occur because the skin is pulled tight along the center of the wound, but the skin at the incision ends is under less tension, causing it to gather.
The primary cause relates to a mismatch between the incision length and the amount of tissue being redraped. If the horizontal incision is not sufficiently tapered when the skin edges are closed, excess tissue gathers at the corners, creating a fold. This effect is often more pronounced in patients with wider hips or significant fat deposits in the flanks. Dog ears are common, affecting up to 20% of abdominoplasty patients.
Surgical Strategies for Prevention
The most definitive prevention of dog ears occurs during the abdominoplasty procedure through careful surgical planning. A surgeon will meticulously plan the incision line, extending it slightly past the main area of skin removal to ensure a smooth transition. This extension tapers the closure angle, which reduces the acute bunching that causes puckering.
Targeted liposuction is also used during surgery to “feather” the edges of the incision. By thinning the fat layer at the lateral ends of the closure, the surgeon allows the skin to lie flatter. This technique is helpful for patients who have thicker fat in the flanks.
Surgeons also employ specialized suturing techniques to manage tension evenly across the incision line. Progressive tension sutures, for example, help distribute the pulling force, preventing excess skin accumulation at the endpoints. Proper planning, including assessing a patient’s anatomy and skin elasticity, is the most effective measure for minimizing this risk.
Patient-Driven Post-Operative Minimization
While the surgeon controls prevention during surgery, the patient plays a significant role in minimizing dog ears during recovery. Consistent use of the prescribed compression garment is important, as it applies continuous, even pressure across the surgical area. This compression helps flatten tissues, smooth the contour, and encourage the skin to retract.
Managing post-operative swelling is also important because temporary swelling can mimic dog ears in the initial months. Adhering to guidelines for rest and avoiding strenuous activity for the first six weeks helps reduce fluid accumulation. Maintaining a stable, healthy weight supports the body’s natural healing process and skin retraction.
Once cleared by the surgeon, gentle scar massage can be beneficial a few weeks post-operation. Massaging the incision ends helps soften and remodel the underlying scar tissue and minor tissue bunching. Manual lymphatic drainage (MLD) techniques may also be used to encourage the removal of localized fluid, further smoothing the transition zone at the scar ends.
Treatment Options for Established Dog Ears
If a persistent bulge remains after the initial healing period (assessed at six to twelve months post-surgery when swelling has fully resolved), treatment options are available. Minor bulges composed mostly of fat can sometimes be addressed with non-surgical alternatives. Targeted fat reduction procedures, such as cryolipolysis or focused radiofrequency, may be used for small areas.
The most common treatment for established dog ears is a minor surgical revision. This is typically a quick, in-office procedure performed under local anesthesia, taking around 30 minutes. The surgeon excises the small amount of excess skin and tissue at the scar end, smoothing the contour. This revision often results in a slightly longer scar but eliminates the protruding tissue.
In some cases, the revision may involve excising excess skin combined with touch-up liposuction in the surrounding area to ensure a flat result. Steroid injections can also be used to help shrink any inflammation or remaining excess tissue. Patients usually experience a rapid recovery from this minor procedure, often resuming normal activities within a week.