Through pregnancy and weight gain and loss the abdominal wall can be expanded in an irregular fashion. Excess skin can be unevenly distributed and the abdominal wall can be weaker on one side than the other. Abdominal wall tightening helps to improve the contour and once the excess skin has been removed the scar can be placed as low as possible. Although the scar is placed as low as possible and the umbilicus placed in the midline the scars can be pulled in different directions postop and the scar may end up being asymmetric. The scar in this lady is 5 months postop and will continue to fade. Scars can be unpredictable and the position is often dictated by the starting point. Patients need to be aware that scars can be irregular and also the umbilicus can move off the midline.