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Why Would a Dr Not Do Muscle Tightening in a Woman Who Has Had 3 Kids? (photo)

I had a full TT done mar 2011. After I healed my stomach was still large. I moved from the state where my tt was done. I kept calling my dr explaining to him that my stomach was not flat, he seemed concerned. I came back and he thought I looked amazing! I told him crying that i was unhappy and Im embaressed to even show ppl I had a tt done. He offered to fix it with lipo for a fee of 3600!and admitted he didnt do muscle repair.Can i do a muscle repair only now? will it help?Scared to go back!!!

Doctor Answers (17)

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Do you always tighten the muscles with tummy tuck?


Hello, and thank you for your question.

It's hard to comment on the interaction that you had with your surgeon prior to your surgery.  But they are reasons why a person may or may not have muscle tightening associated with the tummy tuck.

When a woman has a child, the abdominal wall usually has extra room.  The muscles are lax.  There is additional space in the abdomen because there is no longer a child in the womb and the uterus shrinks.  In this situation tightening the abdominal wall muscles that have stretched are in pregnancy will usually be of benefit and give long-term improvement.

In a patient who is heavy, the room may be taken up by fat inside the abdomen.  In this case tightening of the muscles may be less gratifying.  Even with abdominal wall tightening if there's too much force (weight) inside the abdomen, the abdominal muscles will relax and either find a new equilibrium or go back to where they were.  The body is smarter than doctor and will respond to the forces that are put upon it.

When I consult with my own patients I explain that a slender person will stay more flat, a medium weight person may see improvement but will find a new equilibrium, and I rarely tighten people who are very heavy because not only will they stretch back again but they are often sore and uncomfortable during the process.

Sometimes I don't tighten the muscles for other reasons.  If a patient has medical conditions which make a muscle tightening more risky I may advise against it.  If a patient doesn't need it I may advise against it, or if a patient wishes a quicker and less painful recovery the muscles do not need to be tightened. I think it's important that people know that a non muscle tightening tummy tuck is available to them.

Sometimes people have their fatty fullness outside of the abdomen.  In this case muscle tightening will not help, but liposuction well. I personally do not perform liposuction of the upper abdomen that will be pulled and moved during the tummy tuck because it can increase the risk of healing problems.  I don't mind liposuction of the flanks or hips because that does not impact upon the blood supply of the area that I'm moving.  So if a patient of mine has residual fatty fullness after the skin has been tightened in the upper abdomen we discuss the possibility of a staged liposuction.

So you see your surgeon may have had a variety of reasons for not tightening the muscles.  Staging liposuction in some cases can make sense and the only way to know his thinking is to discuss it with him further.

If you're no longer in the area you may wish to see a board certified plastic surgeon in your location.  While muscles can still be tightened, on physical examination your original or your new surgeon may be able to guide you as to whether it will be worth your while given your height and weight.

I hope this helps to clarify some of the thinking that goes into tummy tuck surgery.






Web reference:

Washington DC Plastic Surgeon
5.0 out of 5 stars 43 reviews

The 3 key elements of Abdominoplasty are.....


The 3 key elements of abdominoplasty are liposuction, skin removal, and muscle tightening. Muscle tightening is as important an element to get the final result to acheive a flat abdomen and a highly enhanced waistline. We recommend muscle plication in almost all patients to get the best outcome. I'm unsure why your doctor was unwilling to do this and without speaking to him I cannot give an answer but it is a routine component to a successful abdominoplasty.

Dr. Joseph Hunstad.

Charlotte Plastic Surgeon
4.5 out of 5 stars 23 reviews

Tummy tuck without muscle repair


We don't really know what was done here or not but you would have needed a muscle repair in my practice.  At this point, liposuction will not fix your problem because the muscles are the issue not fat.  Get your op notes and show them to a second opinion doctor.

Seattle Plastic Surgeon
5.0 out of 5 stars 44 reviews

Why Would a Dr Not Do Muscle Tightening in a Woman Who Has Had 3 Kids?


Thanks for the posted photo album it helps. The issue is your word vs the surgeon's. I bet if I asked him/her if a muscle repair "was attempted" the answer would be YES!. I agree you need muscle repair, so another full TT is needed with out skin excision, sorry. Seek other opinions in person. Follow up would be nice. Regards 

Miami Plastic Surgeon
4.5 out of 5 stars 55 reviews

No muscle repair


Thanks for your question.  A muscle repair would have improved your contour.  I do not know the conversation you had before surgery with your surgeon to know why no muscle repair was done. 

Dallas Plastic Surgeon
5.0 out of 5 stars 61 reviews

Liposuction is not a treatment for loose abdominal musculature


WIthout an examination, it is impossible to tell whether your abdominal bulging is muscular or if you need liposuction.  If the muscles are weak, then liposuction is not the answer.  I suggest that you see another plastic surgeon, since you have concerns and determine whether there is muscular weakness.  Having three children does not automatically imply that you would have a diastasis or hernia.  Muscle repair can be performed as a stand-alone procedure.

New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Abdominal muscle tightening after 3 pregnancies


It seems that muscle tightening might have improved your result, and it is possible to do if you can find it in your interest to go through such an extensive revision. Liposuction is probably not an answer, even without additional cost. Perhaps step back for a year of exercise and good living and then see what you think.

Best of luck,

Peter Johnson, MD

Web reference:

Chicago Plastic Surgeon
4.0 out of 5 stars 25 reviews

Revision tummy tuck works well.



My impression is that you can definitely have a much flatter stomach with muscle repair and some liposuction.

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Rare not to repair fascial laxity (muscle repair) when doing a tummy tuck after pregnancy.


Pregnancy stretches the fascia (investing layer supporting the muscles) of the abdominal wall as well as the skin.  ometimes the fascia is spared buy in my experience this is rare.  The photos suggest you would benefit from fascia repair. 

Atlanta Plastic Surgeon
4.5 out of 5 stars 6 reviews

Muscle repair with a tummy tuck


From your photos, it does appear that a muscle repair/tightening of the muscles will make your abdomen flatter.

Web reference:

Baltimore Plastic Surgeon
5.0 out of 5 stars 61 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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