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My Doctor Says This is "A Perfectly Well Done Tummy Tuck". What Do You Think? (photo)

Almost 2 years ago I had a full tummy tuck. I was once obese and after I lost a lot of weight (from 308lbs to 187), I decided to do the tummy tuck. So, this is what happened. Three days after the surgery my belly was lose. 2 years later it's catastrophy! I visited my doctor 3 weeks ago and he told me this is 'a perfectly done surgery' and then sent me home. What are my options? Can this be repaired?

Doctor Answers (14)

Either your "surgeon" is not an ABPS-certified plastic surgeon, or he is a liar.

+5

With due respect to my colleagues who are answering you with extreme political correctness by asking for pre-operative photos to compare to your present ones, several things appear clear to me.

First of all, your weight loss has been maintained for the past two years, and you deserve hearty congratulations for this, perhaps particularly in light of the abysmal result you have received from this doctor. (I'd be depressed and be tempted to fall back into obesity.)

Secondly, you had umbilical transposition that moved your "new" umbilical exit site only a couple of inches up, leaving your "old" umbilical site as a vertical scar halfway between your present umbilical exit site and your suprapubic tummy tuck scar, the latter not even visible because of the significant residual excess and loose skin overhanging your pubic area.

Furthermore, the lack of visible scars on either side view photo shows you had an extremely short horizontal incision, when the amount of excess skin present pre-operatively absolutely mandated what I call an extended abdominoplasty, or even a full circumferential beltlift procedure.

I don't need to see pre-operative photos to know you had significant loose hanging abdominal skin after a 121 pound weight loss, and that what obviously was a short transverse elliptical skin excision was inadequate--woefully so!

Your surgeon may have performed all the steps of a tummy tuck in a technically correct fashion (skin excision, umbilical transposition, ? fascial plication [muscle repair], and closure. You may have healed uneventfully and without complication.

But one step was omitted--the most critical one, IMHO. That was proper surgical assessment and judgment regarding the amount of skin to excise and the degree of final surgical tightness to achieve in order to accomplish even a "usual and customary" result.

What you received was totally inadequate, and something that any ABPS-certified plastic surgeon (even a newly certified one performing his/her FIRST tummy tuck in private or academic practice) should be ashamed to call their procedure.

Negligent--probably not. Malpractice--possibly. Outside the "standard of care"--I believe so, and if you read between the lines of the other answers, so do most if not ALL of my colleagues. But clearly this is a totally unsatisfactory result for a "full tummy tuck." It may not qualify to win a lawsuit (and would be quite a battle), but it certainly merits complaint to the state board of medical examiners, and perhaps an evening news "expose!" Especially if this is the work of a non-ABPS-certified plastic surgeon masquerading as one!

This kind of tragic result is what gives "plastic surgery" a bad reputation, though I would be surprised if this was performed by an ABPS-certified "real" plastic surgeon. Any one of us, even those with adequate training and only "average" skills, would be ashamed to have this as a result. If this was the result of surgery performed by a so-called "cosmetic surgeon" whose training had little or nothing to do with plastic surgery, and whose "board certification" (if any) is not by the American Board of Plastic Surgery but instead by one of several "bogus" boards, then perhaps part of the blame for this outcome is properly borne by you for choosing (actively or unwittingly) this doctor. Sometimes these non-plastic surgeons are quite clever and openly deceiving in their brash self-promotion and marketing. That is why we (ABPS-certified plastic surgeons whose reputations are tainted by these "pretenders") so often ask patients here and elsewhere to search for ABPS-certified plastic surgeons. Otherwise, there truly are doctors who seek to actively mislead and fool a gullible or trusting patient population into choosing them for low price or supposed "new and improved" operations.

Lest I sound overly pompous, it must be understood that even some ABPS-certified plastic surgeons over-promote, use "brand name" operations designed to seem "latest and greatest and up-to-datest," and all of us are imperfect and can occasionally have less than ideal outcomes. Or even complications. Sometimes bad ones. But, hopefully, not because we lack complete plastic surgery training, ABPS-certification, and decision-making that would let us know your result is WAY OUTSIDE the norm of plastic surgical practice.

The reality for you is that you need a repeat operation consisting of an extended tummy tuck. I believe that you have so much excess skin remaining that a full umbilical transposition can be performed (again) without leaving an inverted-T suprapubic scar or one like you presently have between the umbilicus and pubic scar. Your transverse scar will need to be much longer towards each hip area (allowing removal of the excess skin as widely as possible, and minimizing the chance for lateral dog-ears), and perhaps your muscles may need to be tightened (for the first time, or again and more).

If you had this performed by some “wannabee” cosmetic surgeon who clearly doesn’t know what a “normal” tummy tuck result consists of, seek out one or several ABPS-certified plastic surgeons, obtain consultations, and prepare for the cost and recovery for another operation--this one done properly.

If you had this done by an ABPS-certified plastic surgeon, and although you are not my patient, let me personally apologize for the terribly abysmal quality of your doctor's work. This is NOT representative of the skill, training, and quality work the vast majority of ABPS-certified plastic surgeons bring to their patients, and not at all representative of even marginally-acceptable results. I do not know where you live, but if you wish to travel to Minneapolis and make appropriate post-operative care arrangements, I would be willing to offer to re-do this for operating room and anesthesia costs only (no surgeon's fee whatsoever), which is what I offer for my own patients when they request or require re-operation. You deserve a substantially-better result. Please accept my condolences. Best wishes! Dr. Tholen

 

 

 


Minneapolis Plastic Surgeon
5.0 out of 5 stars 123 reviews

Very Unhappy With Results of Tummy Tuck

+4

Thank you so much for your genuine concern and excellent photos.  I believe you have every right to be unhappy with your results.

While the pre-op photos may be helpful, it is very clear that an adequate amount of skin was not removed. Based on the significant weight loss you experienced (Congratulations!) there is little doubt that an extended tummy tuck (which would also address the excess loose skin around the flanks and possibly onto the back) would have been appropriate.  Other issues can be noted on your photos that should also be addressed with revisional surgery.

It is my strong recommendation that you seek additional opinions from Board Certified Plastic Surgeons to discuss what can be done to give you the results you truly deserve!

Best wishes for a wonderful result

Louis DeLuca, MD
Palm Beach Plastic Surgeon
5.0 out of 5 stars 31 reviews

Tummy Tuck results

+2

I think it may be in your best interest to seek another opinion and bring your pre-op photos in with you.  Sometimes after massive weight loss you have a issue with skin laxity in multiple areas and are sometime left with looseness across you abdomen,not just up and down.  Seek an experienced board certified plastic surgeon for a second opinion.

Charles R. Nathan, MD
Saint Louis Plastic Surgeon
5.0 out of 5 stars 5 reviews

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Touch up tummy tuck with removal of additional skin

+1

It is very difficult to judge your result without seeing what you started with.  Depending upon how you looked before this may represent as good a result as was potentially attainable at your original surgery. That being said, I can certainly see the extra skin that you are concerned about.  A touch up to your tummy tuck with removal of additional skin could certainly be performed at this point and improve your result.  Good luck.

Sacha Obaid, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 20 reviews

Additional correction is possible

+1

Hello,

Thank you for the question and the photos.  A "perfect" tummy tuck has certain qualities but it is also defined by the patient since each patient may want something a little different as their ideal abdominal shape.  It is clear that you are not defining your result as a "perfect" tummy tuck.  Your plastic surgeon may have a different opinion but it is your opinion that matters most.  I think you are correct in seeking additional information and professional opinions.  From my perspective additional tightening is needed.  A full tummy tuck re-do will be the best way to accomplish the best result.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 91 reviews

Unhappy after Tummy Tuck?

+1

Thank you for the question and pictures.

Based on your history and pictures, your disappointment with the results of surgery is certainly understandable.  Although you provide a good “snap shot” of your situation before and after surgery, making a judgment about the quality of work performed without knowing significantly more information is not fair or ( in my opinion) appropriate.

For example, where you started preoperatively and exactly what was discussed as possible options preoperatively will be important to know.  Were you offered an extended tummy tuck or lower body lift procedure?

 Having said that, your result is far from “perfect” and there is certainly  significant room for improvement  in your situation. You will likely benefit from removal of additional skin/adipose tissue circumferentially. The quality of the muscle plication will also need to be assessed.

 I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 718 reviews

Perfectly done TT

+1

 I am so sorry to hear about your result. Your photographs do not show a perfectly done TT.  There is obviously the high possibility for some improvement with additional surgery. May I suggest you start by asking your surgeon for a copy of your operative report and pre-operative photographs. Then, consider a member of the ASAPS in your area for a consult. Please take these materials with you to the visit. These surgeons are experts in revisional cosmetic surgery. Best,

 

Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon
5.0 out of 5 stars 3 reviews

Unsatisfied after a tummy tuck

+1

Thank you for your questions and pictures. It is really difficult to comment without the pre op picture. Usually with so much weight loss the skin is very loose and sometimes you can not be overly agressive.  Also returning after two years make it difficult because a lot can change to your body over this time frame, like weight gain or loss.  What I see can be improved with additional surgery. Good luck

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 29 reviews

TT results.

+1

It is somewhat unfair.to comment on an outcome without looking at preop photos. If this were a one month photo, it would be clear that not enough was done. If the results looked ok at one month and like this now, then I am not sure this outcome could have been prevented. In massive weight loss patients, the skin may stretch out with time after skin reduction surgery such as tummy tuck.
At any rate, the photos describe where you are today, and you ask about options and can this be fixed. Base on these photos, it looks like you would be best served with a tummy tuck that is carried most or all the way around the back as a "belt lipectomy" or lower body lift. The mons can be improved by its elevation and possibly some liposuction. An in person exam, of course, would be needed before make actual recommendations for surgery.
If your surgeon is content with the results at this time, see another surgeon.  RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.
Thank you for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

Tummy Tuck after Massive Weight Loss

+1

           I would add that your doctor did remove at least all of the skin to the level of the belly button the first time and he did transpose the belly button.  Otherwise you would have a vertical scar above your horizontal scar.  In this respect, the doctor did perform a full tummy tuck. 

        Something else to keep in mind is that in patients with a lot of subcutaneous fat the flaps that are closed always have additional skin later. 

         Obviously, the tummy tuck could be revised to be better.  It is not a perfect result.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 203 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.