Lower Abdomen Pooch After Tummy Tuck

Dear ProjectBeautiful,
I do see the "pooch" in the picture you posted, and truthfully it can be caused by several different reasons. The simplest way to get a straight answer is to visit your surgeon and ask them what they think is the cause. But here are some thoughts:
1) The pooch seems to be right above where I'd guess your incision is located. The upper abdominal skin tends to have a thicker fat layer than the mons region in some patients, and this can create a discrepancy. This could be easily addressed with liposuction.
2) You could have a persistent fluid collection under the skin flap (a seroma), which could be drained in the office (I doubt this possibility - you would probably notice a fluid wave at some point)
3) There maybe persistent edema in the skin flap - you can assess for this by noticing how visible the skin indentations from elastic clothing are on the front side (under the belly button), and the back of your body (assuming you did not have a circumferential procedure, or flank lipo). If you see a more marked "dent" that sticks around for a while on the front, that is a sign that you still have post operative edema.
4) You could have laxity of the lower abdominal muscles (but you say it is firm, so unlikely)
5) You might be as tight as can be achieved, but are limited by intraabdominal contents (the liver, stomach, bowels and fat located around them as a cushion). Your surgeon can only tighten the outside as much as the inside contents allow.
With this list and the guidance of your surgeon, I hope you will find a solution!

Liposuction of the tissues above the incision are not generally performed at the time of the initial procedure due to concerns with interfering with healing. You may want to discuss performing liposuction with your surgeon at this point in time

The concerns you have about the fullness of the lower abdomen could be from a number of different things including swelling or additional fat. I encourage you to return to your surgeon for an evaluation. At 9 months post op you are far enough out from surgery to consider liposuction if it is warranted.