Is this normal? The phrase turns up more than 8 million hits on Google, related to everything from puberty to parenting to plastic surgery. On our own site, you’ll find the question posed in relation to every imaginable cosmetic procedure and aesthetics scenario. When we find ourselves in the unfamiliar territory of recovery, one thing is clear: nothing beats boring and predictable.
Following a tummy tuck, you’ll be inundated with instructions for tending to your incisions, dealing with your drains, scheduling your medications, and so much more. Amid the countless bullet points, you’ll likely see a section on red flags—the not-so-normal stuff that no one likes to think about. But complications can happen—and your radar should be tuned to detect them.
While every surgeon’s aftercare roadmap is a little different—and you should always follow your doctor’s individualized guidance—certain tummy tuck mile markers are fairly standard. We asked top plastic surgeons what to expect—and watch out for—in the days to weeks following a tummy tuck, so you’ll know, without question, what’s normal and what’s not.
Day one post-op
On the heels of major abdominal surgery, you can expect to feel sluggish, sore, and somewhat overwhelmed by the sheer task of caring for your healing body. Lean on whomever you’ve enlisted for support during this time, as you’ll need help getting in and out of bed, putting on and taking off compression garments, washing your hair, and managing medications and meals.
What’s normal
“Day one is generally a blur as the anesthesia wears off,” says Dr. John L. Burns Jr., a board-certified plastic surgeon in Dallas. “Most patients sleep a lot.” Once the grogginess fades, you should feel well enough to tackle basic self-care tasks (including emptying drains) and take short, supervised walks, which “help to reduce swelling, avoid constipation, and lower the chance of developing blood clots and/or pneumonia,” says Dr. Camille Cash, a board-certified plastic surgeon in Houston. It’s important to walk on day one, adds Dr. Burns Jr.
Your abdomen will be moderately tender, swollen, and possibly bruised. “There’s some pain at the incision and liposuction sites as well as abdominal tightness from the garments and rectus plication [or muscle repair],” notes Dr. Burns Jr. Many surgeons inject a long-acting anesthetic called Exparel into the abdominal wall during surgery. “This significantly helps to reduce the initial discomfort that patients ordinarily feel after surgery when the effects of the general anesthesia wear off,” explains Dr. Umbareen Mahmood, a New York City board-certified plastic surgeon. The injectable curbs pain for about 72 hours, which means you may actually have less discomfort on day one than you do on day three.
“Low-grade fever is common due to the anesthesia,” says Dr. Burns Jr. “You’ll be given a device called an incentive spirometer to prevent this and help expand your lungs after surgery.”
Your incision will feel tight and numb in spots and will be covered in Steri-Strips and adhesive (these will gradually loosen and fall away over the course of several weeks). You’ll walk slightly hunched over (for about a week) and will be wearing surgical garments 24/7, shedding them only to shower, for the first six weeks post-op, notes Dr. Mahmood. (While they can be tricky to get on and off, surgeons say most patients actually appreciate how supported they feel with them on.) For the first week after surgery, your doctor will want you sleeping on your back, your head elevated, and pillows propped under your knees, to reduce tension on your incision.
Constipation is common, due to the limited activity, pain pills, and dehydration that come with recovery, but you can offset it by drinking plenty of water, walking as much as your surgeon suggests, upping your fiber intake, and taking a stool softener as prescribed.
In the early going, we should note, it’s normal to feel all the feelings. According to Dr. Burns Jr., the first few days post-op can be marked by a mix of euphoria, fear, and exhaustion. “Some patients question, ‘Why did I do this to myself?’” adds Dr. Cash. Others worry about their final result or have anxiety around activity restrictions or sleep changes, Dr. Mahmood tells us. Many feel guilty for spending money on themselves or for not being able to meet the ever-present demands of family and work. While any cosmetic surgery can trigger the blues, “with a tummy tuck, they’re more common in the first week, because it’s hard to manage the drains, the compression garments, and medications,” notes Dr. Farah Naz Khan, a board-certified plastic surgeon in Dallas. “Patients do much better if they prepare ahead of time for a caretaker and supplies to assist with the recovery process.”
As results slowly come into focus and patients begin to realize that the surgery was worth it, worry gives way to relief. “I’ve never had a patient need professional help [coping with the blues],” says Dr. Khan, “but if someone has a baseline level of depression or anxiety preoperatively, I do recommend that they follow up with their therapist in the immediate post-op period.”
What’s not normal
Red flags include fever higher than 101.5℉, extreme pain that medication can’t abate, areas of redness that are hot to the touch, increasing swelling or bruising of the abdomen, rashes, oozing or open incisions, leg pain, trouble breathing, or an excessive amount of bright red blood in your drains.
“Some degree of bruising is normal, but bruising that gets darker [over time] is not,” warns Dr. Khan. It could be a sign of vascular compromise, which “is more common in those who undergo liposuction at the same time as the tummy tuck, since it weakens the blood supply to the remaining abdominal tissue.”
While the combination of drains, garments, and prescribed movement should dramatically curtail complications in the days following a tummy tuck, you’ll want to watch for symptoms of hematoma (blood pooling) and seroma (a buildup of clear fluid) in the abdomen. “If a patient has disproportionate pain, the belly is swollen and bruised, and the drains are putting out a lot of blood, this is an emergency and they should call their surgeon ASAP,” says Dr. Khan. With a seroma, she explains, “fluid accumulates in the belly and patients often describe feeling like a water bed—they can see the fluid shift from side to side.” Hematomas and seromas may require a return trip to the OR.
If you experience any of these issues, call your plastic surgeon right away.
One to two weeks post-op
“The first week post-op is always the hardest,” says Dr. Khan, largely because drains can make life a little miserable. Once they come out, one to two weeks after surgery, patients usually get a major lift. (Drain output determines the precise timing of their removal. Before ditching drains, Dr. Cash likes to see less than 30 milliliters over 24 hours for two consecutive days.)
What’s normal
With the worst of your tummy tuck recovery in the rearview mirror, “patients generally report not needing any narcotic medication or even over-the-counter analgesics, like Tylenol,” says Dr. Mahmood. Bruising commonly subsides by two weeks, possibly sooner for those who’ve been taking arnica religiously. You’ll still be swollen, she adds, but you should be able to see an obvious improvement in the shape of your abdomen, which buoys spirits further.
Once tummy tuck patients are drain-free, Dr. Khan has them start getting lymphatic drainage/scar tissue massages. “This allows the swelling to resolve quickly—and people love seeing their results improve more and more over the next several weeks,” she says.
By one week, patients are standing fully upright, walking without assistance, and—assuming drains are out—they can sleep flat on their back or on their side. Around this time, many patients are feeling more independent and returning to work (though those with labor-intensive jobs will take off a full two weeks).
What’s not normal
Fevers, an altered mental status, rashes, respiratory issues, severe pain, excessive swelling, discoloration across the abdomen, and incisions that are red, hot, bloody, or weepy all warrant a call to your surgeon.
Seromas can develop after drains come out, warns Dr. Burns Jr., so watch for significant swelling.
One month post-op
At your one-month follow-up visit, your surgeon will likely green-light all the stuff you’ve been missing: holding your kids, having sex, driving, exercising, stomach sleeping, and more. Some doctors will clear you for all forms of exercise, save the most intensive core crushers—because muscle repairs need a few more weeks to heal—but others will ask you to wait another month before resuming your regular fitness routine.
What’s normal
“At one month, patients tend to feel great,” Dr. Mahmood tells us. “The majority of the swelling has subsided, they’re allowed to return to their regular lifestyle, and they feel like themselves again, albeit with a restored and enhanced figure.”
The Steri-Strips have likely fallen off by now, revealing your tummy tuck scar, which may look bright red or dark brown, depending on your skin tone. Using sunscreen and silicone-based scar gels daily can help it fade and flatten over time.
You’re still wearing compression to fight bloat, but “patients frequently graduate to a ‘stage 2’ garment, which, generally, is more compressive and can either have no hooks/zippers or can have adjustable hooks, like a corset or faja,” says Dr. Mahmood.
What’s not normal
Happily, “there are very few real issues of concern that can arise at one month post-op,” says Dr. Mahmood. At this point, you shouldn’t be in any pain or moving awkwardly for any reason.
If your scar still hasn’t fully sealed up, or if sections of it seem slow to heal, have your surgeon take a look during your one-month appointment.
Six weeks post-op
Patients who’ve been on an extended exercise hiatus can celebrate the six-week mark with a run or a Spin class. Burpees, crunches, mountain climbers—it’s all fair game. Just be sure to ease in and listen to your body.
What’s normal
At six weeks, “your physical recovery is almost complete,” says Dr. Burns Jr., so you’re less worried about abnormal healing and more concerned with the aesthetics of your outcome. If the reality of your results doesn’t quite match up with your wish-pic ideal, don’t panic. “I tell my patients that we typically see only about 60% of their final results at the six-week mark,” says Dr. Khan. “A lot of the contour abnormalities from lipo will resolve as the swelling continues to subside over the next several weeks to months.”
Most surgeons allow their tummy tuck patients to retire their compression garments at or around six weeks, while others encourage transitioning to a comfortable pair of Spanx or maybe a waist trainer. “Some patients wear their garments up to six months, by choice,” says Dr. Cash, to help chase away lingering swelling or simply to feel more snug and secure in their clothing.
What’s not normal
Again, it’s really too early to judge the appearance of your abdomen, but if something seems off —be it the shape of your new belly button or the tightness of your tummy—talk to your surgeon. Just bear in mind, says Dr. Khan, that swelling can last for a year—especially in the lower midline of the abdomen, due to gravity—and scars can take a full year to mature, so surgeons generally like to wait at least 12 months before discussing potential revisions.
