What can be done to improve the step off appearance? Would like a smooth transition. Do I need another TT? (Photo)

Question

I had a full tt with muscle repair and liposuction 1 yr and a half ago. Scar excision 6 months ago. For the scar revision, I believe he went in and took out some scar tissue but no more lipo was done. I chose my surgeon specifically because he did a "state of the art" no drain tt and also specified he took extra steps to ensure my pubic area would be lifted and flat. I just want a smooth transition. Is this possible? Should my surgeon fix this?

Scott W. Harris, MD, FACS · Answer

I, too, believe that a smooth transition from belly button to pubis is attainable. Unfortunately, it will require more surgery. More aggressive liposuction will help, but might not completely satisfy you. You may need to revise the tummy tuck again. The reason we cannot be absolutely sure is that sometimes people make scars that misbehave and attach down to the muscle layer, creating the indentation your pictures demonstrate. So I would recommend doing more surgery after you heal sufficiently and keep your fingers crossed! Good luck.

Jonathan Heistein, MD · Answer

Hi, I think if you take out the existing scar indentation, you could achieve a smooth transition.  However, the entire depth of the scar, down to the abdominal wall fascia (muscles) should be removed since this would allow a fresh start from which the new scar would form.  Also, if some of the excess skin from your pubic region is removed, then this area may appear tighter afterward.It is possible that some liposuction could also be necessary to improve the contour of what is left behind.Good luck.

Juan Carlos Fuentes, MD · Answer

Some times the step off appearance is due to the difference in the thickness of the flap above and below the scar. More liposuction will make both flaps more even in thickness, and the scar revision will lift more the pubic area.

Jon M. Grazer, MD, MPH, FACS · Answer

In your photos you have a high area above and below the scar. Liposuction can lower these areas. The scar band under the depressed area can be released, using a tool called a pickle fork.  Fat grafting can then be done to elevate the depression and keep it from sticking down.

Thomas Trevisani, MD · Answer

It is difficult to comment accurately without a physical exam, however based on the photo you provided a revision surgery is needed to correct the problem. Also, based on your photo- it does not appear that you had a full tummy tuck based on no scar around belly button... In my opinion--In order to achieve the best result possible a full revision tummy tuck is needed.

Kenneth Hughes, MD · Answer

An exam is always helpful, but the result probably can be improved.  I
would search for the board certified plastic surgeon who you feel is
most likely to give you the best results and who performs hundreds of
these procedures each year. I would look at patient reviews as well as
before and after photos on that surgeon's website.Kenneth Hughes, MDLos Angeles, CA

Remus Repta, MD · Answer

Dear starstuff01,Thank you for the question and the photos.  There is either excess scar tissue at the depression or the deeper tissue need to be re-approximated more to prevent indentation.  It may also be a combination of the two issues.  A pseudo-bursa may also present like this since it can exist above the incision adding fullness.  An in-depth exam and review of your surgical history would be needed to determine which of these possible issues are the source of your contour irregularity and what would need to be done to correct it.  A short video on pseudo-bursa removal is listed below.All the best,Dr. Remus Repta

Peter Fisher, MD (retired) · Answer

Hello and thank you for your question. Yes I believe this can be improved.  The scar needs to be excised again. The tummy  and mons flaps need to be elevated, the tummy flap suctioned and a drain placed. Sorry I think this is your best bet.Peter Fisher M.D.

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