6 months post tummy tuck revision and stomach still appears swollen and bloated. Will I need another revision? (photos)

To make an assessment on the outcome of a plastic surgery procedure we generally always need to see proper before and after pictures. If you’ve had more than one operation, then you should ideally include before and after pictures of each of the procedures. If you don’t have it before, and after pictures, then asked your surgeon to forward the pictures they took.
There are generally four different tissue variables that determine what the abdomen looks like. This is true whether someone has had surgery or not.
The four issue variables that determine what the abdomen looks like include abdominal skin laxity due to previous pregnancy or significant weight loss, excess subcutaneous fat, muscle separation from previous pregnancy, and lastly excess visceral or intra-abdominal fat.
Having had a tummy tuck, it is unlikely that the bulging of your abdomen is due to skin laxity. Your subcutaneous fat layer appears thin. It’s unusual for muscle tightening not to hold after a tummy tuck and there’s only leads to one single variable left and that is excess visceral or intra-abdominal fat.
Excess visceral fat can often be seen on pre-operative pictures and that’s one good reason why patients should always include it before and after pictures. Individuals who have excess visceral fat will have a limited response to a tummy tuck with muscle tightening. Individuals who have a high percentage of visceral fat as a genetic fat distribution can have bulging of their abdomen due to intra-abdominal fat, despite not being obese.
Muscle, separation and excess visceral fat can have a fairly similar appearance. It’s important that plastic surgeons learn to differentiate between the two because only muscle separation is appropriately treated with muscle tightening during a tummy tuck.
One fairly easy way to differentiate visceral fat from muscle separation is to simply lay on your back and see if your abdomen goes flat. If your abdomen still bulges, while laying on your back and visceral fat is most likely the culprit. Individuals who have muscle separation without excess visceral fat will have an abdomen that goes completely flat when laying on their back.
The number one reason patients have a bulging abdomen after a tummy tuck surgery is undiagnosed or under diagnosed excess visceral fat.
It should be pretty easy to differentiate or determine if a visceral fat is an issue on examination and plastic surgeons should be able to do this assessment on any patient because it clearly differentiates the type of results which should be predictable predictable.
Consider having a few second opinion, consultations with other plastic surgeons in your community. Ask them specifically to help assess to see if excess visceral fat is a problem. Your history should also tell you if you have a history of excess visceral fat. Individuals who have this condition usually have some issues with bulging of their abdomen even before their first pregnancy.
Obviously, I’m making some assumptions and you may or may not be an individual who has problems with visceral fat.
It is, however, one of the most common reasons for patients to bulge after this procedure, and is unfortunately sometimes overlooked.
Best,
Mats Hagstrom, MD