Thank you for your question regarding the persistent and worsening bulge in your upper abdomen following a tummy tuck performed nine years ago. Based on your description and the photos you provided, there are several potential causes for this issue, each requiring a different approach. Firstly, I would recommend undergoing an ultrasound to determine the exact cause of the bulging. This diagnostic tool can help us understand whether the bulge is due to: Failed Muscle Repair: Over time, the sutures used in muscle repair can loosen or break, especially if subjected to strain or weight changes. This could cause the abdominal muscles to separate again, leading to a bulge. Visceral Fat: Liposuction would be ineffective if the bulge is due to an increase in visceral fat, which is the fat surrounding internal organs. In this case, weight loss through diet, exercise, and possibly weight loss medications like Zepbound could be beneficial. Suppose the ultrasound shows that the bulge is due to failed muscle repair. In that case, a revision tummy tuck might be necessary to re-tighten the abdominal wall and ensure a more lasting correction. Although you preferred avoiding another tummy tuck, this might be the most effective way to address significant structural issues with the abdominal wall. Regarding liposuction, if the bulge is primarily from subcutaneous fat, particularly around the flanks, liposuction could indeed help in contouring these areas and might be combined with any necessary revision surgery to optimize the overall aesthetic outcome. Given the complexity of your situation, I strongly recommend discussing these options with a board-certified plastic surgeon who specializes in revision procedures. They can provide a tailored approach based on the specific findings from your ultrasound and your previous surgical history. I hope this guidance helps you take the next steps toward resolving this issue and achieving the abdominal contour you desire. Sincerely, J. Timothy Katzen, MD, FASMBS, FICS Plastic and Aesthetic Surgeon