I have a horrible "shelf" or step off just above my incision from my TT. How can this be fixed? (Photo)

Your surgeon should have a high resolution ultrasound (HRUS) at his/her disposal by this point in time. 5 seconds of scanning will tell the surgeon if there is a seroma or not, or if there is an issue with the abdominal wall repair (unlikely). In that case, it would be a combination of swelling and excess fat. I prefer patients wait at least 9 to 12 months from tummy tuck surgery before any additional liposuction is performed. Keep in mind that the results of liposuction would be improved with more skin advancement, but only below the belly button. This gives the surgeon the opportunity to lower you incision further and tighten skin.

while retained fluid can definitely cause a bulge in the lower abdomen after her tummy tuck based on your pictures, I would not suspect that. The important thing would be to determine whether the bulge is from an excessive fat accumulation, or if it is a residual muscle weakness (diastasis). I would determine this by examining. If it is out of stimulation, then liposuction would take care of it. If it’s a residual diastasis, you may need a revision tummy tuck to reconstruct the muscle muscles of the lower abdomen.

Liposuction will help flatten your tummy now that your skin and muscle have been nicely tightened with the tuck. This can be done with local anesthesia and minimal downtime and risk.

Dear susangro2570,
I understand your concern. Based on your photos, it looks like liposuction can improve the shelf. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Go back to your surgeon to see if this is excess fat which can be removed with liposuction, or is fluid which can be seen on ultrasound examination.

Hello; what causes for the swelling? You can learn it; with ultrasound. If it is due to excess fat; with the Vaserlipo technique; problem is solved. If it is due to seroma formation; surgical excision is required. If it is due to muscle laxity; plication must be applied on the caste muscle.

The correction of this contour will depend on the cause. If it is a seroma then it must be addressed by your surgeon. An ultrasound (often performed in the office) can determine if one is present. If the contour is from excess fatty tissue then liposuction should give you a flatter tummy. Compression would be beneficial if lipo is performed. At six months post op swelling from your surgery has resolved.

To make an assessment on the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
If we don’t know what you look like before the procedure then we don’t know what to expect in regards to your outcome.
Plastic surgical outcomes are generally based on two variables.
The first is patient candidacy and the second is the skill or selection of providers.
Personally, I’m not a fan of the floating bellybutton tummy tuck procedure.
There are four tissue variables that determine what the abdomen looks like.
When choosing a procedure, it should be based on having a clear understanding of which of these variables is causing the problem.
The four variables that determine what the abdomen looks like are the following.
1) Abdominal skin laxity typically due to previous pregnancies or weight loss.
2) excess Subcutaneous fat.
3) Muscle separation from previous pregnancies.
4) excess visceral or intra-abdominal fat.
In your case, I’m guessing that you had a pregnancy related changes which were skin laxity and muscle separation.
Most people have a subcutaneous fat layer that is thin in the groin area.
The subcutaneous fat layer is typically the thickest around the mid abdomen.
When skin and fat layer is removed from where it is thin and ending where the fat layer is thick, there’s going to be a natural step off or variation in thickness of the fat layer.You can avoid this by making the incision higher up or you can avoid it by removing subcutaneous fat from the upper skin edge.
In my opinion of floating belly button tummy tuck is a shortcut version of a proper procedure.
I think you should’ve opted for a full tummy tuck with muscle tightening. The reason is that it addresses properly, both abdominal skin laxity, and muscle separation, which were the two variables, keeping you from looking the way you did before you had children. (I’m assuming that’s why you had the procedure)
The fullness of your lower abdomen is primarily due to an abrupt change in subcutaneous fat thickness.
This can be corrected with Liposuction.
I think you also have muscle separation from previous pregnancies and I’m guessing this was not corrected as part of your procedure.
Once a patient has selected a floating bellybutton, you cannot convert to a regular full tummy tuck.
Choosing a floating bellybutton, tummy tuck burns the bridges for converting the procedure.
It’s possible to do a revision, including muscle tightening to get a tight flat abdomen.
It is however, not possible to remove more skin without losing your bellybutton.
The step off in the subcutaneous fat layer can be treated with liposuction or a scar revision.
That, however, it’s only part of the problem.
This is why I don’t like the floating belly button tummy tuck.
It leaves mediocre outcomes, and then the outcome can not be corrected by converting to a proper tummy tuck. I’m sorry if my response is a bit blunt and lacks optimism.
It’s definitely possible to improve your outcome.
Whether this is done with only Liposuction or you have the procedure redone with muscle tightening is a pretty lengthy discussion that is well outside of the scope of this post.
I would like to point out that the ability to deliver consistent quality Liposuction results is more difficult than most people realize.
The number of plastic surgeons who approach mastering Liposuction is quite small.
Most plastic surgeons think they’re better at Liposuction than they actually are.
Selecting providers for Liposuction should be done with great care and caution.
Insist on seeing lots and lots of before and after pictures before selecting providers.
Generally speaking, I recommend patients always schedule multiple in person consultations before having any plastic surgery operation.
Start the process by making a list of potential providers for the procedure you’re interested in your community.
Look for plastic surgeons who seem to have expertise or do a lot of the procedure you’re interested in.
Next schedule in person consultations with each of these providers.
Avoid virtual consultations, please.
Bring pictures of yourself to use as reference for each consultation. Look at how plastic surgeons take before and after pictures to get an idea.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics to your own.
Bring pictures of your own body to use as reference when reviewing before and after pictures.
Being shown a handful of pre-selected images representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they have actually done.
An Experienced plastic surgeon should have access to 100’s-1000’s of before and after pictures to choose from.An experience to plastic surgeon should have no difficulty showing you the before, and after pictures of at least 50 previous patients.
You may not have enough time to review that many pictures, but in the hands of the right provider, there should be what seems like an endless selection of pictures to look at.
Ask yourself if the doctor explained your candidacy for the procedure in sufficient detail?
Do the pictures they showed you look like you do?
I’ve reviewed the four variables that determine what the abdomen looks like above.
A thorough consultation should assess each of those variables and explain how each one is contributing to the patient’s appearance.
There’s no correct number of consultations needed to find the right provider.
The more consultations you scheduled the more likely or to find the better provider for your needs.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
The second biggest mistake I see patient make is assuming that a plastic surgeon who is board certified and has a decade or more of experience with a bunch of good reviews Has mastered most plastic surgical procedures.
Considering that people will be reminded of the outcome every day for the rest of their life, I think scheduling four or five consultations at a minimum seems appropriate for these type of procedures.
I’m sorry you’re not happy with your outcome and I wish that you would’ve found a different provider.
I don’t want to speak poorly of your surgeon because I don’t know who did your operation.
I think it was poorly planned and poorly executed.
That said the results are probably actually fairly average for this procedure. As I mentioned earlier, I don’t like floating bellybutton tummy tucks.
Exceptional work is done by exceptional surgeons, and the majority of surgeons are average.
Best,
Mats Hagstrom MD