Bulging Lower Abdomen Post-Tummy Tuck

This may relfect the fatty layer thickness of the upper abdomen which has been transposed to the lower abdomen. In this case liposuciton is mot performed tha first time around due to concerns wiht vascularity. Alternatively, it may be that your muscles are reapporximated but that you need to perform core strengthening excercises. Lastly it could be intra-abdominal fat and now you are talking geneeral surgery

This is an excellent question as this concern comes up quite often after this type of surgery. 

There are likely two issues here. First and foremost, at 6 weeks you are still very early in the healing period. Most patients have residual swelling which lasts a minimum of 4 months and in some cases, up to 6 months. Second, as mentioned by my colleague, it is likely that the thicker upper abdomen has been transposed to the lower abdomen, thus contributing to lower abdominal fullness. This type of anatomy is a common finding, thus we educate our patients pre-procedurally that they may require a second-stage lipoplasty to obtain optimal results.  For now, I recommend patience, commencement of light exercise, and sound nutrition.

Warmest Regards,

Glenn Vallecillos, MD, FACS

The area of the lower abdomen, just above your incision is the last place you will lose your swelling. I frequently see patients have intermittent swelling for up to 4-6 months after surgery. Remember this is the most dependent portion of your skin flap and until your body and rebuild the lymphatic channels ( that take away swelling) you will intermittently see fullness there.

Dear Bratcatcher,

At six weeks post op, it is still a little early to make judgments about your appearance. You are concerned about being able to 'pinch an inch'. If you surgeon did not perform Liposuction in that particular area, the thickness of the fat will not have changed much from surgery. Keep in mind that there is still swelling of the tissues which will continue to resolve with time (expect 2-4 months for full resolution).

You state that when you sit, there is a 'spare tyre'; if you are concerned about some extra skin, please note that in the sitting position, everyone has excess skin, including post tummy tuck patients. If it is the thickness your are concerned about, the comments above apply again. I see some stretch marks remaining in your photos. This indicates that some of your skin has decreased elasticity; as you heal, the skin will stretch out to some extent, and that may explain why your skin is not as tight as it might have been right after the surgery 

Bottom line: Wait about 6 months. If you are still unhappy with the thickness of the abdominal fat layer, some liposuction will easily solve your concern, hopefully you won't need it as things settle. Good luck.

Best regards,

Lawrence Tong MD FACS FRCSC  

The skin of the abdomen should not necessarily feel paper thin after liposuction plus you are probably still a bit swollen after surgery.

The portion of the abdomen that is in the photo is an area that many plastic surgeons do not always liposuction simultaneously with a tummy tuck (fear of causing tissue necrosis by damaging the circulation to the skin).  After a period of several months (at least 6) you may consider liposuction.

What counts is if you are flat when you are standing up.  Please note that this is all your surgeon can do for you.  Beyond that please note that you have stretch marks in the area you are pinching and this is an indication of poor elasticity so here it may not be possible for your surgeon to ever make to as tight as you might want.  Basically give the healing and shrinking more time and stop pinching the area.

It is still a bit early following your tummy tuck to make a final determination on the amount of remaining tissue. Certainly there can be a degree of post op swelling that will continue to resolve itself over the next several months. A good way to determine if it's post-op related is if  the swelling becomes more noticeable during the course of the day with activity. In six months, if there is persistent subcutaneous fat that you find bothersome, secondary liposuction can be performed. Since the skin with redundant tissue has been already excised/removed, it is highly unlikely to cause any significant laxity.

Hi.

Of course, you should do nothing for six months. But it is likely that a revision with superficial and deep liposuction of your abdomen will make you happy.