Bulging Lower Abdomen Post-Tummy Tuck

I had a TT, MR and a touch of flank lipo 6 weeks ago and am concerned that not enough tissue was taken away. Im a normal BMI and 5ft 9. I am still able to 'pinch an inch' below the navel and there is definite roundness to the lower abdomen so when sitting I notice particularly that I still look like I have a large spare tyre. Is this normal? Im sure my expectations were not so high that I expected a washboard stomach but if there is anything that can be done I would be keen to get rid of this!

Doctor Answers 9

Lower-abdomen bulging following a tummy tuck

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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

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Tummy tuck at six weeks post op

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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.

Jeffrey Kenkel, MD
Dallas Plastic Surgeon

Liposuction after tummy tuck is fine (but it may be simply, post-op swelling)

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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.

Post tummy tuck laxity

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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.

REasons for protuberant lower abdomen after tummy tuck

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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

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

It is still early to judge, but...

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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  

Lawrence Tong, MD
Toronto Plastic Surgeon

Tummy tuck and liposuction

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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.

Shahin Javaheri, MD
San Francisco Plastic Surgeon
4.4 out of 5 stars 6 reviews

Post tuymmy tuck and lipo expectations

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

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Liposuction after tummy tuck can give you a flatter lower abdomen.

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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.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.