Loose skin after a tummy tuck, have I been botched? (Photos)

Thank you for sharing your excellent question and photographs.  Based on the location of your scar and lack of an incision around your belly button it appears that you had a panniculectomy.  This is an insurance covered procedure that is similar to a tummy tuck in that it removes any overhanging skin from the lower abdomen.  Unfortunately a panniculectomy does not fully address the skin laxity and excess present in a patient who has lost over 100 pounds like a tummy tuck or FDL tummy tuck can.  You have done a remarkable job of weight loss and if you would like to maximize your outcome make sure you are at your final goal weight and then speak with an ASPS board certified plastic surgeon skilled in body contouring for weight loss patients.  Hope this helps.

Thank you for your question. You definitely have not been botched. However, from your photos you appear to have skin excess both in vertical and transverse dimensions. In cases like yours a fleur de lis technique with a vertical incision is often best to achieve a tighter waist with all skin excess removed. You should keep in mind however, that no matter how tight your abdomen is made during surgery, skin will always undergo some stress relaxation as you move further away from the surgery. This is inevitable and should always be discussed with patients before the surgery.

First of all, I'm sorry to hear about your disappointment.  Body contouring surgery after massive weight loss can be very challenging.  Every patient is different and expectations need to be managed prior to surgery.   I noticed from your pictures that you have significant stretch marks throughout your entire abdomen.  Your dermis, which is the inner layer of skin, has lost much of its elasticity.   This means it does not stretch and contract like skin that is more elastic. This makes it very difficult to achieve a tight abdomen in many cases.  Also keep in mind that whenever you are sitting, you'll always have some loose skin.  If the skin was very tight when you are in a seated position, you would never be able to stand up. There is also the issue of horizontal and vertical laxity. Horizontal laxity of the skin is the side to side laxity that you can feel and the vertical laxity is the up-and-down laxity of the skin.    To address the side to side laxity generally requires a procedure that takes out skin in that direction which leaves you with a midline scar on the entire length of the abdomen. With all cosmetic surgery, surgeons must make sure that the  benefits outweigh the risks. Many patients are only marginally loose and the surgeon might feel that it is best to simply stay with the traditional procedure and not leave a patient with a more visible scar down the middle of their abdomen.  I guess what I am trying to convey to you is that every individual case can be different, and you cannot always compare someone else's results to yours.  My recommendation is that you speak frankly with your surgeon about your concerns. Realize that things can still change over time as you progress with healing. Unfortunately I do not think your skin will get tighter however. Best wishes to you.