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

Question

I had a tummy tuck 10 weeks ago and at this point I am extremely unhappy about my results. I am only 21 and have never had kids, but I lost around 100 lbs before surgery. I was expecting a tight stomach with no loose skin and right now I still have a large amount of hanging skin. The skin hangs over the sides of my scar and my stomach is not flat. I can also still pull skin away from my sides and upper stomach. What can I do to fix this problem? Is it clear that my surgeon botched my tummy tuck?

Nelson Castillo, MD · Answer

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.

Michael Dobryansky, MD, FACS · Answer

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.

Erik Miles, MD, FACS · Answer

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.

Ram Kalus, MD, FACS · Answer

Thank you for your question and sorry to learn of your disappointment. Your result is far from "botched" even though you are not pleased. Massive weight loss such as your own results in irreversible laxity in the skin and your abdomen was never going to be "tight" as you had hoped and expected. I am guessing your plastic surgeon discussed this with you before surgery but perhaps not. In patients such as yourself, it is not uncommon to have to have a second tightening procedure, but this is by no means a reflection of an inadequately or incorrectly performed first operation. From your results, you appear to be healing well and it appears that your surgeon has done an excellent job. I recommend following up with him or her and following their recommendations. Best of luck to you.

Brian A. Pinsky, MD, FACS · Answer

Thank you for your question and sorry to hear you are not happy with your surgery.  Based on the location of your scars and lack of incisions around the bellybutton, you most likely had a panniculectomy and not an abdominoplasty.  The procedures are different, and possibly this was not adequately explained to you before surgery.  A panniculectomy involves only the removal of excess skin and fat below the bellybutton only. A tummy tuck involves raising the skin up to the level of the ribs, tightening the abdominal muscles, and relocating the bellybutton after removing the extra skin.  Panniculectomies are covered by insurance and a tummy tuck is not. 
Additionally, it can be difficult or impossible to pull the skin as tight as you were envisioning.  After massive weight loss, the skin loses it's elasticity.  This can be seen with the stretch marks that are visible throughout your abdomen.  No matter how tight you are pulled, the skin will stretch and relax to a degree with time and often appears slightly loose after several weeks.  Pulling the skin too tight may put you at risk for bad scarring or wound breakdown.  
Once you are allowed to heal for 3-6 months, you can consider a revision surgery.  I recommend discussing your concerns with your original surgeon.  Good luck!

Samir Shureih, MD · Answer

I do not believe you had a full tummy tuck.There is no scar to reposition the belly button.Therefore you probably had and asked for a panneculectomy, which is removal of the excess overhanging skin only. That could be because that is what your insurance pays for, but does not pay for a formal tummy tuck.For a panneculectomy the results are as expected.If you wish an aesthetic tummy tuck then you need in person examination and plan the next cosmetic surgery

Karol A. Gutowski, MD, FACS · Answer

Without knowing what exactly was done and seeing your before pictures, it is not possible to comment on if your procedure was "botched". However, patients who gained and lost a large amount of weight do tend to have stretched out skin what has lost elasticity, so completely tight skin may not be possible. Give it at least 6 months for swelling to resolve. If needed, an additional procedure can be done to remove skin on the sides.

Evan Sorokin, MD · Answer

First of all, congratulations on the awesome weight loss.  When you have lost this much weight often the skin elasticity is ruined.  You can see you still have stretch marks in the photos and unfortunately the skin itself "got botched" when you had been heavier.  This is unfortunate because even if the surgeon pulled you super tight, the skin can often relax in massive weight loss patients.  The solution may be a small revision to take out a little more skin that when not doing a full tummy tuck will have a better chance of healing as there won't be as much tension on it.  Your results look like the surgeon did a nice job, but it isn't only what we do, but how individuals heal.    Speak to your surgeon, and good luck!

Steven Wallach, MD · Answer

Loose skin can not be completely removed and often with massive weight loss the skin has poor elasticity and can have early rebound laxity. Everyone who has a tummy tuck will have loosened when they bend over. If  not, they would not be able to stand up straight.

Peter Fisher, MD (retired) · Answer

Hello and thank you for your question. Congratulations on your weight loss. Not botched. I do however think that a revision will help. You need to see a plastic surgeon who specializes in post massive weight loss body contouring which I do.I think a repeat procedure would help. Need to wait another 2 to 3 months for all the swelling to subside.Peter Fisher M.D

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

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