Do I need a TT revision, mons pubis lift or both? Will sculpsure give me the results I want? (photo)

Thank you for your question and photos. Based on these photos you do have relatively good shape, but the scar placement and quality detract greatly from the results. You had a "standard" tummy tuck, which might've been acceptable 20 years ago. Your incision is too high ,leaving you with a large pubic area that you perceive as sagging. Do not allow anyone who offers to do a pubic lift. You need the opposite, lowering your incision to the pubic area and shortening the pubic area. Your belly button has outside hypertrophic scars as well. These are the results of poor surgical technique, no progressive tension sutures, placing all the tension on the skin closure which results in hypertrophic scars.If you were my patient, I would redo your abdominoplasty (+/- muscle repair, depending on a physical examination), liposuction of the abdomen, back, waist and hips, lower the scar, reduce the pubic excess, remove your belly button completely. This can be reconstructed later with practically no visible scar.Sculpsure will not give you the results of a great tummy tuck with better scar quality and placement.See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.See attached web reference.

Hello.
Great question. Thank you for your pictures. Based on your images, it appears you may benefit from liposuction itself. Please visit a board certified plastic surgeon for a detailed surgical plan to achieve your desired results. 

Your scar seem to be placed too high. It would be possible to lower your scar without moving your belly button. However, only on the basis of in person evaluation one could give you good idea what result you should expect from liposuction of abdomen/mons and revision/lowering the scar. Good luck.

I do not think sculpture will help what is bothering you. It appears your scar is high and it has thickened a bit. To address the mons area I would suggest revisional abdominoplasty to lower the scar, however this will give you a little vertical scar to maintain your belly button in a natural position. The benefit is the entire scar will be lower and the excess skin you can now pinch can be reduced. I woudl need to do a full exam to best address that but if it can't be completely treated using the horizontal incision vertical incisions in the bikini line can be made to remove the extra skin. Also if the muscle sutures in teh abdomen has loosened, these could be redone at that time as well.  

It seems you scar is high, doesn't follow the natural curves of yor pelvis, and the pubic area if too full.  It may be possible to lower the scar, improve it';s appearance, and reduce the size of the pubic area.It all depends on the amount and elasticity of the remaining skin, so a good exam is needed. Get a few opinions...not all tummy techniques are the same.

What I would do is I would lower the scar in the middle third by cutting out the overly large pubic area. This will reduce the size of the mind as well as lower the scar.

Dear Nicole6345,
I understand your concern. 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 thorough examination you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Results in plastic surgery can be variable and unpredictable.  Sometimes it is not possible to achieve the best possible result with one surgery.  Not having your preoperative photographs available for viewing makes this answer more difficult. 
I do, however, note that you have potential for improvement.  Your upper abdomen has an excellent contour.  Your infraumbilical (below the belly button) plication sutures may have loosened or stretched.  This probably resulted in recurrent rounding  rather than the flatness that you are seeking.  That correction would require additional surgery.  I would also recommend lowering your abdominoplasty scar and simultaneously performing a lift of the mons pubis area.  That too would require return to the operating room.  
I doubt that noninvasive modalities will help much.  Overall, I think you have a very nice figure, and I would delay until you can have the additional surgery.    

The mons pubis area can often be lipo-ed to remove excess fat; however, you are encouraged to have an in person consultation with a board certified plastic surgeon to determine the extent of fat in the region. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing.
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

your abdominal wall contour is most likely more related to your muscle wall than fat layer. Doesn’t seem like you have a lot of body fat from your picture.your incision is questionably high. I’m guessing you didn’t have that much skin laxity and in order to get to above the bellybutton your surgeon put the scar a little higher. You also formed a very visible hypertrophic and hyper pigmented scar. at a year the score may continue to improve to some degree but it would be nice to have the scar look less visible this far out from surgery.I suggest using silicone sheeting/tape For a few months. If you have a revision then use this product starting three or four weeks after surgery. It’s possible that steroid injections could also help soften the scar a little. Steroid injections can thin out the scar and may leave it wide but not as raised.Most likely the best result would come from a full redo of your tummy tuck including more aggressive muscle tightening and lowering the scar as far as possible. To do this the current incision around your belly button would create a small vertical scar between the belly button and the main scar.The belly button stays where it is but the opening around it would come down.Any laxity around the mons pubiscould be addressed at the same time.you’re correct that this could have been done and ideally it should always be as part of a tummy tuck.A revision abdominoplasty will most likely leave you with the small vertical scar in the midline between your belly button in the mitts scar. With the exception of that the overall results should be improved.  if you decide to have a revision then I would encourage you to have ongoing scar management during the first year and a half with Adam minimum using silicone sheeting.resist any temptation to ever scratch your scar. NEVERscratch scars that itch. Follow up with your provider or have a few new consultations with experienced board-certified plastic surgeon. Best, Mats Hagstrom, MD