I have a huge bulge after my tummy tuck. What are my options? (Photo)

Thank you for your question regarding what to do after your tummy tuck, specifically concerning the bulge in the pubic region. I appreciate your sharing your history and the photos you provided. I'm sorry to hear that you're distressed about the protuberant bulge of skin and fat in the mons region. This is not uncommon after inadequate resection of the pubic area during a tummy tuck.

From your description and the photos, it appears that your rectus abdominis muscle is intact, and the primary issue is excess skin and fat in the lower central abdomen and pubic region. Opting for liposuction of the mons might leave you with loose hanging pubic skin and suboptimal results. Therefore, I would suggest considering a pubic reduction or a monsplasty.

During a monsplasty, an incision is made in the pre-existing tummy tuck scar. Tissue dissection is carried down to the pubic region, and a crescent area of skin and fat in the pubic region is removed. Additionally, there is typically a ball of fat in the pubic region just underneath the skin and anterior to the pelvic bone that needs to be addressed.

The monsplasty or pubic reduction procedure typically takes approximately two hours under IV or general anesthesia. A drain will remain in place for approximately 7 to 14 days to help manage swelling and fluid accumulation.

A pubic reduction or monsplasty is an excellent surgery for addressing skin and fat in the pubic or mons region, especially for residual skin and fat left over from a tummy tuck. This procedure should help improve the contour of your lower abdomen and make you feel more comfortable in your clothing.

I hope I’ve answered your question regarding your options for the bulge you're experiencing after your tummy tuck. Good luck, and I hope you achieve the results you are looking for to feel more confident in your appearance.

Sincerely,
Dr. Katzen

Dear Diaoli,
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 a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Your situation is not uncommon, and understood. Dramatic changes in body shape can be accomplished with careful planning, active patient commitment and participation, and expert surgical execution. My approach would include a duration of fat loss by austerity diet with tirzepatide and/or phentermine, then body contouring with liposuction and possible fat transfer with secondary tummy tuck incorporating a robust plication supported by absorbable mesh and several months (at least) wearing specialized waist trainer.

Thank you for your question and photos. Preop photos would've been helpful. Going forward, you had a standard tummy tuck, albeit with a low incision, but the pubic area wasn't addressed adequately. You also have a rectangular shape with no feminine definitions, but that is not your main concern. If you want just the lower abdomen/pubic roll fixed, you will need liposuction of the lower abdomen (I would recommend the whole abdomen) and lifting the excess pubic skin and remove the excess lower abdominal. If you want a feminine figure, then you would need liposuction 360 degrees of your torso in addition to the procedure mentioned above. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Your mons pubis area was not addressed with your tuck, (some surgeon's do this) and can be easily treated with liposuction. Go back to your surgeon or find another to help.

From the photo it appears you would have improvement with liposuction, skin removal, or both. This would smooth out the area and improve your abdominal contour. It may be able to be done under local anesthesia or light sedation. Visit with your surgeon to learn more.

To make an assessment regarding the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures, didn’t ask your surgeon to forward the pictures they took.
Before prescribing an operation, we need to have a clear understanding of what the problem is.
The most common reason patients complain of bulging after a tummy tuck is due to access, visceral or intra-abdominal fat.
This can only be reduced with weight loss.
There are four tissue variables to determine what the abdomen looks like.
in other words, if somebody doesn’t like the way they abdomen looks the problem is based on one or more of these four variables.
Those variables are.
1) abdominal skin laxity due to previous pregnancy or weight loss.
2) excess subcutaneous fat.
3) muscle separation from previous pregnancy.
4) excess visceral, or intra abdominal fat.
Your tummy tuck addressed abdominal skin, laxity and muscle separation. It looks like you also had liposuction in conjunction with the procedure.
That only leaves excess visceral fat as the explanation for a bulging abdomen.
Weight loss is the only way to reduce this fat.
This could most likely have been determined during your initial assessments.
In a perfect world individuals who have access, visceral fat should be told of this condition, and how it may limit or impact the outcome of the procedure without successful weight loss.
Follow up with your provider or schedule in person second opinion consultations with other providers in your community.
Best,
Mats Hagstrom, MD