14 months after tummy tuck with muscle repair, bulge in lower abdomen when I sit. Is an upper body lift my only option?

Question

TT w MR...1.2 yrs po...At 1st i was super tight sitting & standing then I started to notice a bulge when sitting. Ive addressed it several times. PS said after the skin heals it relaxes & the only way to fix it is to have a upper body lift. I honestly feel like shes just trying to get more money out of me. I had already had a BR 8 m prior to the TT. Is there any Else I can do? Feeling a little depressed.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question, and congratulations on your excellent tummy tuck results! Your standing pictures show a very tight and well-healed abdominal wall, which is a testament to your surgeon's skill and your body's ability to heal.
The slight overhang when sitting is due to the relaxation of the skin and tissues, which is a normal and necessary adaptation of your body to different positions. If your abdominal skin was too tight when sitting, you would have discomfort and difficulty standing upright.
If this minor overhang continues to concern you, there are options to consider. An upper body lift, also known as a reverse tummy tuck, might help by pulling the lower abdominal skin upwards. This would be done through an incision underneath the breast. Another option could be a vertical abdominoplasty, where an incision is made from your sternum to your belly button and then down to the pubic region. This procedure involves removing skin vertically, which can also help to reduce the appearance of any overhang.
However, these procedures come with their own risks and benefits and should be thoroughly discussed with your surgeon before making a decision.
Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear yellyd2010,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Geuris Cruz Quiroz, MD · Answer

Thank you for your question dear @yellyd2010. First congratulations for your journey!!. Based on your pictures specially the first one before the procedure it is very important to let you now that you had intraabdominal fat ( fat under the muscle) this type of fat only can be reduce with exercises and a healthy diet of carbs, protein and fat, Tummy tuck procedure only can get rid of extra skin, and looks like when you standing up you do not have that, if you see your side pictures after the procedure you still have the fat under your muscle, my recommendation is to wait for your healing process to be done, you are still have a lot of inflammation and start doing exercises (cardio) and lifting weight and do not forget to have a better way to eat. Best of luck!

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  It looks like you maybe dealing with some intra abdominal fat.  This type of fat can only be broken down with low carb diet and exercise.  Best of luck to you.

Camille Cash, MD · Answer

From your photos it does not appear that an upper body lift will resolve your concerns.  It appears you have visceral/internal fat that is influencing your current look.  This is the fat located behind the muscle wall and can only be addressed with weight loss.  I encourage you to address that first and see if your concerns improve.

Connie Hiers, MD, FACS · Answer

Everything must push forward when you sit. You appear to have gotten a nice result. Try losing some weight so you have less internal fat.

Kamran Abolmaali, MD · Answer

Thank you for your question,I do not think upper body lift would resolve your problem. I am just curious if you have lost some more weight after your tummy tuck surgery, which has lead to some extra skin. Part of the bulge in upper abdomen is due to the fat around the intestines, which can not be removed by tummy tuck or liposuction. To get rid of that, I suggest to try to lose some more weight.All the best.

Douglas Taranow, DO, FACOS · Answer

It appears that you have increased intra-abdominal fat (visceral fat) which may not be addressed with surgery.  This requires weight loss (diet and exercise) to reduce the internal fat putting pressure on the muscles causing them to be rounded (convex).
Best wishes.
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

We do not judge tummy tuck results in a sitting position.
Everyone has a skin fold on their abdomen in a sitting position.
It’s not possible to have a tight flat abdomen with your hips fully flexed.
If your abdomen is tight and flat in a flex position you wouldn’t have the skin laxity to be able to stand up straight
There are four variables that determine what someone’s abdomen looks like. In other words if someone doesn’t like to rob them and it is always because of one or more of four different variables.
It’s essential to make a correct diagnosis before considering having a treatment.
That should’ve been done during your in person consultation after your examination.
The four variables are skin laxity, excess subcutaneous fat, muscle separation from previous pregnancies and excess visceral or intra-abdominal fat.
The tummy tuck primarily treats abdominal skin laxity and muscle separation. It will reduce subcutaneous fat to some degree by pulling the skin and fat layer tight. kind of like a rubber band gets thin when you pull that tight.
The one variable that’s not treated by having a tummy tuck is access visceral fat.
Visceral fat is why your abdomen is still bulging. no amount of muscle tightening can override excess visceral fat. This should have been discussed during your assessment as part of your consultation.
Individuals who have excess visceral fat should be encouraged to lose weight before having a full tummy tuck.
It’s not too late to lose weight and improve your outcome.
10 pounds should have a pretty remarkable impact but you’ll probably need to lose closer to 50 pounds to get a really good looking abdomen.
Begin your weight loss journey and take photographs of your torso as you successfully go down in weight.
I think you’ll find that 10 pounds has a pretty remarkable impact and each additional pound will be in the right direction.
Weight gain will make the problem worse.
Your outcome it’s not related to how the surgery was performed but is instead related to your obesity.
You need to do your part in order to get the results you want.
Best,
Mats Hagstrom MD

14 months after tummy tuck with muscle repair, bulge in lower abdomen when I sit. Is an upper body lift my only option?

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