Is my belly button too low? Why is my pubic area bulging? Why is there still fat pockets under bust area? What revisions needed?

Question

I’m 5’6”, 170lbs, 36 yo F, 1.5 year post op extended tummy tuck with umbilical hernia repair, liposuction. I do not feel like I got the best results. I feel that my belly button is too low or the incision is too high. When underwear/pants/bikini bottoms are in right position to cover my scar, the belly button seems very low. I’m stuck with fat pockets under bust area and a bulging pubic area. Why? Can it be fixed?

Ira H. Rex III, MD · Answer

I suspect you could get better results with a revision.  The upper abdominal fullness seems to be mostly fat and could be liposuctioned to improve the contour without to much concerned for loose tissue.  The pubic area and similarly be suctioned to decrease the bulge.  That may lead to moderate loose tissue which probably could be tightened with a simple excision of skin.  I would consider your incision to be somewhat high, restricting certain bathing suits, but your bellybutton is probably in good position.  Perhaps your bellybutton could be revised to decrease some of the visible scarring and dark pigmentation.  A consultation with a plastic surgeon would likely be helpful to see how some of these things can be improved.

Julia Stevenson, MD · Answer

Thank you for your question! Your concerns are completely understandable. Without knowing how your presurgical abdomen appeared, it is not unreasonable to believe perhaps your surgical issue required more than one procedure for safe correction. The umbilicus appears to be close to the correct location and perhaps the scar may be slightly high. The contouring of the fat along the scar is what makes it more noticeable. Liposuctioning of the upper/lower abdomen and flanks would help with the appearance of the upper abdomen and the prominence of the abdominal scar. Scar revision with better alignment of the fat near the scar may also help improve the transition from the lower abdomen to the pubic region. Wishing you the best!

Daniel Careaga, MD · Answer

tummy tuck operations in general, have a very high, patient satisfaction rate and a very low revision rate. Having said that, occasionally a revision is necessary. Many surgeons, myself included, do not recommend performing liposuction of the abdomen at the same time as a tummy tuck. The reason for this is that it does increase your chance of having a fairly serious wound healing complication that can be disfiguring. Now that time has passed, and your tummy tuck has healed completely. You can absolutely come back and perform liposuction on your entire abdomen, including your pubic. That will remove all of the leftover fat deposits, including those bulges in the upper abdomen and pubes that are bothering you. 
Belly button position is obviously a very important part of tummy tuck planning and based on your pictures, I do not see anything abnormal about its position. The landmark for determining belly button position is your hip bone on the side, known as the anterior superior iliac spine. If you feel that bone and come across to the midline, your belly button should land approximately at that level. Looking at your picture, I think that you are right around there. What happens is that the scar placement can make your belly button appear relatively lower down.

Daniel Barrett, MD · Answer

Dear Loving275766,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

George Marosan, MD · Answer

Thank you for your question and photos. I must agree that this is a poor result by today's standards. Maybe it was Ok 30 years ago. You have a high scar, large pubic mound, fat rolls in your upper abdomen, scarred poorly designed belly button. As a Total Definer surgeon, I would have to redo the whole operation. BTW, this is not a touchup. You will need VASER liposuction 360 degrees, including the upper abdomen, pubic area liposuction and excision of excess tissue and lowering your abdominoplasty scar to the pubic bone level. Unfortunately, your scars laterally are high, but one must accept this limitation, not to create two scars laterally. I would remove your belly button at the same time and build one later that will look natural, hooded and without visible scars. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Zoran Potparic, MD · Answer

It is very likely that your scar can be lowered and that will increase the distance from BB. Liposuction of mons pubis will improve appearance of that area. In person or teleconference consultation with another board certified plastic surgeon is recommended.

Connie Hiers, MD, FACS · Answer

Liposuction can be done in the pubic are and below the breasts. Many surgeons do not include the pubic area when doing the tummy tuck. (I personally always include it with my tucks because ladies and men are not happy without it being treated.)  Trying to move the umbilicus is usually not possible, but sometimes the inferior scar can be lowered when treating the pubic area.

Camille Cash, MD · Answer

From the submitted photos you would benefit from a revision to your tummy tuck.  It appears the incision is high.  Liposuction can be performed on the mons to improve the appearance.  It's best to begin by scheduling a consultation with a board certified plastic surgeon to discuss your concerns and learn more about the options.

Darryl J. Blinski, MD · Answer

Based on your post photos, the initial surgery was poorly planned with the tummy tuck incision place too high. That’s causing the issues. You’re having only virtual consultation in person. A consultation would allow a determination if your candidate for complete revision of tummy tuck with additional Lipo fee most likely from $10,000-$20,000. Again, best of virtual concert with.

Is my belly button too low? Why is my pubic area bulging? Why is there still fat pockets under bust area? What revisions needed?

Answers (9)

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