To make an accurate assessment regarding the outcome of any plastic surgery procedure we need to see a complete set of proper before and after pictures. If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took. Failure of muscle tightening is extremely uncommon. By far the most common reason patients bulge after a tummy tuck is because they have excess intra-abdominal or visceral fat. This should’ve been assessed during your consultation before scheduling surgery. Individuals who have access visceral fat are not great candidates for liposuction until they first lose weight. Without even seeing pictures. I’m quite certain that is what your underlying problem is. I see this so often. There are four tissue variables that determine what the abdomen looks like. Each of these tissue variables has its own way of being treated. To get a quality assessment before surgery. It is important to understand which variables are contributing. The four tissue variables that determine what the abdomen looks like are the following. 1) abdominal skin laxity typically due to previous pregnancies or significant weight loss. 2) excess subcutaneous fat. 3) muscle separation from previous pregnancy. 4) excess visceral or intra-abdominal fat. A tummy tuck will treat skin laxity and muscle separation. Excess subcutaneous fat can be reduced with liposuction or weight loss. Excess visceral fat can only be reduced with weight loss. Doing a tummy tuck on someone who has access, visceral fat will always end up with a bulging abdomen. The volume of excess visceral fat has to go somewhere. visceral, fat and muscle separation can have a fairly similar appearance during initial preoperative evaluation. Differentiating between the two isn’t rocket science and is something all plastic surgeons should know how to do. You can do this whether you’ve had surgery or before you have surgery. It is, however much better to assess the presence of excess visceral fat before you have a tummy tuck so you can understand your candidacy and neither not have the procedure or lose the appropriate amount of weight before surgery to get a quality outcome. One way to differentiate is to see what your abdomen looks like if you lay on your back. If the problem is exclusively related to muscle separation, then the abdominal wall should have a concave appearance when you lay on your back. The abdominal wall should fall into the abdomen, making it not only flat but concave. an individuals with access visual fat even when, laying on their back, the rabbit men may still bulge slightly. The other way to differentiate is to determine how much pressure it takes to press your abdominal wall flat. For reference a flat abdominal wall should create a beeline between the sternum and the pubic bone. If you envision align between the sternum and the pubic bone, try pressing your abdominal wall until it reaches that imaginary line and try to hold it in this position with your non-dominant hand for several minutes. If this takes a lot of pressure, then excess visceral fat is a significant problem and most likely the reason your results are not to your liking. To get a flat abdomen, you need to lose weight. To understand how much weight you need to lose a suggest you get a baseline set of pictures at your current weight. Next drop 5 pounds and retake the pictures. Continue doing this at 5 pound intervals until your content with the shape of your abdominal wall. You will then know what weight you need to maintain to have and abdomen Looks good. Individuals who have excess visceral fat, are not good candidates for a tummy tuck, unless they first manage the visceral fat with successful weight loss. The good news is, you can obtain a high-quality outcome with weight loss. Best, Mats Hagstrom, MD