Still not flat 6 months after tummy tuck - how can I get this flat? (photos)

It may be that you need to have the muscles plicated again. There may have been too much intraabdominal pressure and the prior plication sutures didn't hold.

Your abdomen looks protruding because your muscle is very loose and allows the cavity organs to protrude.
In my opinion you will need to do a tight and wide muscle repair, in my hands would be about 6-7 inches. But you must understand our muscle is literally a steak and the muscle will not remain tight and flat forever, unless you really work out your muscle to maintain the tightness. And weight gain is your enemy having in mind, your genetics is to develop protruding appearance.
Be encouraged.
Dr. Cárdenas

It is very difficult to give you good advise based on these photos only. There are two aspects of abdominal bulge (prominence); intraabdominal fat around organs that is pushing abdominal wall, unavailale to liposuction and, superficial fat, above the abdominal muscles, that could be removed and shaped with additional liposuction. In short, weight loss (abdominal fat) and additional liposuction of abdomen and flanks, may create significant improvement. In person, second opinion consultation with a board certified plastic surgeon with good reputation in body contouring surgery, is recommended. Good luck.

Dear Thoughtful900011,
based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You did not show your before photos, but if you have internal fat, this is not treated with surgery. If you have external fat, this can be removed with liposuction. Not all fat is removed with a tummy tuck for safety to the skin.

The abdominal contour that concerns you is likely from one of two things. The first is that you did not have muscle repair during your tummy tuck and the muscle wall laxity is causing the rounded appearance. The other scenario is that you have intraabdominal fat. This is the fat behind your muscle wall that surrounds your organs. The only way to address that fat is through weight loss, which will improve the overall contour.

To make a quality assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If you don’t have before and after pictures and ask your surgeon to forward the ones they took.
Your abdomen is still bulging because you have a substantial amount of excess visceral fat.
Most likely that is evident on your before pictures and you should’ve been told that you wouldn’t have a flat abdomen unless you lose weight first.
You can still lose weight and get a flat abdomen but no abdominal muscle tightening is going to override the intra-abdominal pressure from carrying excess visceral fat.
Try losing 10 to 15 pounds and take comparison pictures. You’ll see a remarkable improvement. Once you see the correlation between weight loss and getting a flat abdomen hopefully it’ll motivate you to continue losing more weight.
At this point it’s up to you how flat you want your abdomen to be. More weight loss equals flatter abdomen.
The procedure was done correctly. What was not done correctly was perhaps discussing the limitations of a tummy tuck in individuals who have access visceral fat.
In the end there are four variables that determine what someone’s abdomen looks like. These are dominoes skin laxity, excess subcutaneous fat, muscle separation from previous pregnancies and excess visceral fat.
Three out of the four have been treated but the fourth being visceral fat was a major contributing factor and can only be addressed through weight loss.
Best,
Mats Hagstrom MD