Concerns over muscle stretching 2 years post abdominoplasty (Photo)

Dear SCAUST,
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

Thank you for your detailed history and the accompanying images. First and foremost, kudos on your impressive 77-pound weight loss post-gastric sleeve!
Based on the provided information, it appears that while your abdomen's skin and subcutaneous fat remain relatively unchanged, the main issue lies in the visceral fat behind your rectus muscle. This fat surrounds your internal organs, and with the weight gain, it seems to be pushing out your rectus abdominis muscle, leading to a distended appearance.
Here's a suggested plan of action:
Weight Loss: Aim to shed the gained 26 pounds. There are effective medications like Mounjaro and Ozempic that can support this effort. Post weight loss, we can reassess your abdominal region.
Muscle Repair: If, after losing weight, your abdomen remains distended, it may be beneficial to consider muscle repair. Using your prior tummy tuck incision, a surgeon could repair the muscle from sternum to pubis. Suturing the internal oblique muscles might further fortify your abdominal wall.
Mesh Application: If muscle plication alone doesn't suffice, applying a mesh over the abdominal wall can offer added support and help achieve a flatter appearance.
Always remember, the primary step should be weight reduction. Depending on the results post weight loss, surgical intervention can be contemplated.
Wishing you all the best in your continued health journey!
Sincerely,
Dr. Katzen

You would benefit from a repeat tummy tuck. I recommend an abdominoplasty with mesh reinforcement. The mesh creates a more flatten abdomen by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.