Lower belly bulge - what is the best way to reinforce weak fascia in a lower tummy tuck revision? (photos)

Bulging of the abdomen after a tummy tuck should make someone immediately consider if weight gain is involved.
Get on the scale and make sure you’ve not gained weight since your procedure.
There are four variables that determine what the shape of the abdomen is.
This is generally true whether someone has had surgery or not.
They are skin laxity, subcutaneous fat, muscle separation/bulging muscle wall or excess visceral fat.
Skin laxity is clearly not the issue and you don’t seem to have much subcutaneous fat so the question is is this muscle wall bulging or visceral fat causing an increased intra-abdominal pressure.
One way to differentiate is to simply lay on your back. if your abdomen goes completely flat when you lay on your back and this is more likely to be related to your muscle wall.
You can also make the differentiation by taking your nondominant hand and pressing your lower abdomen until it’s nice and flat If it takes a significant amount of pressure depressed you’re having them and flat and visceral fat may be contributing. if you wait it’s up even five or 10 pounds from your surgery weight and visceral fat may be contributing and simply losing some weight may improve your outcome significantly.
If it takes very little pressure to press your abdomen flat or it goes completely flat when you lay on your back then the second plastic surgeon may be correct.
Plastic surgeons have different approaches to how they do muscle tightening.
I’ve seen the full spectrum and there are some that do this part of the procedure in sufficiently.
I’ve seen surgeons do muscle tightening with a single running strand of absorbable suture.
I’ve also seen it done with both interrupted and running permanent suture reinforcing the facia with mesh(belt and suspenders and then some).
Getting a copy of your operative report from your first surgeons office could shed some light on how the procedure was performed though it probably will not give a definitive answer.
A plastic surgeon should be able to differentiate if visceral fat is a contributing variable during an examination.
The first and easiest way to differentiate is to understand if you’ve had weight fluctuations.
Excess visceral fat after a well done tummy tuck is more likely to cause bulging of the upper abdomen.
This may in fact be your abdominal fascia that is stretching.
Difficult to tell if this is in anyway related to how the surgery was performed.
Typically muscle tightening tends to hold.
Postoperative bulging can happen and can sometimes be explained and sometimes it can’t.
An accurate assessment will for sure require an examination.
Good luck,
Mats Hagstrom MD