Had Full TT But Only Fat Below the Belly Button Was Removed, Is This Normal? (photo)

I had a full tummy tuck 7 months ago. I am happy with everything below the incision but above the belly button I still have all the fat I had before. A huge spare tire. My surgeon said that it would be a separate and additional surgery to remove fat (liposuction) above the belly button and below the breast. My understanding of an adominoplasty was that all the areas of the front of the stomach are treated not just below the belly button. Am I wrong?

Doctor Answers 8

Tummy Tuck - Had Full TT But Only Fat Below the Belly Button Was Removed, Is This Normal?

You may have had more done than you think, even if it's still not the result you expected.

In general, a full tummy tuck (which it appears that you had, since there is a scar around your belly button) involves the removal of skin and fat of the abdomen.  Normally, the skin is lifted up all the way to the ribs, pulled down like a window shade and then the excess is removed (these are the basics of the procedure; there are many variants and additional procedures that can be performed).

However, there is some controversy regarding the amount of fat that can or should be removed from the upper portion of whatever skin remains from the abdomen; ie, the area above the belly button.  There has been some concern that an overly-aggressive fat removal could lead to impaired wound healing.  This is a legitimate concern since the blood flow that is required for good healing comes from the upper abdominal tissue (the "flap") and from the side. 

That being said, at least some fat can be removed safely during this procedure.  Exactly how much is where the controversy begins, and there's no "absolute" answer.  As a result, it is not uncommon to have exactly the situation you have - happy with the lower area, less happy with the upper area.

Correction options include lipo as a secondary procedure or, at its extreme, redoing the tummy tuck, although this is not necessarily a good option for many reasons. 

You should, of course, discuss these issues with your plastic surgeon.

I hope that this helps, and good luck,

Dr. E

New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Looks like some fat was left behind

There are three component to most "tummy tuck" procedures - fat, skin, and tightening muscle. It looks as if the skin was removed, and I suspect that the muscle was tightend, but some fat looks like it was left behind.  Liposuction at the time of tummy tuck is done by some, but not all plastic surgeons, because of a concern for skin loss, wound healing problems, and blood clots whcih have been associated with the combination of these two procedures.  It sounds like the main issue is that you didn't understand ahead of time that there might be some redisule fat after the procedure that would need to be treated to get you the look you want.  This is a discussion you should have with your plastic surgeon, but at this point, I agree that liposuction would be the best way to treat the issues you now face.   

Daniel Sherick, MD
Ann Arbor Plastic Surgeon
4.7 out of 5 stars 13 reviews

Tummy Tuck Results?

Thank you for the question and pictures.

It is very likely that your plastic surgeon was hesitant to form more liposuction  of the upper abdominal wall because of concerns of disruption of blood flow and potential for problems with  wound healing.  These concerns may necessitate a two-stage approach  wherein a 2nd phase liposuction procedure  is performed.

Assuming your surgeon is a board-certified plastic surgeon  I would  suggest continued  follow-up and communication  of your concerns. 

I hope this helps.


Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Lipoabdominoplasty vs. Full Abdominoplasty

You are correct that a full abdominoplasty will go all the way up to the rib cage.  However, the fat that existed above the belly button before surgery cannot be excessively romoved during the standard abdominoplasty without the risk of inturrupting the blood supply to the skin.  The options are to limit the amount of undermining of the upper skin flap and perform liposuction of the upper abdomen (lipoabdominoplasty) or to undermine much wider and perform liposuction at a later date.  It looks like you had the second one.  Fortunately, now that you have healed, you could now have more agressive liposuction in this area with minimal risk of skin loss.  I believe these options should have been explained to you.  In your case, I would have done a combination lipoabdominoplasty and then only offered more liposuction later if you wanted even a thinner waist.  From your photos, It looks like the skin could have been pulled a bit tighter.

Martin O`Toole, MD, FACS
Los Angeles Plastic Surgeon
4.7 out of 5 stars 28 reviews

Concurrent liposuction with tummy tuck is not agreed on by all plastic surgeons


Your before photo would help, but it does appear that liposuction of the abdominal area and flanks was either not performed or performed insufficiently.  With that said there is some disagreement among plastic surgeons about doing liposuction at the same time as a tummy tuck.  I think more and more are realizing that when performed properly it is a safe and effective part of a tummy tuck.  I routinely peform liposuction with all tummy tuck procedures that benefit from it.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

Various Options to Treat the Upper Abdomen

There are two schools of thought when it comes to abdominoplasty. The more traditional route is to do the abdominoplasty with skin removal and abdominal wall plication first, followed by  secondary liposuction to improve the upper contour. This is thought to decrease wound healing complications. The other option is to perform more limited undermining with more aggressive liposuction. It seems as though your surgeon fell into the more traditional school. Good Luck!

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 94 reviews

Fat remains after tummy tuck

Most doctors will not do radical fat removal during a tummy tuck because it may increase the risk of wound complications, blood clots, etc. 

In cases where there is a large amount of fat present, it may be safer to perform the sculpting at a later session.


Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Tummy tuck results

Some fat from the upper abdomen is removed but it's not much.  The blood supply of the skin is very important in healing after tummy tuck and therefore direct removal or lipo is limited in that area. 

Liposuction after 7 months is likely safe and should help your contour.

Now for the tough question.  What is your weight compared to your pre-tummy tuck weight?  If it is the same, you have actually gained some fat and since the lower abdominal fat pad is gone, any weight may have gone to your midriff area.  It's super important for patients to understand body contouring arithmetic.  If you are 150 prior to surgery and the surgeon removes 5 pounds, your new weight is 145.  If it creeps back up to 150, you have actually gained fat.  I know it's a total bummer but it is true.

If you are one of those patients who has had their weight creep up, get down to your new weight and see how your abdomen looks.  It may look just fine.


Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 72 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.