Why does my belly still look big after full abdominoplasty? Will I need a revision? (Photos)

Question

I had a full abdominoplasty May 11th,2021 with liposuction of the flanks. After surgery I was not happy with my results so I told my surgeon about it and he didn’t like that. He told me that I need to lose weight to get the flat belly I want but prior to surgery he told me diet and exercise will not give me the results I want and surgery was the answer. My belly still looks big even though I had a tummy tuck, what can I do to get this fixed, will I need to get a revision ?

Gerald Minniti, MD, FACS · Answer

Without an exam, it is difficult to say with certainty. However, your photos suggest intra-abdominal fat, something that can't be removed in a surgical procedure. This is easy to diagnosis in a physical examination.

Vasileios Vasilakis, MD, FACS · Answer

Thank you for the question. It is difficulty to determine what your best options are without a physical examination. My recommendation is to visit with several plastic surgeons before you make your final decision. I wish you the best of luck. Vasileios Vasilakis, MD. Double board-certified, fellowship-trained plastic surgeon, Houston. TX.

Daniel Barrett, MD · Answer

Dear Azeena,
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

Camille Cash, MD · Answer

A tummy tuck can remove excess skin and fat in front of the abdominal wall as well as correct abdominal wall laxity.  It cannot address fat behind the abdominal wall that is around the organs.  This is called visceral fat.  The only way to address this is through diet and exercise.  If your abdominal laxity was addressed during surgery then the protrusion is likely visceral fat.

Mats Hagstrom, MD (license on probation) · Answer

Most likely you have exes visceral fat and without weight reduction the results of the procedure will be limited.

Without an examination it’s not possible to make an assessment if your muscle tightening was sufficient but most of the time when patients bulge after a proper tummy tuck it is because of exes visceral fat pushing against the back of the muscle wall.

In the end there are four variables that contribute to the shape and contour of the abdomen.

These are skin laxity, access subcutaneous fat, muscle separation from previous pregnancies called diastasis recti and lastly access visceral or intra-abdominal fat.

A tummy tuck primarily treats skin laxity and muscle separation.

Liposuction treats excess subcutaneous fat.

Visceral fat can only be reduced through weight loss.

I suggest trying to drop a few pounds and take some reference pictures to see if it helps.

I’m guessing even 5 pounds will make a significant difference and 10 pounds may do the trick.

It is possible that muscle tightening was insufficient but that is usually not the case.

To get a proper assessment on the outcome of your procedure with a second opinion you’ll need to schedule in person consultations with other providers.

Best,

Mats Hagstrom MD

Richard P. Rand, MD, FACS (retired) · Answer

All that a TT can do is remove excess skin below the BB and the aft attached to it as well as tighten the muscles. If there is too much fat inside the abdominal cavity (intra-abdominal or also called central fat), you will still have a fuller looking abdomen. All that solves this is weight loss.

Why does my belly still look big after full abdominoplasty? Will I need a revision? (Photos)

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