9 months after TT with muscle plication. Is this indicative of laxity/separation of obliques? (Photo)

Question

I had TT with muscle plication below BB only 3/18. Lower abdomen still bulging though no midline muscle separation can be felt or seen. I have read about oblique muscle plication. When I lean back w/o engaging my core I can see the small diastasis in upper abs, with similar, more extreme, outward bulging along the obliques. Is this indicative of laxity/separation of obliques? Does it appear that oblique plication would significantly flatten my tummy? 5'4 135lbs, for reference.. Thank you!

Daniel Barrett, MD · Answer

Dear mango88,
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

I encourage you to return to your surgeon for further evaluation.  It appears any diastasis from the midline was corrected.  An in person evaluation is needed to determine if you are experiencing skin laxity or if something else is occurring to cause the contours that concern you.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a procedure we always need to see standard and before and after pictures.
If you don’t have before and after pictures and ask your surgeon to forward the ones they took.
I understand you were trying to demonstrate the area of concern but results are generally judged based on standardized pictures standing in a neutral position.
It’s not clear if you had a mini tummy tuck or a full tummy tuck.
It would be unusual to do muscle tightening of the lower abdomen only. typically if that’s done it causes the upper abdomen to bulge.
The contour of the abdomen can generally be broken down into four components and if there is an issue it is almost always one of those four.
The four variables to determine what someone’s abdomen looks like it’s related to skin laxity, subcutaneous fat the muscle wall or visceral fat or intra-abdominal fat
In your case it appears everything is related to the muscle wall so most likely the outcome of your procedure is a reflection of how the operation is done in relationship to what your abdominal wall looked like before the operation.
It’s unlikely your results can be altered without re-doing the procedure.
A straight tight muscle ball should be a B line between your sternum and your pubic bone. if the abdominal wall bulges beyond that it is generally due to muscle separation or visceral fat.
To get a meaningful assessment you really are going to need an in person second opinion consultation.
If your provider is not offering sufficient explanations then schedule in person and second opinion consult. for second opinion consultations people should come prepared to bring with them all copies of before and after pictures and a copy of your operative report. These are all available to you from your surgeons office if you request them.
Best,
Mats Hagstrom MD

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
From your photos, I note excellent skin and muscle tightness vertically, but there is residual skin laxity horizontally, resulting in folds of redundant skin and soft tissue. I do not think this is a muscular problem.
You may be a candidate for revision. 15% of cosmetic surgeries require secondary touch up procedures to optimize the result. Extending the incisions further laterally as an "extended abdominoplasty" will eliminate the pleating and flatten the result. 
Best wishes...

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