Loose skin after tummy tuck and gastric sleeve. Will I need a revision? (photos)

You lost a significant amount of weight and that is wonderful!!
The tummy tuck is designó only remove excess of length and in your case was very well treated.
When you bend over that skin hanging is pure excess of width and nothing will eliminate it but a resection of the vector of excess through a Fleur de Lis.
Be encouraged. My recommendation is to look for a surgeon who is expert on After weight loss surgery.
Dr. Cárdenas

Dear Cheerful433106,
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

Adding the vertical tuck or doing the back area will take care of the vertical looseness you have from weight loss. The horizontal incision cannot remove all the vertical excess.

Congratulations on your weight loss! Your photos indicated that you still have laxity of your skin. A revision will be needed to address it. I encourage you to visit with a board certified plastic surgeon near you for a consultation. You will want to wait to have surgery until you have reached your weight loss goal and can maintain it as significant future weight loss can impact your results.

Excess skin in some abdominoplasty patients is from side to side as well as the hanging part. To remove that skin a scar needs to be placed from the breast bone to the pubic area. good luck

When morbidly obese people successfully lose a lot of weight they typically develop skin laxity. The obesity was not in a simply vertical or horizontal direction. so the skin laxity people who lose a lot of weight develop is loose in many directions.
A standard tummy tuck or even an extended tummy tuck only only reduce skin laxity in a vertical direction. it removes a strip of skin parallel to the scar. Individuals who have more skin laxity than what is efficient with the removal of a standard tummy tuck may need to have both horizontal and vertical skin laxity removed. This means adding a vertical scar typically on the midline abdomen and the design of this procedure is often called the fleur-de-lis pattern in tummy tuck.
Sometimes a wraparound tummy tuck can minimize the chance of needing the vertical scar by recruiting some of the horizontal skin laxity around the back. Being able to make a good assessment and differentiate which patients really need a fleur-de-lis pattern tummy tuck or who can get away with just a regular tummy tuck can’t be a difficult decision.
Some patients are also very apprehensive about adding the vertical scar because it tends to not look very appealing.
Do you have a good skin tightness in an up down direction but it is still loose horizontally or left to right.
If you want more skin tightening then you’ll need a revision converting your tummy tuck to a fleur-de-lis pattern removing skin in the horizontal plane.
We typically do not judge tummy tuck results with a flexed abdomen since everyone will have skin laxity when they bend forward, sit down or flex their torso.
If you’re unhappy with the outcome of your procedure then you should spend some time looking at your before pictures. that is not to say your procedure couldn’t have been performed better.
Ideally the different options and different variations of a tummy tuck procedure should’ve been presented to you and you should’ve been allowed to be part of the decision making of what is the better procedure depending on your needs, your assessment and what you’re trying to achieve.
Some people are very critical and will want to avoid the vertical scar while others are very sensitive about still having remaining horizontal skin laxity.
Follow up with your surgeon and talk about the possibility of doing a revision or converting the procedure to a fleur-de-lis or possibly wraparound or body lift type procedure.
Based on your pictures a fleur-de-lis pattern is probably going to be the better option.
Other than that it looks like your procedure was performed correctly.
It would be helpful if you included proper before and after pictures. To assess the outcome of an operation we really need to see what you look like before surgery. likewise, knowing how many pounds of weight you lost would also give us an idea in regards to assessing the outcome and decision making.
Alternatively you could have a few in person consultations with other board-certified plastic surgeons to get a more quality second opinion.
Best,
Mats Hagstrom MD

It is the weight gain that stretches out the skin and ruins its elasticity and tightness. Weight loss does not make that return so when surgery is done, all the surgeon can do is remove the excess skin but cannot make the remaining skin "tight." That just isn't possible unfortunately. If you good good standing straight up, and are smooth and flat standing, there's not much benefit from a revision. Your standing pictures look smooth and flat.