Unsatisfactory tummy tuck - what kind of revision will help? (photos)

I had a skin only tummy tuck 15 months ago after losing 90 lbs. I wish I had been advised to get lipo too. However, I am still left with a large amouunt of sagging skin when I sit down. I can't bear the thought of undergoing a full tummy tuck again, it was an awful recovery with hematomas and an infection. 1.) Is a revision necessary? 2.) would a mini TT and lipo be enough, or is a full TT the only to fix this?

Doctor Answers 9

Full tummy tuck with muscle reconstruction

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The answer is not that you didn't have liposuction.  That is actually a dangerous move.  You should have had a muscle repair and more skin removed.  You need another full tummy tuck.

Unhappy with TT after significant weight loss

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Hello Gaia,Unfortunately to improve your abdomen you will require a full revision TT.  Liposuction will help reduce the thickness of the tissue that remains and help with the contour but after a significant weight loss like yours the elastin in your tissue just doesn't snap back. I take care of a lot of post massive weight loss patients and often excision of skin is not only needed in the horizontal butt also vertical direction to achieve the best contour.  If a vertical scar is not acceptable for you, than you may have to accept some laxity with your abdomen.  A mini TT would not address enough of the lower abdominal excess and could distort the belly button.  It also would not address any of the upper abdomen excess.I'm sorry to hear that your had such a difficult recovery with your first surgery.  Your result can be improved but would require further excision to be a meaningful change. I hope this helps.Best of Luck!Dr. Rednam

Rukmini V. Rednam, MD
Houston Plastic Surgeon
5.0 out of 5 stars 40 reviews

You don't need liposuction

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Hi,Thanks so much for your inquiry. And congratulations on your weight loss, that is a huge accomplishment. One of the challenges of tummy tucks is that the excess skin can be in two different vectors. Before surgery, you had extra skin in the up-down direction, but also in the in-out direction. The tummy tuck will address the skin excess in the up-down direction, but not the excess in the other direction. This is part of the reason why you still have laxity. The only way to truly address it is to either extend the incision all the way along your hips and "pull" the remaining skin taught along this increased area, or do a "fleur-de-lis" abdominoplasty.  I don't think in your case, your skin excess is enough to warrant a fleur-de-lis with its additional scaring. However, you may benefit from a revision that extends the scar laterally and gets the skin tighter. Even by doing this, you still will have some laxity because your skin elasticity has been reduced from the weight loss. But if you are bothered by your appearance after the tummy tuck, it's worth talking to your surgeon about another procedure to take some additional skin. You have risks, and those risks are not less with a revision. So it's important to weigh the risks and benefits, and think about how much this bothers you.Best of luck,Dr. Weintraub

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Revision TT

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It appears you had a reasonable result. With a Hx of massive weight loss you may need not only a transverse scar but a short vertical scar to achieve your best/desired result. Performing lipo or a fat resection of the abdominoplasty flap definitely helps with the bulk of the remaining tissue. See a second or third consultation/opinion as someone examining you will be able to better assist in which procedure would be best for you.

Tummy tuck

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Hello and thanks for the question. To improve your results you will need a full tummy tuck to tighten your abdominal muscles and remove skin. Massive weight loss patients do have issues with skin elasticity so liposuction should be used selectively. 

Tummy Tuck revision

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You appear under corrected. You will likely need an extension operation to get a tighter correction. Without seeing you I can't be too detailed as to what I would recommend. Lipo will not add much for you by your appearance. 
Best Regards,
John Di Saia MD

John P. Di Saia, MD
Orange Plastic Surgeon

Unsatisfactory tummy tuck - what kind of revision will help?

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Thank you for sharing your question and photographs.  I think you have obtained a nice improvement after your initial tummy tuck and the "need" for any revision depends on your desired outcome. I agree that you have some skin excess to your lower abdomen that will only improve with an additional surgery to remove skin, and not liposuction which will only cause increased skin laxity.  Talk to a board certified plastic surgeon in consultation ,they can offer you the best treatment advice after a thorough discussion.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

TT revisions

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Based on your photos and history of weight loss one can imagine that your abdominal skin have lost elasticity and ability to contract. For that reason you seem to have both vertical and horizontal skin laxity? Clinical exam in person would be necessary to give you more detailed analysis. There are several options one may consider in your case; from extensive  abdominoplasty including vertical skin removal and midline scar (which I am sure you would not like to entertain) to skin only lower abdomen excision with or without liposuction.
You should seek a second opinion consultation with an experienced board certified plastic surgeon with good reputation in body contouring surgery for detailed clinical evaluation and discuss your options. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Unsatisfactory tummy tuck - what kind of revision will help?

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I'm sorry for your concern and what you went through.  Hematomas and infection are some of the complications that can happen with a tummy tuck.  The two complications may have contributed to the laxity as well but it is hard to say for sure.  Based on your pictures, I think a full revision tummy tuck with liposuction of the sides would yield the best result for you.  A mini tummy tuck could get rid of some of the laxity but would place your belly button too low.  A full revision should give you a tight stomach with a nice contour.  The good news is that the muscles should not have to be tightened  again, therefore the recovery should be quicker and more comfortable.

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.