Did my surgeon not take enough skin? (Photo)

Question

I’ve been having some issues since about 6MPO. The “bulge” on the right side just above the incision and what seems like saggy skin above the belly button that I didn’t have before.around 3-4MPO I was very flat even with the swelling. Now I am just not happy and I have a healthy active lifestyle so it is very frustrating. Thoughts?

J. Timothy Katzen, MD, FACS · Answer

Hello Vivid108076. Thank you for your question regarding the concerns you have post-tummy tuck, particularly regarding the amount of skin removed and the appearance of a bulge.

From the details and pictures you provided, it's important to consider a few key aspects. After a tummy tuck, it is typical for the abdomen not to appear completely flat when sitting, as some redundancy is necessary to allow for comfortable movement and standing. If the skin were too tight, it would restrict your ability to stand straight and move freely.

Regarding the bulge you mentioned, which is visible in your six-month postoperative standing picture, it's essential to follow up with your plastic surgeon. While it appears that sufficient skin was removed during your surgery, a physical examination and possibly imaging studies like an ultrasound or CT scan could help determine the nature of the bulge. These tests can assess whether the bulge is due to subcutaneous fat in front of the muscle, which could be addressed with liposuction, or if it is visceral fat located behind the muscle. Visceral fat is more challenging to remove surgically and is typically managed with dietary changes and exercise.

You mention maintaining a healthy, active lifestyle, which is excellent. However, if the bulge persists, consider the following dietary strategies:

Ketogenic Diet: High in fats and very low in carbohydrates, helping to reduce insulin and sugar levels.
Carnivore Diet: Focuses solely on animal products and is extremely low in carbs.
Intermittent Fasting: Cycles between periods of fasting and eating, which can improve metabolism and reduce fat storage.
Calorie Deficit Diet: Consuming fewer calories than you burn can lead to weight loss.
Additionally, combining aerobic and anaerobic exercises can enhance fat loss and improve muscle tone, which might help tighten the area if the issue is related to subcutaneous fat.

If lifestyle changes do not resolve the issue, discussing temporary weight loss medications with your healthcare provider might be an option.

It’s crucial to maintain ongoing communication with your plastic surgeon, who can provide guidance tailored to your specific situation and help determine if further interventions are necessary.

I hope I've provided clarity regarding your concerns post-tummy tuck. Please feel free to reach out with any more questions.

Good luck, and I hope you achieve the results you desire.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Daniel Barrett, MD · Answer

Dear Vivid108076,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Arif Eroglu, MD · Answer

Hello; your problem; but not standing position; if it occurs when you sit; most likely, abdominal muscle repair was not done at all or was done inadequately.Even while standing; if you have a problem too; it is necessary for deleting fat from your belly.

Gerald Minniti, MD, FACS · Answer

Bad news: your surgeon placed your incision too high and know you have 'too much skin'. Good news: a relatively small surgery can correct both problems (skin excess and high scar). In essence, it's a mini-tummy tuck.

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, your problem is more than skin only issue. What I see is a very high abdominoplasty scar, scarred belly button, no abdominal wall contouring. If you were my patient, I would completely redo your surgery with further muscle tightening, lowering your scar to the pubic bone level, VASER liposuction to define waist, hips, semilunar lines and epigastric midline to create a youthful and athletic abdomen. These surgeries I do in our certified in office operating suite under deep intravenous sedation. 
See a board certified plastic surgeon with extensive experience in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Jeremy Bosworth, MD · Answer

It is not unusual for there to be some relaxation or skin after surgery and every surgeon has their own techniques for evaluating how aggressive they can be with skin removal and their comfort level with how tight they can get you, as well as how much liposuction is done to the central tummy at time of tummy tuck. If everything was flat after a few months PO then it was possibly just the most skin your surgeon felt he could get out safely at the time and your skin has relaxed. Its possible that more skin could have been taken but without being there at the time it is hard to judge that. It looks like you maybe had a little wound healing issue at the central area so taking more skin might have just made things too tight and made that even worse.Continuing to stay in shape, eat healthy, exercise can continue to make your results even better.

Connie Hiers, MD, FACS · Answer

Go back to your surgeon and be examined to see if you have a fluid collection that needs to be drained. An ultrasound can be done to confirm this.

Camille Cash, MD · Answer

I'm sorry you are unhappy with your tummy tuck.  From the posted photos it appears you would benefit from a revision.  Liposuction could further contour the abdomen and hips giving you more defined curves.  Any redundant skin could also be excised. See a board certified plastic surgeon near you for a consultation.

Han Hoang, MD · Answer

Skin is not the issue here. At the initial tummy tuck, I usually recommend my patients to also have liposuction. There are areas that aggressive liposuction can cause wound problems after tummy tuck and there are areas with much lower risks. The bulge that you are concerning about can be improved with liposuction and/or weight loss. I recommend cardio and core exercises, maybe a few lbs weight loss, and possibly liposuction at 1 year post op. Good luck and you look good already, just need a little more TLC. Han Hoang, Board Certified Plastic Surgeon, Huntington Beach, CA 92647

Darryl J. Blinski, MD · Answer

Based on your series of nicely posted photos appears you had a limited tummy tuck with poor muscle repair. Based on the photos without in person or virtual consultation, only correction of lateral dog years and muscle repair by doing revision full tummy type. Can you attain desired results. Expect fees to range from eight to $20,000. Best to virtual consult with.

Did my surgeon not take enough skin? (Photo)

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