Why would my plastic surgeon leave my muffin top like this? Is this just swelling? (photos)

I had a full TT with lipo to my hips & flanks 12/4/12. I have been very happy with my tummy but was left with a horrible muffin top. When I told my PS I was unhappy he told me it was residual swelling and would go away. At my 1 yr check up I asked him what happened to my flanks, that they still look horrible. His explanation was that when doing a TT it is hard to roll a person over to do lipo in that area. Is his response accurate? Why wouldn't he lipo first if that was the case?

Doctor Answers 4

Dreaded muffin tops

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will occur after body contouring procedures since the skin will always flow over any kind of belted or waisted garment.  Your post op photo actually looks pretty good, even if not perfectly even as you mention.  I could be more objective if you posted your before photos as well.  No one can guarantee perfect symmetry.  If you have loose skin and don't want it, excision (and the resultant scars) is all that is left for you.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Unhappy with TT results

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Your problem does not appear to be one of inadequate liposuction but return or persistence of loose skin. It is important, in the preoperative discussions, that you have a thorough understanding of what can and cannot be achieved by a standard tummy tuck. Although a great deal of skin can be pulled in and removed from the flanks, the incision has to end somewhere. Wherever it ends, there is a transition from operated upon to not operated upon.  Extra skin in the not operated upon area can be cut out by extending the incision but you have to be okay with a longer incision. It may be that you need a full circumferential incision to make you comfortable but in a person with your small frame and otherwise pleasing shape, that is a lot of scar.
Dr. Pyle

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 125 reviews

Abdominoplasty Results

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I am sorry you are not completely happy with your results.  I usually roll patients from side to side to perform liposuction and that is not really a problem for me.  From your picture, it actually looks like you have some extra skin on the flanks ("muffin top") - by the way you are stretching it out.  If that is true, you would need skin excised (cut out) which would extend or lengthen the scar around the back a bit.  This looks to me like it would give you the flattest appearing belly (especially on your left side which seems to have more skin than the right).  But you would have to be ok with a longer scar.  Best of luck!

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Muffin Top after TT & Lipo

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Hi bvalentine.

Sorry that you aren't totally happy with your result.  It is fair to say that it is difficult to roll a patient over to sculpt all the way around to the back while doing a tt, but it isn't impossible- think about a 360 body lift, in which it is done all the time.  Add to the mix, you had extensive lipo.

I can't exactly say why you have the asymmetry without preop pics.  Things that can contribute include boney structures, spine, fat thickness, muscle differences, and technical asymmetries due to any of the procedures performed.  One side is ALWAYS asymmetrical.

Regarding what I see from your pics.  On tightening the abs, some of the back fat is brought forward.  I can't tell if you have lax skin at the flanks, as I don't know what the pinching middle pic shows.  I would guess that additional lipo on the left flank and perhaps back should fix the problems, and since you are over a year out, you should be surgically ready.  You may need a bit more skin removed but that can only be determined by exam.

Personally, I do lipo last to "fine tune" the sculpting because you can't put it back, so I have no issue with the described technique order.  Not sounding like I am "standing up" for him or anyone else, I will tell you that it sometimes looks great when we finish, but healing sometimes doesn't produce the result we anticipate.

Those are my honest thoughts.

Also, I enclosed a link to a patient similar to you.


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.