Loose and Saggy Upper Abdomen After Tummy Tuck

I had a full Tummy Tuck 6 months ago. After the procedure, my surgeon told me that since my belly button was 'high' to begin with, he was able to leave it intact after the Tummy Tuck. My fear is that this really translates into, "I didn't remove as much skin as I should have." I now have a taut lower abdomen, but the entire area above my navel is loose and saggy. Last week, my surgeon performed laser skin tightening on my upper abdomen (his solution). I am not at all convinced that this will remedy the problem. Is this a normal result, or am I right to have expected better? I am not overweight and I have done regular abdominal workouts both pre and post surgery. Thank you!

Doctor Answers 15

I hope your laser treatments are at no charge

Dear Sioux,

You are far from overweight. The two pieces of information you have left out are your age and whether or not you had full term pregnancies. If you are over 50 or have had pregnancies it is highly unlikely that your skin is going to contract even with the laser treatments. Also, if either of these is the case, it is difficult to understand why your surgeon only did a mini abdominoplasty. Did you restrict him/her in any way, e.g. "I don't want a long scar" or "I don't want a scar around my belly button"? That is the only reason that I could see for not doing a full abdominoplasty. If you do go back for a revision surgery it will likely require a longer scar and either a lowering of, or a scar around, your belly button. Good luck!

Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews

You only had a mini tummy tuck and the upper abdomen wasn't addressed

When a patient comes in for abdominal improvement, there are basically 3 options for them:

1. Liposuction - this only removes fat and doesn't tighten muscles or remove excess skin. It is limited to those patients who would benefit only from this and have good skin elasticity. This would not appear to be what you needed.

2. A mini tummy tuck - this procedure only addresses the lower abdomen and tightens the muscles below the belly button and removes a small amount of skin. The muscles and skin above the belly button are not addresses and there is no incision around the belly button. I personally almost never do this operation because I don't want patients to end up with your result. If you have issues and needs above the belly button, the will not be improved by anything other than a full tummy tuck.

The problem with a full tummy tuck in someone like you is that you don't have much extra skin and in order to avoid a vertical scar in the lower abdomen from where your belly button was, the horizontal scar would need to be higher than where yours is now. The only other way around this is to "float" the belly button but this can make it look too low on the abdominal wall. So your was maybe not a simple case.

3. A full tummy tuck - what most patients need to address their lower AND upper abdominal issues. The scar is a bit longer but not too much especially if you get the abdomen you want.

These issues would preferably have been discussed preop so you could have voiced some preferences in the choices. At this point, I don't know of any external treatments that will change your upper abdomen significantly. Either you need to accept the result or consider having a full tummy tuck.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Mini vs typical abdominoplasty

A mini abdominoplasty (where there is no incision around your belly button) will not address significant skin excess in the upper abdomen. The dissection of a mini goes to about the level of the belly button, pulling the skin inferior to the belly button tight.

It is usually not effective in addressing upper abdominal skin.

You may have limited options in the short term as there may not be enough skin for a full abdominoplasty at this point. However, time may help both the appearance of your upper abdomen as well as your potential for a full abdominoplasty revision.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Mini vs. full tummy tuck

First, some clarification on terminology: It looks like what you had was a version of a mini-abdominoplasty, with the umbilicus (belly button) relocated to a lower position. This is actually a common procedure but isn't a "full" abdominoplasty. If you were to have the full version, there would be a scar around the umbi, and more tightening of the upper abdominal skin, but because you had a high umbi to begin with it would likely not have been possible to remove all of the skin between the pubic area and the umbi, which is how the standard full version is done. This means there would be a hole in the skin flap where the umbi was, which would have been closed leaving a scar somewhere in the lower abdomen. It may or may not have been a good trade-off but your surgeon's judgment was to avoid it so there is no scar on the umbi or the lower abdomen, which is a good thing. So yes he could have removed more skin but there is a trade-off to doing that.

The laser treatment will take some time to have full effect, so i would advise some patience and make sure you are being followed-up regularly with your plastic surgeon.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Loose saggy upper abdomen

Hello. By the look of your photo it seems you need a tummy tuck revision. Sounds as though your surgeon performed a mini tummy tuck. You indeed need a full tummy tuck. Speak to your surgeon to let him know these are not the results you desired to achieve. Best of luck to you.

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 75 reviews

Mini Tummy Tuck is NO substitute for a Full Tummy Tuck

As a 43 year old woman with a history of 3 full term pregnancies you should have had a "full" Tummy Tuck / Abdominoplasty.

It is clear from the length of the scar (right sided dog ear included), the appearance of the belly button and the loose skin above the umbilicus that you had a Mini- tummy tuck where only the infra-umbilical abdomen was addressed.

In my opinion had you had a full tummy tuck your result would have been significantly better. I am sure that my colleagues share my curiosity and would like to know if your surgeon was a Plastic surgeon (www.PlasticSurgery.org) or another physician practicing plastic Surgery. Practically every mid-size to large city has non-Plastic surgeons legally practicing Plastic surgery.

You may wish to consult another local Plastic surgeon and see what he / she suggests. In general, tightening of the loose skin above your belly button at THIS point is "doable" but it would require the present belly button location to remain as a vertical scar lower down in the mid line.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Upper Abdominoplasty Reverse Upper Tummy Tuck

Not infrequently I see patients in whom there is as much skin laxity in the upper abdomen as there is in the lower abdomen. In fact, some patients after pregnancy will have fairly 'toned' lower abdominal skin, but very lax and redundant upper abdominal skin. In these situations, the removal of skin in a vertically downward direction ( a conventional tummy tuck) is not adequate to correct the upper abdominal skin laxity. Such patients are often very good candidates for what I refer to as a 'reverse upper' abdominoplasty.

This surgical technique involves removing excess abdominal skin vertically upwards using incisions hidden in the inframammary folds underneath the breasts. In general, this operation is best reserved for patients with fairly full or at least slightly droopy breasts, which serve to nicely conceal the inframammary folds. An important part of this procedure is the placement of permanent lifting sutures that elevate the lower skin edge, following removal of excess skin, to the upper skin edge in the inframammary fold. These permanent sutures ensure that the resulting surgical scar remains hidden within the inframammary fold.

A great advantage of this procedure is that the patient's original belly button is preserved, and thus there are absolutely no surgical scars that are visible when wearing a two-piece swimsuit or typical underwear (bra and panties). Additionally, because this procedure generally requires less skin undermining and thus less interruption of the normal blood supply of abdominal skin, more thorough liposuction of the waist and back can be performed at the same time.

Many patients having this surgery, therefore, undergo a reverse upper abdominoplasty combined with a lower 'mini' abdominoplasty, tightening of the entire length of the rectus abdominis muscles, and liposuction of the circumferential trunk - and keep the belly button with which they were born. I usually refer to this operation as 'reverse upper / modified lower abdominoplasty'.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

No nonsurgical solution will help

The photograph indicates that your surgeon performed a mini abdominoplasty. This removes only the portion of tissue below the belly button. All belly buttons are located in essentially the same place and your surgeons explanation that it was "too high" is concerning. I often perform this surgery with full abdominal liposuction when there is not enough skin/fat to be removed. However, I explain that there may be an excess of skin in the upper umbilical, belly button, region. Some of this excess skin can be remove with a superior belly button cresent excision but it's not perfect. A second possiblity is a full abdominoplasty but likely you will end up with a long transverse scar and a short vertical scar (from inferior movement of the umbilicus incision).

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 33 reviews

A mini-tummy tuck does not tighten the upper abdomen

It seems that at your initial procedure you only had a mini-tummy tuck. if you did not have an incision around your umbilicus, then the upper abdomen was most likely not touched- muscle was not tightened and the excess skin was not removed.

I don't beleive that laser tightening is going to give you the same tighening of the upper abdominal skin as a full tummy tuck would have accomplished.

Unfortuantely, you might eventually have to have a full abdominoplasty and not a mini-tummy tuck.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Stay the course and give it time…you are only a few days since your tummy tuck revision!

Thank you for your question. Stay the course and give it time…you are only a few days since your tummy tuck revision.

A standard tummy tuck corrects three tissue layers of the abdominal wall: loose skin, excessive fat, and separated abdominal wall muscles. Typically, the tightest and flattest abdomen is seen following a tummy tuck procedure.

The procedure you underwent was not a standard or formal tummy tuck but rather a shortened variation of one, termed a mini-tummy tuck. This term is used because it is not as an extreme surgery and it is usually performed faster, associated with a shortened downtime and recovery, and potentially with fewer complications.

It is essential that your goals and expectations be realistic understanding the short comings of this operation, because a mini-tummy tuck may be a compromise in cosmetic results.

I would strongly recommend that you continue to follow-up with your treating surgeon. After all, he/she knows you the best and understands what technique was surgically employed. Be open and direct when discussing your concerns.

Moreover, remain patient as your final results will not be seen until six months or more. I hope this helps!

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

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.