Loose and Saggy Upper Abdomen After Tummy Tuck

Question

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!

Steven H. Williams, MD · Answer

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.

J. Timothy Katzen, MD, FACS · Answer

Hello siouxmac,

Thank you for sharing your concerns. It sounds like you're experiencing some dissatisfaction with the results of your tummy tuck procedure.

Based on your description, it appears that you may have undergone a mini tummy tuck rather than a full tummy tuck. A mini tummy tuck typically addresses the skin and fat below the belly button and may not adequately address concerns above the navel.

Before proceeding with any surgery, it's crucial to have a thorough discussion with your surgeon about your goals and expectations. If a full tummy tuck was not discussed as an option prior to your surgery, it's understandable that you may be disappointed with the outcome.

In your case, I would recommend considering a full tummy tuck to address the loose and saggy skin above your navel. Additionally, liposuction of the superior iliac crest area may help create a more defined waistline and achieve the hourglass figure you desire.

It's essential to have an open and honest conversation with your surgeon about your concerns and explore all possible options for achieving your desired results. Your surgeon can provide personalized recommendations based on your unique anatomy and aesthetic goals.

If you're still unsatisfied with the outcome of your procedure, seeking a second opinion from another board-certified plastic surgeon may also be beneficial.

I hope you find a solution that meets your expectations and helps you achieve the aesthetic results you desire.

Sincerely, Dr. Katzen

Richard J. Bruneteau, MD · Answer

Your pictures and history indicate that you’ve actually had
a mini abdominoplasty.When patients
have loose saggy upper abdominal skin following this type of procedure,
correction usually always requires conversion to a full abdominoplasty.This procedure involves raising a flap to
the level of the rib cage.The skin is
then advanced in a downward direction and the excess skin is removed at the
level of the lower abdominal incision.An umbilical transposition is an important part of this procedure. Under
these circumstances you appear to be excellent candidate for conversion to a
full abdominoplasty.This procedure
would remove your excess upper abdominal skin, tighten your abdominal muscles
and improve your abdominal contour.If
you’re considering additional surgery it’s important that you consult a board
certified plastic surgeon with experience in this area.This surgeon should be able to formulate a
treatment plan that addresses your anatomic findings and achieves your
aesthetic goals.

Jaime Perez, MD · Answer

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.

Sean Younai, MD, FACS · Answer

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.

Richard Baxter, MD · Answer

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.

Michael Law, MD · Answer

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'.

Leo Keegan, MD · Answer

If there is no scar around your belly button then skin was only removed from the lower abdomen. Your belly button may have been disconnected from its fascial attachment. Laser tightening is likely to be effective. You may need a revisionary surgery.

Peter A. Aldea, MD · Answer

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

Steven Wallach, MD · Answer

Loose skin above the umbilicus requires a full tummy tuck. Skin tightening with lasers wil give about 15-20% improvement, so best for patients with very mild sagging.

Loose and Saggy Upper Abdomen After Tummy Tuck

Answers (16)