Still Have Loose Skin After Vertical Tummy Tuck

Question

Hi, I have lost a total of 182 pound by exercice and well eating in two years. After 1 years of stabilisation, I go with a full tummy tuck with vertical incision to have a great result. But, 3 weeks after churgery, I still have loose skin upper my ombilic !! The tummy tuck have a nice look upper my ppubis, but not upper (see picture). I will ask my doctor wath to doo, but I need argument ! I thiunk it would probably try to said that it normal. Please give me your opinion.

Brent Moelleken, MD · Answer

Patients who have lost a massive amount of weight have very poor elasticity of their skin.  Like a spent elastic waistband, these fibers are simply gone.

	So often the results of even the best tummy tucks look great when the patient is standing, but show the looseness when the patient leans forward.

	This is unfortunately a fact of life and unavoidable.

	Most patients are OK with this, especially when they compare their before-after results!

Thomas P. Sterry, MD · Answer

I happen to do a lot of plastic surgery after weight loss here in New York City.  I understand that you are frustrated with your upper abdominal excess skin, but please try to satisfied with your appearance.  You look terrific and the elongated scar that would be required to go all the way up your tummy to remove this skin is probably not worth the improvement...at least it wouldn't be worth it to me if I were a patient.  Now, many times this IS worth doing, I just don't think so in your case.  i would try to make peace with the way you look now.

	Best of luck.

David Shafer, MD, FACS · Answer

You look fantastic based on your before pictures and based on the incisions that your surgeon used to perform your surgery.  You are also recently post-op as I see some steristrips still in place.  I think you really need to take a close loos at your before pictures and feel great about yourself and what you have accomplished.  

	 

	Best of Luck.

Robert L. Kraft, MD, FACS · Answer

What a weight loss! Congratulations?  You are still early in the healing process and need to give it time.  However, some patients have skin that completely loses its elasticity and does not contract even after it has been pulled down during the surgery.  In some cases I literally do the stretching twice during the surgery because the skin is like an elastic waistband that has stretched and won't snap back.  I note that you are slightly bent over and that would certainly distort the result.

Darryl J. Blinski, MD · Answer

The other posters are being very polite to you. Yes it is great the massive weight loss. In a real world your result is excellent. Your issue is one of "realistic Expectations"! From MIAMI Dr. Darryl j. Blinski

Peter E. Johnson, MD · Answer

Your weight loss had been exceptional and overall after three weeks you are looking well. The vertical tummy tuck does allow the skin laxity to taken up around the waist as well as a reduction of the skin low and across the pubic line and this seems to have been a good choice. Stay with your binder for pressure and wait another three to six months to judge your result.

	Best of luck,

	peterejohnsonmd

Peter A. Aldea, MD · Answer

Congratulations on your MAJOR achievement.

	Respectfully, I think your idea of what can realistically be achieved with surgery is a bit overly optimistic. Plastic Surgery is like a game of Poker where you cannot get new cards. As a surgeon, I must "play" the hand you, the patient, deals me as best as I can. HAD you had better quality skin, your result would have been magnificent. But - your former obesity largely destroyed the elasticity of your skin and what appears to be perfect in the operating room ALWAYS sags in the weeks and months to come.

	You CAN have a revision procedure to remove the excess skin vertically in the center (but not at the uppermost portion near the ribs) but be prepared for some recurrent laxity.

	Remember - "le mieux est l'ennemi du bien"

	Dr. Peter Aldea

Robin T.W. Yuan, MD · Answer

Congratulations on your weight loss. That is tremendous and healthy. Any cosmetic improvement is icing on the cake. The vertical scar tummy tuck, or in your case the inverted-T scar, can tighten the torsp from side to side. However, if you are not more aggressive in pulling the skin down surgically, it will result in the pleating or laxity you describe. This is because the vertical scar only allows excision of skin from side-to-side and reduces the horizonal dimension of the skin. In the vertical direction, it may actually lengthen the resulting skin dimensions since the vertical scar is like the hypotenuse of a triangle that is derived from the two other sides of the triangle. It is merely a geometrical situation and has nothing to do with the way the procedure was performed, only possibly the choice of procedure or the way it might have been described to you.

Richard P. Rand, MD, FACS (retired) · Answer

The weight gain and loss of 182 pounds has destroyed your skin elasticity and no matter how tight your doctor tried to make you there will always be laxity. The tighter they try to make you, the more complications and the worse the scar. So there is a balance here and your expectations can't reasonably be for anything other than what you look like standing straight up. Bending over, all bets are off!

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