I still have excess skin and fat after my tummy tuck. Can more be done? (Photo)

Hello Tanay11,

Thank you for your question regarding excess skin and fat after a tummy tuck.

Thank you for your history and your pictures. By examining your pictures, your abdomen appears relatively flat in the standing position. When you are sitting, there is some laxity of the lower abdominal skin. There has to be some laxity of the skin to allow you to stand up straight. If all the lower abdominal skin were removed in the sitting position, you would never be able to stand up straight. Therefore, even with the most extreme and tightest tummy tuck, there is some residual abdominal skin when you sit down.

The only thing I see on your profile view is a slight distention of the abdominal wall below the belly button. Was your six-pack muscle sutured with permanent sutures from your xiphoid to the pubic region? If the muscle was not plicated, this would be the only correction I would suggest. You could also consider some liposuction over the superior iliac crests or the love handles, which would give you more of an hourglass shape. However, honestly, I don’t think you have much fat in that region.

Another alternative is to sculpt out your abdominal muscles with VASER liposuction. This would give you a different and more athletic look, although it may not necessarily be the look you are seeking. Overall, I think you have excellent results. Follow up with your plastic surgeon and discuss your concerns with her.

Good luck. I hope I’ve answered your question regarding potential revisions after a tummy tuck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Liposuction can help with the "roll" effect regarding the lower tummy skin. Your skin elasticity looks adequate; however, it may be that some more skin resection in the form of a mini tuck can help maximize your result; something to consider. Thank you.

Dear Tanay11,
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

You have a very nice result. From the photographs, it seems the skin tightness of your lower abdomen is just right. We all have loose skin in the lower abdomen when we bend over or sit down or we would not be able to stand up straight!

Actually, if you are still at the same weight as prior to surgery, you have gained weight. I would suggest doing liposuction to remove excess fat.

An in person evaluation is best but it does appear a revision would be helpful. Liposuction can be used to help define your curves. Weight loss would also add to your results to address visceral fat (the fat behind the muscle wall).

It appears that you have excess fat and this can be treated with either weight loss or liposuction. It would help top see your preoperative photos.

Sorry to see the problem you are having. It doesn't look like you need more skin removed. My question is did your surgeon tighten your muscles? Or, did they tighten them enough? When you're standing up straight, your skin looks very tight, but your abdomen still appears round from the side view. So, my guess is that your need your muscles below your belly button tightened more.

This response was dictated.
I apologize in advance for the grammatical errors.
To make a quality assessment regarding the outcome of any plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
After pictures should be taken the same way before pictures are taken.
We do not judge tummy tuck results or make assessments of patients in the sitting position.
All people will have skin redundancy with the hips flexed.
If you had tight skin in position you wouldn’t be able to stand up straight.
There are four tissue variables that determine what someone’s abdomen looks like.
This is true whether someone has had surgery or not.
The four variables that determine what the abdomen looks like are the following.
1) abdominal skin laxity typically due to previous pregnancies and or weight loss.
2) Excess subcutaneous fat.
3) muscle separation from previous pregnancy.
4) Visceral or intra-abdominal fat.
Saxity is probably not contributing in a major way to the appearance of your abdomen. Paragraph perhaps more skin could’ve been removed and perhaps the skin removal could’ve been extended a little further on the sides.
Previous pregnancies do not change distribution and you don’t look like obese person, so I don’t think subcutaneous fat is contributing significantly.
The appears to be slight bulging of your abdominal wall.
This could represent insufficient muscle tightening or excess visceral fat.
Differentiating between muscle, separation and excess visceral fat may be a little challenging to some people.
Plastic surgeons should have no difficulty assessing both visceral, fat and muscle separation both during a preoperative consultation, and during postoperative visits.
A straight abdominal wall should create a B line between the sternum and the pubic bone.
If the abdominal muscle wall forward to this fictitious line then the abdominal wall is bulging.
The pair of access visceral, fat and muscle separation is fairly similar.
There are a few ways you can differentiate if visceral, fat or lack of muscle tightening is causing the abdomen to bulge.
Generally muscle tightening is sufficient, is rarely the underlying problem unless someone has not had surgical correction.
Failure of muscle tightening after a tummy tuck is highly unusual.
to differentiate between persistent muscle, separation and excess visceral fat, dry laying on your back.
The abdomen easily sink in to a concave appearance that excess visceral fat may not be an issue.
Another way to determine the difference is the press the abdomen flat until your muscle wall lines up with your pubic bone and sternum with your non-dominant hand.
If this requires a significant amount of pressure to press your abdomen flat then visceral fat may be a contributing factor.
If pressing your abdomen, flat creates a full sensation leaving you feeling like you can’t take a deep breath, then visceral fat again, and may be a contributing factor.
each individual person candidate for the procedure should be determined before surgery during in person, consultations
A full tummy, tack, primarily treats, abdominal skin, laxity, and muscle separation.
Individuals who have excess visceral fat should be told that this will compromise the result to some degree and without further weight loss patient may not get a flat abdomen.
I don’t know if you have excess visceral fat or how well your muscle tightening was done.
I would have a better ability to make an assessment if I could see proper before and after pictures.
I generally judge tummy tuck results based on variables.
The first is the surgeon ability to create, consistent, natural looking bellybuttons.
This is one of the harder parts of the procedure and surgeons do this well consistently tend to be detail, oriented, and all other aspects of the procedure inequality manner as well.
The second variable is the design of the incision.
the incision should be said low following an atomic contours, naturally and evenly on both sides, leaving the torso, looking ballast, attractive, and proportionate from all directions and ankles, including from behind.
To get a better understanding of what I consider quality incision designs consider looking at the before and after pictures of Eleonore Zetrenne, M.D.
Her incision designs are in my opinion ideal, and was most likely inspired by the master Mark Kobayashi, MD.
Having safe interest in your provider is a very important component.
In the end, the two single most important variables that determine outcomes and typically are most correlated with consistent high. Patient satisfaction is patient understanding the candidacy for the procedure and the selection of providers.
Being board-certified in plastic surgery with years of experience, and overall good reputation does not mean somebody has mastered any single procedure.
There will always be significant differences among plastic surgeons, and some simply have better skills than others try to
Likewise, not everybody seeking tummy tuck. Surgery is an ideal candidate.
The patient is an excellent candidate for tummy tuck. Surgery has the potential of having an excellent outcome in the hands of the right provider.
They also have the potential of having pour outcomes in the hands of providers, lack skill, and experience.
An individual who is not a good candidate, does not have the potential for quality outcomes, regardless of food as the procedure.
The great majority of patience are neither perfect candidates, nor non-candidates, but fall somewhere in the middle of a spectrum.
I suggest you follow up with your provider at this. Discuss your concerns with him or her.
It should not be all that difficult to SS exactly why the results look the way they do.
The problem can always be reduced to wonder more of the four above tissue variables that determine what the abdomen looks like.
If you want the proper second opinion consultation, then schedule those as in person consultations with other providers in your community.
For second opinion consultations, come prepared to bring it with you the complete set of proper before and after pictures and preferably a copy of your previous offer never born.
These should all be available from your current providers office if you request them.
Best,
Matt Ayrom, MD.