Indented scar plus swelling - could this flatten or will I need a revision? (Photos)

Question

I’m at the 6 month mark post tummy tuck surgery. I had lost 37kg so had excess skin removed and muscle repair. My surgeon who did my gastric sleeve did my tummy tuck. I had a bleed after surgery causing a heamatoma that covered my stomach from memory 27cm x 16cm x 4cm. (I had that drained the first time was 4 weeks after surgery and they got a litre out, the second time was about another 4 weeks later and they said there was 600ml that could be removed but the doctor on only got a tiny 30ml out. I ended up with MRSA after an allergic reaction to the dressing caused a large blister across my incision too so this did not help. I’ve tried everything from multiple endomologie sessions, dry body brushing, binder, no binder etc but I’m at a loss as to what to do next. I just wanted other surgeons opinions on whether or not you think the will possibly turn out to be a flat stomach or am I dreaming and will need a revision? The last scan approx one month ago showed the heamatoma / seroma had shrunk and was approx 16x11x1cm.

Camille Cash, MD · Answer

At six months post op you are not yet at your final results, but the changes from here will be more minor versus significant.  In order to improve your results you may need to consider a revision.  I encourage you to have the procedure performed by a board certified plastic surgeon to optimize your results.

Karl William Schwarz, MD · Answer

I think you will most certainly need a revision. It is best to wait for at least 12 months given your infection and hematoma.

The indentation happens when the edges of the upper flap and the lower flap are not well aligned when the abdomen is closed and you end up with a divot. This can be corrected, but I think your best bet is to wait for at least 12 months and then I would start off with circumferential liposuction to remove all of the fat and then give it another 6 months at least, 12 months better, to evaluate the skin to see if there is any skin that needs to be removed. I would guess that the divot gets better with the lipo but in case there is some more work needed than a revision at this point would be done.

I would suggest waiting for at least 12 months after your surgery and then I would see a plastic surgeon. It sounds like you had your tummy tuck with a general surgeon. I would suggest seeing a plastic surgeon. A tummy tuck is pretty easy to perform, but it is hard to do it well. The devil is in the details so I think you would be best off with a board certified plastic surgeon who is experienced in performing tummy tucks.

Mats Hagstrom, MD (license on probation) · Answer

You should tell your gastric bypass surgeon to stop playing plastic surgery.
If you want to be a plastic surgeon, you should go to plastic surgery school.
Your tummy tuck was poorly designed and poorly executed.
You should’ve had this done by a skilled board certified plastic surgeon.
I’m assuming your provider was not certified in plastic surgery because it would be rare for a plastic surgeon to be doing gastric sleeve surgery. 
Your incision was placed too high and it’s going to be difficult to correct. 
You also had insufficient skin excision, leaving you with significant “dog ears”. 
All of that said it is possible to improve your outcome, but the best shot of getting a good tummy tuck result is to do it right the first time.
Revisions for this procedure tend to only give slight improvements.
Some parts are easier to improve on than others.
Lowering the incision will require redoing most of the procedure and creating a second scar from the new belly button position.
Excising, the skin laxity that still remains on the side and backside is fairly easy and straightforward and will improve your outcome quite a bit.
 The next step should be to find the best provider for your needs.
Finding the right plastic surgeon is not at all easy or straightforward.
Please start by making sure they’re at least certified in plastic surgery and have a lot of experience with weight loss tummy tuck surgery.
Your procedure most likely needs to be extended to a circumferential a.k.a wrap around tummy tuck, a.k.a. body lift. 
To do that the patient needs to be turned during surgery.
Not wanting to turn the patient during surgery is one of the main reasons surgeons don’t remove enough skin along the sides and back leaving big “dog ears”
At this point, I suggest you do the following.
First get a copy of your medical record from your current provider.
This should include any photographs taken and a copy of your operative report at a minimum.
It would also be helpful if it included your consultation note.
You can obtain the copies of your medical record by simply requesting them from their office.
They have a legal obligation to forward your medical records, though they can charge you for copying and mailing fees.
Usually less than $20.
Next make a list of plastic surgeons in your community that seem to have a lot of experience with quality tummy, tuck and body lift surgery.
After that schedule in person to consultations with each of the providers on your list.
There’s no correct number of consultations needed to find the right provider.
The more consultations you schedule the better of a patient you’ll be when it comes to vetting providers and finding the best providers for your needs.
Bring all your before and after pictures and copy of your operative report to the new provider.
Having pictures of yourself is really helpful to use as a reference during the consultation.
During each consultation, ask each provider to open up their portfolio and show you the extent of results they have of previous patient who had similar body characteristics.
They may not have people who look exactly like you do now, but they’ll most likely have operated on people who looked like you before your tummy tuck. 
As sufficiently experienced surgeon should have more before, and after pictures than you have time to look at during the consultation.
In other words, there should not be a limitation of only one or two or three cases.
Experience surgeons have lots and lots of pictures that they should be willing to show patients.
 Seeing the best outcomes of their career isn’t really helpful when it comes to understanding what average results look like create.
Average providers deliver average work.
Only exceptional providers deliver exceptional outcomes.
If you’re gonna go through this procedure twice, then make sure it’s done by someone who is really talented and has sufficient experience.
It might be helpful to have a really good idea of what the outcomes should look like when the procedure is done well.
Have a reference point of what you would like to look like when it’s all done.
It shouldn’t be that hard to find it before and after pictures of people who look like you before the procedure and had a really great looking outcomes. 
Continuing schedule consultations until you feel comfortable, you found the best provider for your needs.
Finding the right plastic surgeon can be time intensive and potentially cost money.
Spending the time to interview multiple providers is a good investment in yourself.
Had you done so in the first place you wouldn’t be here looking for a second procedure.
Please, please please learn how to vent plastic surgeons, thoroughly, and accurately during in person consultations.
I know it’s not easy and most people don’t have much experience.
The more consultations you have the better you’ll be at the process.
 I hope I wasn’t too pessimistic.
Hopefully, you gained something useful from this.
I’m sorry you find yourself in this situation.
I wish you all the very best.
Mats Hagstrom MD

Indented scar plus swelling - could this flatten or will I need a revision? (Photos)

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Indented scar plus swelling - could this flatten or will I need a revision? (Photos)

Answers (3)

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Recommended reading

Everything you need to know about Tummy Tuck Revision

Our mission is to create a world where every investment in modern beauty is Worth It.