Based on these photos, what is your recommendation for my revision? (Photo)

It looks like you had a mini tummy tuck rather than a full tummy tuck. Mini tummy tucks are often dissappointing but it could be converted to a full tummy tuck which would remove much more skin. However the scar would also be longer

Dear JJ103351,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Based on your photos and the way you are pinching your skin, you have excess of length and more importantly excess of width on your abdominal area.
So you need to re do the Tummy tuck to remove the excess of length and a Fleur de Lis to remove the excess of width.
Be encouraged!!
Dr. Cárdenas

Thank you for your question and photos. It seems like you underwent massive weight loss prior to surgery. Based on these photos, and the skin laxity you have, you would've benefited from a a lower body lift with the abdominoplasty. A revision is referred to a limited surgical procedure. You need a re-do abdominoplasty, lowering your high scar placement, liposuction 360 degrees and a lower body/buttock lift. This will give you the tight desired results. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

You obviously have loose skin and diminished skin tone; lack of tissue elesticity may be one of the reasons for your current situation. No doubt that there is some discrepancy in fat tissue bulk between two sides. It is a question whether revision of current TT with more skin removal bellow BB will be sufficient, or you will need vertical skin excision due to horizontal laxity. Liposuction should be part of procedure. Only on the basis of in person evaluation, a board certified plastic surgeon would be able to give you more detailed plan of treatment. Hope this helps.

You have a lot of vertical excess of skin which is not removed with just a lower incision. You will need the vertical mid abdominal incision, the posterior back lift, or both. Your photos do not show hypertrophic scarring, but that still could be an issue. Dog ears can be trimmed in the office, or easily removed with the posterior back lift.

From the posted photos it appears you will have improvement from a revision to the tummy tuck. An in person evaluation is needed to determine if a standard tummy tuck would be sufficient or if a fleur de lis approach is needed to address excess skin along the midline. Visit with a board certified plastic surgeon near you for a consultation. I've included a video I hope you find helpful.

To make an assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If you don’t have before and after pictures, then contact your surgeon and ask them to forward the pictures they took. Weight loss patients typically have diffuse skin laxity of their torso in both horizontal and vertical directions. The skin laxity is not focused on just the front of the abdomen And the more extensive tummy tuck is needed in order to deal with the diffuse skin laxity on your body from your successful weight loss. It would be helpful to know how many pounds weight fluctuations you’ve had at your maximum.
To get more diffused skin tightening, you’ll need a wraparound tummy tuck, and may need to consider a fleur-de-lis pattern as well. This will add longer scars, which will most likely heal with the same hypertrophic nature. You do not have evidence of excess subcutaneous fat and Liposuction is not indicated. Weight loss patients need more skin surgery, and if there is any doubt, the procedure should be made more extensive rather than less. Weight loss patients don’t need liposuction they need extensive skin surgery.
A tummy tuck, whether extended or regular will only tighten skin in a vertical direction. Patients will still be left with horizontal skin laxity, unless they had a vertical component with the fleur-de-lis incision.
The fleur-de-lis pattern leaves a highly visible scar and isn’t for everyone. You have to balance, the desire to have tight skin versus highly visible scars.
I recommend all patients have multiple in person consultations before scheduling, permanent, irreversible body contouring procedures. There’s no recommended correct number of consultations, but I suggest patient start by having at least five in person consultations before scheduling surgery. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of patients with similar body characteristics. Male tummy tucks are not as common as tummy tucks based on previous pregnancies, but a sufficiently experienced surgeon should have pictures of skin only male tummy tucks from successful weight loss patients. Look carefully at results, especially making note of the extent of surgery.
Without knowing the conversation you had with your provider, it’s hard to be critical of the outcome. It’s also important to show before and after pictures when judging outcomes from cosmetic surgery procedures.
Considering you will most likely need a more extensive procedure a second surgery may, in fact, be more involved in the primary procedure rather than a revision.
In the end, choosing the correct procedure is a balancing act between patient candidacy, provider skill and experience, and balancing what you’re trying to achieve with what you’re willing to go through.
Best,
Mats Hagstrom, MD