I'm Not Happy Wth my TT/MR/lipo Results. What Are Realistic Expecation at This Point? Im Not Happy! (photo)

I'm 5 months PO and went to see my PS as I'm concerned about my results..still able to grab fat and still have love handles. My doctor informed me he should have gone back further with incision. Doesn't think I need any more lipo but rather needs to extend incision to fix. However, now after I paid $8,400 for TT/MR/ and lipo of sides and into back...hips and thighs....NOW he wants to charge me another $5.400 to go back into surgery to extend the incision. (I'm 5'3 120-125 pounds)

Doctor Answers 8

Revision likely needed to address your concerns.

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Review of your pictures indicates that you have an excellent clinical result from your abdominoplasty procedure. Although you continue to have excess flank skin, this is normal after this procedure.
It’s not unusual for patients who have redundant abdominal tissue to have a roll that extends posteriorly around the back.Unfortunately, this roll isn’t addressed with abdominoplasty and a transition zone always exists.This roll can be addressed by performing a circumferential procedure at the time of abdominoplasty or a flank panniculectomy at a later date.
Since a secondary procedure is a separate procedure that involves a different anatomic area it’s not unusual for surgeons to charge an additional fee.
If you’re considering revisional surgery it’s important to thoroughly discuss these issues with your plastic surgeon.It’s important to have realistic expectations.Your surgeon should hopefully be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

I'm Not Happy Wth my TT/MR/lipo Results

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I agree with the previous posts.  Your surgeon did a very good job!  If you are looking for more tightening at the hip/flank area where you are pinching, then you would need additional skin excision, and this is a separate procedure from an abdominoplasty.  You should have a frank discussion with your plastic surgeon as to what your expectations are so that you can be informed about realistic expectations going forward.  You have high expectations, and they may not be met with additional surgery.  Good luck!

Tummy tuck results

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Dear Minnesota,

From the photos that you provide, it appears that you have a very nice result.  The tummy tuck does NOT involve removing loose skin from the flank area.  That procedure would require extension of your scar around to your back.  The pinching that you show is mostly skin and the seated photo that you show is no more overhang than anyone with more than 10% body fat would have.  You still have a few more months of healing to get through.  I would recommend reviewing your pre surgery photos in that time and perhaps you will see the extent of improvement that you have attained. 

I'm Not Happy Wth my TT/MR/lipo Results. What Are Realistic Expecation at This Point? Im Not Happy! (photo

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     The result is good and the extension of the incision is the right next move.  This side tuck will fix skin laxity on the sides, while a tummy tuck will fix laxity on the tummy.  I would not get too upset with your surgeon as the result is nice even if it has not met your expectations.  The fee may be a little high, but if you went with someone else you may not get the same quality and you may have to pay more.  See if your surgeon has some flexibility on this fee.  Kenneth Hughes, MD Los Angeles, CA

With tummy tuck, maximum tightness is at center of abdomen

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The design of the tummy tuck incision is such that the most skin is resected at the middle. The skin edges are then tapered as one goes to the sides. Tightness decreases as one moves away from the center. So in the love handle area very little skin is excised, just enough to create a smooth line incision. See the weblink below for a diagram of the excision pattern

If you want skin tightness on the sides that is indeed another procedure, more like a belt lipectomy, because when you excise a lot of skin on the side, the tapering of the scar extends all the way to the back.

Finally, I see your picture sitting to show skin excess. The distance from breast bone to pubic bone shrinks by 30% when you sit down, so it is normal for skin to fold over when you sit down, especially on the sides where little skin was removed.

Unhappy in Minnesota

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Dear TTmommyMN,  Judging purely by your pictures I think you've got a very nice result. I think your expectations may have been a little too high. You have numerous stretch marks visible in the area you are pinching. Whether that is because you have excess skin below or above is hard to determine. Bottom line, extending the incision is what you'll need. That scar won't be too pretty. And when one extends the scar that far back it often is under considerable tension because it is fighting against the tight closure up front. In my experience when you do that you get a mediocre result in the front and the back. Or, one or both scars are under so much tension they result in very poor scarring. BTW, You got a lot of surgery the first time for $8,400. Remember the enemy of good is better. Good luck.

Not Happy after Tummy Tuck Surgery?

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It seems, based on your pictures, that you have achieved a nice result with tummy tuck surgery;  because you have concerns about “love handles”, it may be that you should have undergone an extended tummy tuck initially. In other words, there may have been a failure of communication when it comes to discussing goals and expected outcomes where a standard tummy tuck procedure.

 Generally speaking, treatment of the stubborn "muffin top" involves excision (lipectomy) of excess skin and adipose tissue. Liposuction  surgery alone  will potentially leave you with loose skin and an  unsatisfactory result.
Although not relevant in your case, patients who are undergoing a standard tummy tuck procedure  should be aware however that often an “extended” tummy tuck is necessary to treat the muffin top area.

This extended tummy tuck procedure involves flank and back skin and adipose tissue excision as well as liposuction surgery. If liposuction alone is done the patient may still end up with the muffin top and require further surgery to improve the waistline in the future.

 At this point,  given your concerns ( and assuming you will accept a longer scar in exchange for improved contour), your best option may be extension of the tummy tuck to the flank and back areas.  Additional expenses associated with this procedure are reasonable.

 Best wishes.

Breast Enlargement, Board Certified, Fat Transfer Breast, Nipntuck Breast Enlargement, Silicone Gel implants, Saline Implants

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Sorry to hear of your disappointment.  I would not expect any further improvement in the result however, your scar will continue to lighten during the next six months.  Further excision of skin extending the scars onto your flanks is the only way to resolve some of your concerns.  Much like doing a lateral thigh lift or belt lift.  I see you have a scar which is a bit higher than the W shaped scar offered in some offices.  I wonder if complete revision of the scar is in order. This would lower the scar so that it might be easier to cover with a two piece bathing suit.  Sadly, all revision surgery cost money.  You might seek out some other opinions with regard to revision surgery.  I wish you the best.

Ralph W. Bashioum, MD
Minneapolis Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.