Why is my lower abdomen not flat 4 months post op full tummy tuck with muscle repair? (photo)

I appreciate your concerns and i'm sorry this has brought you some anxiety. I suggest you wait for any revision until 1 year. At this point, most patients have not fully recovered in the lymphatics and so the fluid/swelling becomes trapped in this layer. On my patients, I suggest Arnica lymphatic massaging, bromalein, and tight compression. When a doctor retires, usually some other physician takes over the practice or charts and this person may be available for a second opinion!Best wishes, Dr. ALDO

Hello. Great question. Thank you for your images, However, a personal examination is needed to determine if your bulge is swelling, fat or seroma.

Dear proudmommyoffour,
I understand your concern and it is quite normal to be concerned about the outcome following a tummy tuck surgery. However, you are still in the very early stages of the healing process.Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.At the early stage of the healing process, the tissues are still swollen. Once the swelling subsides  you will be able to see the final result of your surgery.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Your surgeon likely had another colleague take over his patients before retiring. I encourage you to schedule a visit with her/him for an evaluation. Swelling can occur with too much activity sometimes. It could be seroma formation. It also could be something different. An exam should help provide potential solutions.

Hello dear!!
Thanks for the question and provided information as well.
You are still early on the healing process, it can take up to six months to see your final results, so please be patient. At the stage you are in, inflammation is normal.
If you have any concerns, please follow up close with your plastic surgeon.
Good luck :)

 Although your concerns are understandable, what you describe is commonly encountered after this procedure. Patients will like their “flatness” immediately after surgery; then, these same patients are disappointed for a period of time once swelling of the tissues occurs. In the longer term (this may take several months and even up to one year), the swelling dissipates and the skin of the abdominal wall "redrapes"  over the smaller underlying  musculoskeletal framework (where the abdominal wall muscles have been brought together again in the midline).Generally speaking, abdominal wall "swelling" after tummy tuck may be related to:
1. Swelling in the soft tissues. This may take several months to resolve and may worsen with increased activity or at the end of the day. Patience is required to allow for resolution of the swelling. On one side to hear about your concerns after bus stop when patients are2. Fluid accumulation in the space between the skin and the abdominal wall muscle. this may consist of blood ( hematoma) or serum (seroma). This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound may be helpful). Treatment consists of aspiration; several episodes of aspiration may be necessary. 
3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance.  One of the steps of a tummy tuck procedure involves reapproximation (plication) of the rectus muscles. These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.
  
4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year (or greater) a complete skin redraping to occur.
  Best wishes. 

Hi and welcome to our forum!
A photograph doesn't convey what examination can reveal. The nature of your problem is uncertain without examination. A large fluid wave may actually "slosh". Swelling may also appear as fullness which may take 6-12 months to subside. 
When a physician retires, active patients are usually transferred to another physician in the area. Does his / her telephone message give you any information? Is the number disconnected? Have any other plastic surgeons in the area agreed to see you under these circumstances? Have you contacted your local hospital to see if any doctors have taken over your physician's practice?
If all else fails and you have no other recourse available, you can present to your family physician or to your nearest emergency department to be sure that you do not have a seroma.
Best wishes...