No Muscle Tightening After Tummy Tuck?

Many surgeons refer to "tightening of the muscles". This is in fact never done during a tummy tuck. Rather, the fascia, the tough lining of the muscles, is tightened.
Almost always during a full tummy tuck, the fascia is tightened, unless there is a specific reason not to (i.e. a massive weight loss patient who intends to have children shortly but needed the apron off).
Many patients are under the misconception that if the deep layer (fascia) is teightened, the stomach will be flat. This is not true. It will certainly be flatter, but it may not be flat. The reasons for this are many. If there is a lot of fat inside the abdomen, where the surgery does not reach, this fat is never removed. Only weight loss will remove this "intraabdominal fat". Patients should be especially motivated to reduce this intraabdominal fat: not only does it look bad, but it predisposes to diabetes and heart disease.
Some patients have very lax (loose) fascia that simply cannot be tightened completely. Often, intraabdominal fat presses outward, but sometimes the fascia is just lax. Not everybody is made the same. It is sometimes possible to perform a more aggressive tightening with the used of a mesh, or even resection of the fascia and closure. These procedures are more involved and carry higher risk. They are usually reserved for patients with massive weight loss.
It is the job of the surgeon to make the fascia as tight as it is safely possible. It is the job of the patient to keep their fitness and abdominal muscles strong and tight as well. This can be accomplished by daily crunches and dietary restraint, not easy but very rewarding. A motivated patient can make a good tummy tuck result into a great result. It is the very rare patients who looks great but expends no effort to get there.
If the fascia was for some reason not tightened during surgery (the doctor's oprative note will indicate whether this was done of not), and the abdomen is still bulging, it is possible to redo the tummy tuck and tighten the deep fascia.

Dear asbestos,

I'm sorry to hear that you're not fully satisfied with the results of your tummy tuck. It's important to have open communication with your surgeon, especially if you have concerns about the outcome of your surgery, such as the absence of muscle tightening which is typically a key component of a tummy tuck to achieve an aesthetic result.

If you suspect that muscle repair was not performed during your tummy tuck, the best course of action is to directly ask your surgeon. A detailed discussion can provide clarity on the surgical techniques used and whether muscle repair was included in your procedure. Tummy tucks usually involve muscle tightening to refine the abdominal contour and address issues like diastasis recti, which contributes significantly to achieving a flat and toned abdomen.

Your concerns about the cosmetic aspects, such as bulging flanks and the appearance of your navel, are valid and should be addressed. It might be helpful to include pictures when seeking advice from other surgeons for more tailored recommendations.

If after speaking with your original surgeon you still have concerns, or if a revision is suggested but you're seeking a second opinion, consulting with a different board-certified plastic surgeon could provide additional insights and options.

I understand this might be a challenging time for you, but seeking a follow-up and exploring the possibility of a revision could be steps towards achieving the results you desire. Remember, your satisfaction and well-being are paramount.

I wish you the best in your follow-up and any potential revision process.

Sincerely,

Dr. Katzen

In most cases, the abdominal muscles are tightened when
patients undergo abdominoplasty surgery.This doesn’t mean that the abdomen will be totally flat.Unfortunately, when patients have weak
muscles, they tend to relax over the course of time.This often results in the abdomen not being
totally flat.For this reason, results
are always best when this procedure is combined with an exercise regimen.In
addition, a persistent abdominal bulge or fullness may be related to other
factors.In some cases patients may have
residual subcutaneous fat or persistent intra-abdominal fat.In some
cases, a conscious decision is made not to tighten the abdominal muscles. This
decision is made when patients anticipate future pregnancies or the surgeon
feels that tightening the muscles may lead to respiratory insufficiency. In your
case, it’s virtually impossible to make a recommendation without an operative
report, pictures and a physical exam.For these reasons, it’s appropriate to discuss your situation with your
plastic surgeon. Your surgeon should be able to clarify your situation.

I'm sorry to hear that you're unhappy with your results. It's important that you discuss your results with your surgeon at this point and find out if your surgery performed muscle repair or not, since it’s not always a part of a tummy tuck. You should also be following a healthy exercise and diet regimen to enhance your results. Try concentrating on strengthening your core with planks, crunches and other similar exercises. 

Please ask your surgeon about what they did exactly during your surgery. It is possible that no muscle plication was performed, however it may also be something else.

It is difficult to assess your description without the use of a photograph. However, it sounds as if you have significant intra-abdominal fatty deposits as well as circumferential laxity that would better be treated with belt lipectomy. A muscle repair would do little to effect your flanks whether or not it was performed.