Advice for revision TT? Still have hernia, epigastric bulge & inadequate tissue removal (Photos)

Question

full tummy tuck over 6 months ago with muscle repair and new belly button. Have an epi-gastric bulge which is often painful with loose skin still above. Hernia was not fixed. Looking for full tummy tuck would be happy with new belly button. Not looking to mention original surgeon nor to return to same person.

Daniel Barrett, MD · Answer

Dear lelanna,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

An in person evaluation is always best to determine specific recommendations.  It does appear from the photos that you may have some improvement with liposuction.  The upper abdominal contour could either be subcutaneous fat, which can be suctioned, or visceral fat which cannot.  I encourage you to visit a few board certified plastic surgeons in your area to discuss your concerns and learn more about your options.

Douglas Taranow, DO, FACOS · Answer

Pre-operative photos would answer many of the questions I now have.
You have a nice shape, but still have some fat and skin...which is not always unusual after a lipo TT 9Abdominoplasty).  During an abdominoplasty, the skin is pulled slightly from the sides inward (at the bottom of the belly, not top) and downward.  It does not address the loose skin over the upper abdomen pinching the skin sideways.  Likewise, I do NOT liposuction the abdominal flap at the same time as the TT to protect the blood supply.  The upper epigastric curve may be fat, or lack of muscle plication (unable to diagnose this without an examination).  
The umbilical hernia would need to be examined to see what's going on.
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

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 ask your surgeon to forward the pictures they took. Without knowing what you look like before the procedure, we can’t make an assessment on the outcome of the surgery. Understanding the procedure in the first place is key to understanding why the results look the way they do. From the pictures you’ve shown your result is fairly typical. Bulging of the upper abdomen typically happens for two reasons. 
Individuals who are barrel chested can’t I have Tommy top results with fullness in the upper abdomen compared to the lower abdomen. Another way to make this assessment is to compare the relationship between the sternum and the pubic bone. If the sternum sits significantly forward to the pubic bone then muscle tightening creates a backwards and slanted abdominal wall with more projection of the upper abdomen than the lower abdomen. Generally speaking the more aggressive, the muscle tightening is done the more of this in inverse abdominal wall angle is created. The second reason patients have bulging of the upper abdomen is in individuals who have excess visceral fat. This can often be determined preoperatively during consultations. Individuals who have excess visceral fat need to lose weight or they will have bulging despite muscle tightening. This often shows more in the upper abdomen than the lower abdomen. Visceral, fat, and body contour relationships can contribute to results, which are generally fairly predictable based on accurate assessments during in person, preoperative consultations. 
Tummy tech is a fairly permanent and irreversible procedure. The amount of improvements possible with revision surgery may be limited and choosing to redo the entire procedure should be addressed with a certain degree of conservativeness.
Best,
Mats Hagstrom, MD

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