Still have a pooch after a tummy tuck. Any suggestions? (Photo)

Well, what it's not is intra-abdominal fat. A lactose free diet would be worthless unless you are truly lactose intolerant, i.e. substantial gas and diarrhea within hours after eating dairy. What it could be is persistent swelling (I give it one year for tummy tuck patients), persistent fat, both fat and swelling, or incomplete abdominal wall repair.

Thank you for your question regarding what to do with your tummy after a prior tummy tuck. From your history in your pictures, it appears that you have residual skin of your lower abdominal wall. If it were just this, it could be removed with liposuction. However, in the top picture I see excess residual skin. The only way to really remove skin from the anterior-abdominal wall is with surgical revision. I would suggest going through your prior tummy tuck scar and pulling the skin more tightly. In my opinion, this procedure can probably be done under local anesthesia in the office. Please consult with your plastic surgeon. Although it’s always a good idea to watch what you eat, diet and exercise, I would suggest more of a ketogenic diet to further reduce your weight. However, further weight loss I believe will make this problem worse not better because this is a skin problem not a visceral fat or fat under the skin problem. I hope this answer helps.

If you have any more questions regarding a tummy tuck, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy please contact my office. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Make sure they have performed at least 100 tummy tuck or circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, tummy tuck or lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

It's difficult to tell what is causing the contour that concerns you without an exam. If it is subcutaneous fat it could be addressed by liposuction. Some other potential causes are swelling persisting from surgery, visceral fat, or failure of the muscle wall repair.