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.

Thank you for sharing your question. Most likely this is a bit of skin and fat discrepancy between the upper abdominal skin and the lower pelvis. If this does not improve with time, light liposuction may be able to improve upon your results.

Dear lizzy9407,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

A physical exam would be necessary to properly answer your question. The differential diagnosis includes: superficial (subcutaneous) fat, visceral fat, incomplete muscle tightening, bloating...etc.
Dr. Taranow

Your picture shows a beautiful curve. But some don't like that feminine shape.

That area is usually not liposuctioned at the time of abdominoplasty because of blood flow concerns. That could certainly be done now that you are healed and will remove that small amount of fat.

I treat many of these exact issues post TT. First you must obtain a sub cutaneous scan to rule ut seroma vs excess fat. If fat then liposuction will solve this issue. If laxity in lower recti muscle then plication should improve.

Hi and welcome to our forum!
Height and weight information would be helpful although you appear quite slim.
One cannot make an accurate diagnosis from a single photograph.
From the photo, I note a fullness of the lower abdomen which suggests the presence of an infraumbilical fat repository or may be evidence of disruption of the rectus muscle repair. A physical examination will usually differentiate between the two entities.
A fat repository can be liposuctioned, while suture line disruption requires a secondary revision.
Revisit your plastic surgeon.
Best wishes...