5'4" and 165 lbs. 3 weeks ago I had a full tummy tuck with the additional vertical incision. I don't think my doctor removed enough excess skin vertically because their is still quite a bit. My rolls go vertically now instead of horizontally. The skin above my new belly button is still pizza doughish. Ugghhh! Is this due to swelling? If not, how do I go about telling my plastic surgeon that I am not happy? Is it typical to have to pay for a revision? I am already into for 25,000? (w/lift & aug.)
Revision After Vertical Tummy Tuck?
Doctor Answers 9
Revision after Fleur-de-lis tummy tuck.
Your first photo shows a healing vertical scar and a barely-visible horizontal scar peeking out from your underwear. I presume the other photo is your pre-op appearance--congratulations on your weight loss!
Since you have already had breast lift and augmentation surgery by this same surgeon, I also presume you had a satisfactory result from that procedure, or you would have gone elsewhere for this second operation.
All that being said, you appear to be healing without complication from this operation, and at 3 weeks post-op are concerned about your result.
Very few doctors will openly criticize the work of someone else (after all, that could be our patient seeing a colleague or competitor, and not one of us is perfect or always obtains wonderful results). So, it is with the utmost humility and hesitancy that I must agree with you--this is really substandard work by any ABPS-certified plastic surgeon. You have excess skin in both vertical and horizontal dimensions; the whole tummy tuck was inadequate. If this was done by a "bogus-boarded" "cosmetic surgeon" then this is not surprising.
But, any fully-trained and ABPS-certified plastic surgeon who considers this an "OK" job should review the before and afters of a few colleagues, and offer you a no-charge re-do. Normally, the patient would be responsible for operating room and anesthesia charges for revisional surgery, but this really is a stinker of a result, and any self-respecting surgeon should want to do a better job for you. If I were giving out grades, this would get a D minus, only avoiding an F because you did not have any complications! (BTW, in my office this would also have cost you several thousand less; click on the link below for examples of my work.)
Please let us know what the training and credentials were of the surgeon who did this work; other patients should know why we continually "harp" about appropriate training, ABPS certification, and experience. This is why! Good luck and best wishes!
Tummy Tuck Revision
This is a difficult question to answer without more pre and post op photo views from other angles. Also, knowing the pre-operative discussion with your plastic surgeon would be very important here as well. For example, did you talk about reasonable expectations, safety, length of procedure, or any susequent procedures that may need to be done afterwards (sometimes 6-9 months after the original procedure).
In short, your results are less than optimal but you obviously have a good relationship with the surgeon who performed your procedure(s), ie. you have had multiple procedures performed by this surgeon. I think it is reasonable to wait longer to see how things ultimately turn out, however, I also think you should initiate the discussion about "what if this doesn't improve?" This way, you have time to talk with your surgeon now and formulate a plan (and price) of what to do if you are still unhappy later.
Good luck, Erez Sternberg, MD.
Revision after your Tummy Tuck
What you had is a "fleur de lis" abdominoplasty. While you are very early after your surgey, I am fairly certain that your loose skin will only get worse. As the swelling goes down, the skin will get looser, so if you are unhappy now, you will probably be more unhappy in a few months. You should wait at least 6 months to 1 year before undergoing a revision but I would at least have a discussion with your doctor now about it to find out what his or her policy is. You may have to pay for the anesthesia/facility fee but find out if your surgeon will be charging you a surgeon fee for a revision. If you go to another doctor, you will be responsible for the entire fee again.
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Suboptimal Fleur-de-lis Tummy Tuck Result
What you had is a combined horizontal and vertical tummy tuck pattern, known as the fleur-de-lis tummy tuck. Based on your before and early after photos, I can well understand your concern. As the swelling further subsides and relaxes, you will probably develop a little more loose skin. It is clear that the amount of abdominal skin resection was very conservative. While there is nothing wrong with being conservative, any patients that I have ever treated would be disappointed with this result. While a revision is going to be needed to get a more desired abdominal contour, that should not be done for 6 months after the original procedure. This is an issue to be addressed by you with your treating plastic surgeon. The earlier you bridge this issue the better.
Revision After Vertical Tummy Tuck?
This is an issue concerning the pre operative discussions and informed consent. Best to have hard an idea of the "what if" factor. What if the result is not to my liking? Yes I agree you need a revision but if neither you or the surgeon of record had this discussion than there is a problem. Sorry.
A Tummy Tuck in not always enough
I always feel a bit ill at ease in bringing up less-than-cheery issues with people I have not met, but....
Seeing the degree of laxity and fatty excess you had pre-operatively, you would have been better served with a staged approach from the beginning. That means from the beginning you plan multiple operations. This is of course a matter of opinion and how you can handle it now that you are in a surgeon's care will vary.
It is time for a sit down with your doctor at which time you can both (hopefully civilly) discuss how to get you from where you are to where you can be.
You are not really best for a revision but an extension in my opinion anyway.
John Di Saia MD
Certainly the goal with any cosmetic surgery is a happy patient.
It is impossible to assess the overall result at 3 weeks out from any cosmetic procedure. You will need to give the recovery some time for swelling and immediate surgical changes to mature. I would follow the directions of your surgeon regarding post-op care etc and once you are 6 months out or more - you can critically review the result and if still concerned discuss your concerns.
With respect to additional charges, I don't usually charge a surgical fee for revisions but often there is a charge for the facility and anaesthesia in these situations. As a plastic surgeon, we are all trying to create the best result for the patient in the least number of steps/procedures, but this may not always happen depending on the shape, size and tissue quality of individual patients.
Revision Tummy Tuck Surgery
You are only 3 weeks post op surgery so you have to allow yourself time to heal before having a revision. I understand your concerns regarding the excess skin and most likely you will need a revision but it is really important to wait until your body has recovered from this first surgery. In regards to finances, each office is different in how they handle revisionary surgery - talk to your surgeon....they should be able to assist you.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.