This is actually a fairly common occurrence, particularly in those patients who undergo abdominoplasty after large weight loss. The reason why this happens is that our abdomens are really spherical, three dimensional objects. When we plan abdominoplasty, we sort of think of the tummy as a two dimensional plane with height and width basically. Then, in order to keep the scar hidden in an acceptable position and orientation, we limit our plan to basically shortening the excess in only one direction - up and down. However, if you recall from above, our tummies are actually 3 dimensional, so when the skin of the abdomen stretches, not only does the skin stretch in the "up and down" direction, it also stretches in the "side-to-side" direction as well. Furthermore, when the skin of the abdomen, or anywhere on the body for that matter, loses elasticity, it does so evenly in every square inch of it. However, when we do a tummy tuck we can only remove the skin from the lower abdomen, and we must leave the skin of the upper abdomen there, it just gets stretched a little tighter by the abdominoplasty, but it is still the same stretched, loose skin. Every square inch of it. Pulling that skin in the up and down direction only tightens it vertically, but it still has excess and remains loose in the horizontal direction. The central portion is usually the tightest because it typically has the greatest excursion, that is, it is pulled farther and tighter. Thus, the tightest "band" is in the center in a vertical direction, and the lax skin on the sides is relatively looser and can fold around the tighter, more stable zone in the center. Additionally, the lower abdomen always winds up being tighter than the upper abdomen in these cases because it is closer to the site of the incision and thus the tension on the skin is greater. The farther you go from the incision, the more the tension is lost and "dampened" by the residual laxity of the remaining skin. The way to alleviate this is to also remove skin in the side-to-side direction, or horizontally, but most of the time that creates scars that people don't want to accept unless the horizontal excess is so extreme that they are willing to undergo that type of procedure. In those cases we do a procedure called a "fleur de lis" abdominoplasty in which an additional vertical scar is placed from the pubic bone to the bottom of the ribcage in the midline so that the horizontal excess in skin can also be reduced. Another approach to this is to remove skin on each side of the torso, sort of from armpit to hip, and tighten things up that way. Again, this allows for removal of horizontal excess. As you can see, there is no perfect solution to this dilemma, and most people would rather retain the mild laxity of the abdominal skin and fat than choose one of the other options. Another thing that could possibly give some improvement, but it would be unpredictable how much, would be some liposuction of the abdomen to follow up the tummy tuck. This may reduce some of the bulk of the remaining loose tissues and create some contraction of them so as to lessen the tendency to fall forward loosely and fold. I doubt your 10 lb weight loss actually created this, but it may have contributed only because it may have lessened the bulk of the upper abdominal tissues allowing them to fall forward more loosely and fold. Your surgeon didn't create it either, at least not in the sense that anything was done improperly; it just happens when the tissues are loose like that in that part of the abdomen. It's what we would refer to as a limitation of the procedure.
