Enough skin for revision tummy tuck? (Photo)

Question

Hi - I had an original TT in 2019. I then had scar revision in 2021. However I still have a fair bit of skin left and I'm overall unhappy with the results. I have seen other Tummy tucks which are much flatter and have had lipo (which my surgeon did not do as he does not offer this procedure) Can I get some feedback please?

Carmina Cardenas, MD · Answer

We develop saggy skin in our abdomen in different vectors: length and width, Timmy Tuck only gets rid of excess of length but nothing of the width. 
When you bend over the excess is purely of width. So if you want a perfect tight abdominal skin you will need a Fleur de Lis. 
Why others look better than you most likely because their tissues are different: tighter, they are younger, they have not excess of width. 
Liposuction will not tighten the skin in any vector. On the contrary, will only cause deflation and the excess will be more obvious. 
I never ever do liposuction at the same time of the Tummy Tuck, always 5-6 months later to be in the safe side. Just have in mind your problem is not excess of fat only. 
Be encouraged. Look for a doctor who is an expert on Tummy Tucks and have hundreds of photos and reviews about it. 
Dr. Cárdenas

Daniel Barrett, MD · Answer

Dear cwardrop,
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

Camille Cash, MD · Answer

From your photos it appears you would benefit from further skin excision to give you an improved look.  Liposuction can also be added to further contour the hips/flanks.  See a board certified plastic surgeon near you to learn more.

Darryl J. Blinski, MD · Answer

Thanks for trying to post photos, best to do virtual consults with... Revision full TT can be offered with a fee from $10,000 (since it is a revision must charge higher fee).

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a procedure we really need to see proper before and after pictures. If you don’t have before and after pictures then ask your surgeon to forward the ones they took.
A tummy tuck creates skin tightness and a vertical direction but not in a horizontal direction. Patient still have substantial skin laxity may need an extended tummy tuck and for some individuals adding a vertical component is indicated though I do not think that’s the case for you.
Equality tummy tuck should first and foremost have a natural looking belly button. Other characteristics are a low sets car that follows anatomic contours naturally. The torso should look good from all angles including from behind.
Not having a flat abdomen after a tummy tuck can be due to patient having excess visceral fat, skeletal shape that’s more barrel chested where the sternum sits in front of the pubic bone, insufficient muscle tightening or excess subcutaneous fat on the front of the abdomen.
The fat layer naturally becomes thin from a tummy tuck by pulling the skin and fat layer tight. This is just like how a rubber band becomes thin when you pull it tight.
Potential bulging of your abdomen needs to be differentiated to have a clear understanding of what the underlying cause is.
If it’s visceral fat you need to lose weight. If it’s due to skeletal structure there may not be much that can be done, insufficient muscle tightening requires a redo operation and subcutaneous fat can be reduced with Liposuction.
In the end your surgeon is responsible for the outcome and you are responsible for choosing that surgeon.
Some people are better candidates for getting good results and then others and this is why seeing before and after pictures is important in making an assessment on the outcome of an operation.
If you want a proper second opinion consultation then schedule those with local board-certified plastic surgeons in your community. Come prepared for second opinion consultation by bringing copies of all before and after pictures and a copy of your previous operative reports.
Best,
Mats Hagstrom MD

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