What was done wrong here? (photos)

I posted previously about my high cut scar. I am not 4 weeks out and still in my opinion have so much lose skin? I'm having lipo on my flanks and upper abdomin but my surgeon now says that my dog ears will go away? That I would need monoplasty to get rid of my lower stomach extra skin? That I would have had to be cut both vertical and horizontal but she never told me this BEFORE surgery? I need to know your thoughts. I'm 4 weeks out but my swelling is very minimal. Thank you

Doctor Answers 5

Redo tummy tuck

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       Dear ladybug,

    Thanks for submitting your before and after pictures and wow, what an incompetent surgeon !  So sorry for your bad outcome. That is exactly the reason why I explain to my patients that the initial cost is not always the final cost if corrective surgery is necessary, like in your situation. It is not wise to select the lowest cost surgeon, but rather the most experienced and skilled surgeon. 

     Always select experiences board certified plastic surgeon who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with flat stomach, nice belly button and low scar. Also check the reviews on 'RealsSelf for ratings and positive experience reports.

    The good news about your situation is that , from observing your post operative pictures, you still have significant skin laxity of your upper abdomen, which will allow to lower your scar significantly (2-3 inches ?) and tighten your skin and muscles further, creating more youthful skin and flatter stomach. However, you will have to wait 3-6 months and choose a much better surgeon ...

                       Best of luck,

                                        Dr Widder

I would get a second opinion before getting any vertical incisions...

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I am sorry your tummy tuck as turned out this way... It seems your tummy tuck incision was placed too high given your anatomy and skin laxity and now is much too elevated.

When marking the incision on patients, I think it is crucial to mark the incision with the skin under tension, and not to just mark it "in the fold". If you look at your pre-operative photos, you can see your where your "pooch" is and the crease underneath it. Some surgeons will say, "Look, I'm going to put the scar in your crease!" and make the incision in the crease under the pooch. This seems great and reasonable to the patient at the time. However, if the skin is very lax as it tends to be after massive weight loss, when this skin is stretched under tension as it is after a tummy tuck, it will pull the skin upwards, resulting in results like yours with the pubic mound stretched up nearly to the belly button and too short of a distance between the belly button and the scar.

It is much more appropriate to put the lax skin under tension and then mark the incision at a distance that results in a normal appearing pubic mound. In some patients with lax skin, this means putting the incision in the public hair and actually removing the upper half of the pubic hair containing skin. However, this means afterwards, your incision will be low where it belongs.

However, in your case, what has happened has already been done. Although I cannot say with 100% certainty based solely on the photographs, I believe it would be possible to lower your scar at a later date as it seems there is still some laxity of the skin between the belly button and the incision. I wouldn't suggest doing this until at least 3-6 months have past from your initial surgery. It will not get you all the way back to perfect, but it would go a long way towards improving your result. Best of luck!

What was done wrong here Tummy tuck surgery)?

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I am sorry to hear about your concerns after tummy tuck surgery: they are certainly understandable.  My honest thoughts: in  my humble opinion, you have undergone a poorly designed tummy tuck procedure leaving you with a scar that is much too high and bilateral excess skin/adipose tissue (that may resolve to some degree but will likely require additional surgery to correct).

 My best suggestion:  avoid further surgery for now. Give yourself at least six months (to one year) before evaluating the final outcome of the procedure performed.  Based on your outcome thus far, I think that is very likely that additional surgery will be beneficial.  Frankly, I would suggest that you seek second opinion consultations with well experienced board-certified plastic surgeons at that time. Best wishes.

Poor tummy tuck

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Dear 1Ladybug35,

Thank you for your pictures.  Your incision is very high.  I am not convinced that a vertical incision and/or liposuction will be helpful.  In my opinion, I would recommend placing tissue expanders  beneath the abdominal skin.  The expanders are inflated to create excess skin.  That excess skin is used to lower your scar.  

Earl Stephenson, Jr, MD, DDS, FACS

What was done wrong tummy tuck

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I understand your concerns. Your scar is located high on your belly. Although liposuction can reduce fat and cause skin shrinkage, be thoroughly evaluated for the amount of loose skin. Loose skin doesn't stop at only the front. It can extend around the side as shown in your photos and also around your backside. Consideration should be given to removal of side and even perhaps backside skin (body lift) because going all around will allow a greater amount of side skin and fat to me removed. Upper belly fat can be managed with liposuction although option does include vertical removal (fleur de lis) if the scar isn't a concern. 

Gary Vela, MD, FACS
Baltimore Plastic Surgeon

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.