Loose skin after tummy tuck - why did this happen? What could be done to fix it? (Photo)

The issue you're having is residual horizontal skin laxity. This is more commonly seen in massive weight loss patients, and not in someone like you. For those people a 'fleur de lys' tummy tuck is required, which entails a vertical excision of skin and a vertical scar. Fortunately, I can hardly believe this would be the case for you. In general, a tummy tuck mostly tightens vertically, but specialized sutures call 'progressive tension sutures' can also redirect the forces of tension into oblique direction in addition to a downward pull, and I think that is the answer for you. The bad news is that it is another surgery, one where the entire skin would be elevated off of your muscle, including your belly button, and then it would be re-pulled, using progressive tension sutures. This would advance your skin downward and towards the midline (the oblique pull I mentioned), taking up the slack you now have. On the positive side, you would not need any drains and your current scar would be lowered, possible significantly.

Dear Sweetpeenk99037,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Thank you for your question regarding the loose skin you are experiencing after a tummy tuck. I'm sorry to hear about the issues you've faced, particularly when leaning forward or being on your hands and knees. It's understandable to feel disappointed, especially when the results don't meet all your expectations across different positions and activities.

By examining your pictures and considering your description, you might be a good candidate for a vertical torsoplasty or an hourglassing procedure. This procedure involves an incision that starts at your armpit, extends down your sides, over your hips, and effectively brings in your waistline. This would not only help contour your midsection but also significantly reduce the loose skin that bothers you.

Another option could be a vertical incision down your stomach. This approach focuses on tightening the skin vertically and may be suitable depending on the distribution of your loose skin.

Choosing between these options often depends on which scar you would be more comfortable with and the specific aesthetic goals you want to achieve. Most of my patients opt for the vertical torsoplasty because of the dramatic improvement in body contour and the creation of beautiful curves it provides.

Given your concerns, I recommend discussing these surgical options with a board-certified plastic surgeon who can provide you with tailored advice and an approach that best suits your needs and expectations.

Sincerely,
Dr. Katzen

Sorry you're experiencing this problem. Based on your pictures this looks like horizontal skin laxity. Unfortunately surgery would be the only way to improve. The treatment plan with least incisions would involve some contouring abdominal liposuction and skin tightening (there are many different technologies, i.e. Renuvion, Bodytite, SmartLipo). You may want to get a second opinion if your original surgeon is not answering your questions. Hope this helps!

You have some vertical excess skin that can be addressed in two ways. A vertical incision could be added to remove this skin, or minimally invasive radio-frequency treatment like Renuvion may give you enough tightening without any additional scars.

Typically those with excessive skin laxity in the midline have it addressed through a fleur de lis incision. It is most frequently seen in those that have had major weight loss. It leaves a vertical scar on the abdomen which most people would rather avoid. I've included a video I hope you find helpful.

At tummy tuck, primarily treats, abdominal skin, laxity, and muscle separation from previous pregnancies.
Individuals who develop a significant amount of skin laxity from previous pregnancies and weight loss will have skin redundancy in different directions.
The skin will be loose in a horizontal direction and a vertical direction.
It’s basically overall diffuse loose skin.
Standard tummy tuck only reduces skin laxity in a vertical direction.
That is because the incision is horizontal.
Most people will have some remaining skin laxity in a horizontal direction, unless a vertical scar from the sternum to the pubic bone is added.
This type of tummy tuck is sometimes called a Fleur du lys pattern.
The added, vertical scar is typically unsightly and highly undesirable.
In some individuals, especially those who have had massive weight loss it is indicated.
We typically judge tummy tucks based on upright standing position with the abdomen, flexed or crawling around the floor, like a dog.
Overall, I think your outcome is excellent and very much within normal standards.
To make an accurate assessment on the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
If you have concerns about the outcome of your procedure, then perhaps you need to spend a little more time looking at your before pictures.
Best,
Mats Hagstrom, MD