Second opinion on small bulge above incision? (Photos)

As your doctor said, intensive liposuction was not applied to that area in order not to disturb the blood circulation. I recommend completing the healing process (approximately 1 year), after which correction can be made with liposuction if necessary.

Thank your for your question! I agree with your surgeon with regard to the tendency of this area to retain edema for months after surgery. There are two common causes of persistent or recurrent lower abdominal bulging after an abdominoplasty. One is an untreated or recurrent diastasis recti (separation of the rectus abdominis muscles). If this is the cause, re-operation is necessary to perform a rectus plication. The second relates to the fact that, for many patients, there is a significant difference in thickness between the upper abdominal skin and fat (often 1 inch thicker) and the mons/groin skin and fat. These two areas are brought into contact when the upper abdominal skin is pulled down and your incision is closed. I disagree with your surgeon's statement that the upper abdominal fat cannot be safely thinned to match the mons/groin thickness during an abdominoplasty. I routinely perform this maneuver specifically to avoid the lower abdominal bulge/fullness and create a seamless transition during my abdominoplasties. At this point, I agree with waiting 9-12 months prior to a touch-up procedure to eliminate the effects of edema/swelling as much as possible so that when you have liposuction your surgeon can accurately thin the bulging area and create a natural, harmonious transition.

Hello Lily2013,
You do have a larger bulge than usual for 6 months after a tummy tuck, right in the area that is the slowest area to heal. This does occasionally happen after a tummy tuck, and can even take up to a year or sometimes longer to disappear. If it does not resolve, liposuction can be used to remove the bulge, however I encourage you to wait the year before proceeding. Any changes after a year will be very slow and not very significant.
In the mean time, you can consider lymphatic massage as a treatment, and consider wearing a compression garment.
I encourage you to follow up with your surgeon in 3 months time.
All the best to you,
Dr. Nancy de Kleer

Dear Lily2013,
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

Based on this single photo. It does give the impression that it can be solved with a slight liposuction of that area. According to the doctor, it is a delicate and hypersensitive area in terms of double trauma (cut and liposuction) during surgery.

Your surgeon is correct in that is the last place the swelling leaves is right above the incision. Your surgeon is also correct that not all the fat in that area can be removed with the tuck because of risking damage to the circulation of the skin. However, sometimes a small pocket of fluid forms and needs to be drained. This can be determined by examination. Otherwise, follow your surgeon's advice.

The area that concerns you can still be related to residual swelling from surgery. If this is what is causing it you should notice improvement over the next few months as you complete healing. If it does not improve there may be a little pocket of fat there. This can often be addressed with a little liposuction done under local anesthetic at the office. A little more time is needed to know which it is.

To make an assessment requires an examination. The bulging can be caused by skin laxity, excess subcutaneous fat or a bulging muscle wall.

At six months your results are final and are not going to change by waiting further.

What your provider said is technically true but could also be used as an excuse.

To make an assessment try putting the skin under tension to see if it represents skin laxity.(probably not). To feel the thickness of subcutaneous fat gently push against the skin with the tip of one finger until you feel the underlying muscle wall. see if the thickness of fat is consistent with the rest of your abdomen.

A straight muscle wall should make a beeline from your pubic bone to your sternum. You can feel the muscle wall by gently pushing your fingertip against the skin until you feel the muscle wall underneath just like described for assessing the fat layer.

A secondary liposuction procedure is probably most appropriate. I suggest you follow up with your surgeon and have him address this concern and offer you a revision procedure.

Best,

Mats Hagstrom MD

Hi and welcome to our forum!From your "before" photo, I note a unusual significant superior abdominal fat roll. It appears to have been moved inferiorly during abdominoplasty as expected. It is true that most surgeons will not perform liposuction of the abdomen at the time of abdominoplasty due to the blood supply interruption caused by the surgery itself. This injury self corrects after abdominoplasty over a period of 6-12 months, allowing secondary liposuction to be performed. Due to the size of the roll, a future liposuction is probable. 15% of cosmetic surgeries can be improved with a secondary touch-up procedure.Best wishes...