Age 43, 143 lbs, 5ft8 - would excess skin/bulge be from poor skin elasticity or even muscle repair failure? (Photos)

Thank you for your inquiry! We would love to sit down with you in person and discuss your concerns and your options. Schedule a consultation with a Board-Certified Plastic Surgeon to assist you in reaching your goals.

It looks like a combination of both muscle/fascial laxity and recurrent skin excess. If your surgeon delivered a high quality operation, removing as much skin as she/he thought was safe and tightened the muscle as much as possible, then it may be an issue of soft tissue elasticity. A revision abdominoplasty may provide incremental improvement. However, your tissues may stretch a second time. An in person exam is necessary to help determine the best course of action. Nicotine cessation is mandatory before any additional surgery.

Thank you for your question regarding an abdominal bulge after a 360 circumferential body lift and 360 lipo. Thank you also for your pictures. When you inhale, it appears in your series of pictures; the mass goes away. These can be seen in pictures 3 and 4 at the top. This means that the muscle is weak. For repair, I would suggest muscle plication. Even though this has previously been done, It may have loosened or need to be tightened again. Another alternative is the insertion of mesh. Mesh can form a sling on the lower abdominal wall and be anchored from side to side. We may never understand why this happened to you; however, we must push forward and seek a solution. Therefore, I think it would be the repair of the rectus abdominal muscles from the umbilicus to the pubic region. Thank you for your question regarding cess the skin/bulge is from poor skin elasticity or even muscle repair failure.
Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

The technique I recommend an abdominoplasty with mesh reinforcement, if you are not planning future pregnancies. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight. You have to be a non-smoker to be able to have this procedure done.

Best Wishes,

Gary Horndeski, M.D.

This could be related to several issues1) inadequate tightening of the abdominal wall in a vertical or horizontal manner2) inadequate thinning of the abdominal fat in the central part of the abdominoplasty3) excess intra-abdominal fatI would highly recommend seeing a board eligible or board certified plastic surgeon for a physical exam and accurate analysis with safe recommendations for potential surgical options. Best of luck!

Dear Adventurous652074,
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

Hello Dear,
Thank you for the question and photos you have provided. Sometimes no matter what you do, some areas are prone to hold the fat even tough the other regions of the body is slimmer. We call these kind of fats stubborn fats. The only permanent solution to this would be tummy tuck. But before the tummy tuck, liposuction should be performed on your abdominal area to free you from the stubborn fat. Once this procedure is completed, the excess skin will be cut surgically and removed.
Be safe, be happy

Hi and welcome to our forum!From your photos, I note a minimal degree of residual lower abdominal fullness. Without a physical examination, I cannot ascertain if this represents fatty tissue accumulation or if it is caused by residual separation of your anterior abdominal muscles. You include a photo of your abdomen with your hips flexed. The distance between the bottom of your ribcage and the pubis decreases when you sit. Pregnancy and age both contribute to stretching of the abdominal skin. Dermal elastic fibers rupture, and, as a result, (like an old stretched out rubber band) the skin permanently loses its ability to contract. You may be tight when standing, but lax when sitting. If you are made tight when sitting, you won't be able to stand straight! If on examination, you demonstrate a fat repository of the lower abdomen, liposuction will correct it. If it proves to be residual or recurrent anterior muscular separation, an abdominoplasty revision may be indicated. 15% of cosmetic procedures can be improved through secondary touch-up.Revisit your plastic surgeon for evaluation and discussion.Best wishes...