Why is my stomach NOT flat 7 months post tummy tuck and lipo? (Photo)

Question

I'm 7 month post-op from a tummy tuck, lipo on back, flanks, upper stomach, and bra line, with fat transfer to my butt. I am NOT Flat when standing & especially when sitting. I'm so disappointed with results. surgeon reassured me at each post op appt it was just swelling and I needed time and patience. Now at 6 months she claims my expectations were not realistic and need more lipo! I feel constant bloating and I'm uncomfortable. She said lipo wasn't done on mid section since unsafe with TT. Updated to add: BMI of 26.5

Stan M. Valnicek, MD · Answer

Thank you for your question. Overall the liposuction of the hips and back look really good. Y
The swelling you experience at this stage is common after tummy tuck. It can be due to seroma cavities, lymphatic obstruction or general fat thickness in the lower flap. Your surgeon is correct in stating that you can only thin that area so a certain degree at the end of the surgery as we are trying to preserve adequate blood flow to the upper edge to minimize healing complications and tissue necrosis. Liposuction to that lower abdominal area can make this even riskier if done concurrently with the tummy tuck. 
I find that my own patients often have persisting swelling much as you demonstrate once we get past 6 months and the lymphatics have generally had time to recover. It is a shame to come this far without addressing this. Because that lower abdomen is generally numb after tummy tuck, I just bring them back and liposuction it down under local anaesthetic. This can be done safely at this point, has a quick recovery and polishes the result to the point that 99% of patients are happy. I would discuss your options with your surgeon and I am sure they can touch this up for you.
Stan Valnicek

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding your results 7 months after your tummy tuck and liposuction. I appreciate you sharing your history and photos.

It’s understandably disappointing to feel that your results are not meeting your expectations. Based on your description, the issue may lie in whether or not the rectus abdominis muscles (your abdominal muscles) were properly sutured or plicated during your initial procedure. Typically, muscle plication is performed during a tummy tuck to address diastasis recti (separation of the abdominal muscles), which can contribute to a flat abdominal appearance. If this step was not performed or was inadequately done, the abdominal wall may still appear distended, especially when standing or sitting.

If your rectus muscles were not tightened, a revision tummy tuck may be necessary to address this. During the revision, muscle plication can be performed to reinforce the abdominal wall. In cases of severe muscle weakness or large gaps, some surgeons may also use surgical mesh to reconstruct and support the abdominal wall for a more lasting and dramatic improvement.

Regarding additional liposuction, while it may remove some remaining fat, it is unlikely to address the core issue if the problem is with the muscle wall. In some cases, excessive or improperly planned liposuction after a tummy tuck can even worsen the overall appearance by creating irregularities or further weakening the abdominal contour.

Given your ongoing bloating and discomfort, I recommend consulting with a board-certified plastic surgeon who specializes in revision procedures. They can thoroughly evaluate whether your abdominal muscles were adequately repaired and help determine the best course of action to achieve your desired results. Seeking multiple opinions, even if it means traveling out of state, may give you a clearer understanding of your options.

I hope this provides clarity and guidance regarding your concerns. Best of luck!

Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear vanonymous84,
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

Miguel Mota, MD · Answer

Thank you for the photos. It seems to me that you need more muscle repair and even more important more skin excision. It looks like the vertical scar you have on your midline is from your belly button. Your surgeon probably thought you did not have enough skin to pull all the way down so he wasn’t as aggressive. I believe more muscle repair and more skin excision would have given you a not only flatter tummy but a tighter tummy as well.

Best regards,
Dr. Miguel Mota

Best regards,
Dr. Miguel Mota

Gerald Minniti, MD, FACS · Answer

List of issues: 1. Your scar is too high (extremely common), leaving you with a large pubic triangle. 2. You have residual fat under your abdominal skin. 3. The skin above the transverse incision is overhanging. 4. Your vertical scar is too conspicuous. You will need a revision surgery to address these issues, which should include liposuction of the abdomen, advancement of the abdominal skin downward (but leaving belly button alone), and revising your vertical scar. Contrary to the other commenter's remarks, liposuction has been routinely performed on the abdomen simultaneous to a tummy tuck for almost two decades, so this revision would be a single surgery. This surgery will give you more overall abdominal definition, a flat contour of your lower abdomen as it transitions to the pubic region, and a lower scar.

Connie Hiers, MD, FACS · Answer

You may have two issues causing your abdomen to protrude. One, you may have some excess fat which now can be safely treated with liposuction. Liposuction cannot be down safely in that area at the same time as the tuck or it may damage the blood supply to your skin. You also may have internal swelling, you mentioned bloating, which is usually related to food allergies. This is not treated with surgery, but diet changes. I would suggest asking your medical doctor to test you for food allergies.

Camille Cash, MD · Answer

At seven months post op the majority of your swelling should be resolved.  In order to improve your results a revision will be needed.  If abdominal wall correction was not performed , having that done will give you a tighter flatter tummy.  It also appears that further skin removal will achieve improved results.

Debra L. Stafford, MD · Answer

Hello. I am able to appreciate a significant improvement although fullness in the lower abdomen is evident based upon the provided photographs.
Was muscle plication (suturing of the rectus abdominis muscle) from the pubis to the xiphoid performed ? 
If not, suturing of the muscle would tighten the abdominal wall further. In addition, you may possibly have residual fat in the lower abdomen so additional liposuction could be helpful.

Darryl J. Blinski, MD · Answer

Great posted before and after photos. This posting demonstrates why preop discussions are so important to avoid mis understanding to outcomes of large surgeries. Looking at you preop views your BMI was well over 30, so you had more lipo fat available then could safely be removed when doing a Full TT.  In most states, where office surgery is offered, the standard rule is only 1 liter of lipo fat (supernatant fat) can be removed in combination with full TT. Also the golden rule is NEVER lipo the fat of abdominal skin lifted in Tt, because the skin will loose the blood supply and die or have necrosis. Thus, your chosen surgeon did the safe and proper surgical care. Unfortunately you did not fully understand exactly the process of needed 2 separate operations to attain the best possible results. If you are still confused best to virtual with...

Mats Hagstrom, MD (license on probation) · Answer

Most plastic surgeons will not do, aggressive, liposuction, upper and lower, abdomen in conjunction with a Tummy tuck.
It does appear your subcutaneous fat layer is significant on your lower abdomen, and the second round of Liposuction should improve your outcome. 
Nobody has a flat abdomen in a sitting position. It’s normal to have skin redundancy and bulging of the lower abdomen when sitting. This is true whether you’ve had a tummy tuck or not.
Best,
Mats Hagstrom, MD

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