Does this look like a muscle repair failure or another issues? 49, 5'6, 125 lbs 4 months post (photo)

I agree that a little more time is needed to see your final results however I don’t know if Liposuction was done at the time of your initial surgery. Some surgeons do while others feel it adds a degree of risk to circulation. Discuss your concerns with your surgeon and he may be willing to do some contouring Liposuction to your tummy and pubic area once you are healed.

At 4 months it is still early on in your recovery. Please allow at least 6 months for the initial swelling to subside, as it is certainly contributing to the “thickness” and “puffiness” you mentioned. At that time, you can reassess your results and speak to your surgeon about your concerns, should have any.

What you may be experiencing is soft tissue edema (swelling) which may require longer time in you to resolve.  In most patients the turn around time is 4-6 months.  However even after this time there will be good days and bad days.  Most often in the morning, everything is soft and flat, but by the end of the day swelling kicks in and the tissue feel firm and doughy.I would discuss this with your plastic surgeon and see if he/she recommends for you to maybe go back to a compression garment (spanx) for the time being.Hope that helps.

Dear JoannaW2,I understand your concern and it is quite normal to be concerned about the outcome following a tummy tuck surgery. However, you are still in the very early stages of the healing process.Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.At the early stage of the healing process, the tissues are still swollen. Once the swelling subsides  you will be able to see the final result of your surgery.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I'm sorry you are unhappy with your tummy tuck. Without pre operative photos it's difficult to comment on specifics. Your photos do not show any obvious signs of muscle repair failure. Your hip area may benefit from some touch up liposuction or excision of dog ears, but it is still too early to tell. I encourage you to discuss your concerns with your surgeon.

that is causing concern but more the planning of your incisions, the scarring around the belly button, whether liposuction was done on your flanks at the same time, and the mild redundancies around the incisions.  You really need to be discussing your concerns with your surgeon and allow your surgeon to come up with ways to help you achieve your goals.

It's unfortunate that you aren't currently happy with your results, but try not to get too discouraged.  You will most likely see continued improvement in the abdominal fullness as well as your overall contour as time goes on.  Try to be patient and stay positive.  Increased activity may contribute to the swelling once you are back up to speed.  That too will improve with time.

I'm sorry to hear about the concerns you have after tummy tuck surgery.  As you likely know, your plastic surgeon will be your best resource for precise diagnosis, advice, and the most meaningful reassurance...
Generally, abdominal wall "swelling" after tummy tuck may be related to:
1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
Often patients will like their “flatness” immediately after surgery; then, these same patients are disappointed for a period of time once swelling of the tissues occurs. In the longer term (this may take several months and even up to one year), the swelling dissipates and the skin of the abdominal wall "redrapes"  over the smaller underlying  musculoskeletal framework (where the abdominal wall muscles have been brought together again in the midline). 
Often, patients will report that the swelling increases as their activity level increases and gets worse later on in the day. Sometimes, the use of compressive garments may be helpful to control the edema. The swelling resolves many months (and even beyond one year post op in some cases) as the lymphatic and venous systems begin functioning normally.
2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.
 Disruption of the muscle plication is best diagnosed on physical examination with your surgeon examining you in different positions (your plastic surgeon will be in the best position to accurately advise you and/or provide you with accurate assessment and/or meaningful reassurance.
4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery  in some cases (this factor does not seem to be likely in your case).
Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year (or greater) for complete skin redraping  to occur.
I hope this helps.   Best wishes for an outcome that you will be pleased with longer-term.
 

Thanks for the pics and questions.  Being a patient requires patience and a lot of faith (that the desired outcomes will materialize).  Based on the profile photos, the musculofascial repair appears intact, hence the puffy stomach and thick body should represent post-op edema.  How long did you wear the compression garments, post-op?  Do ask your PS whether manual lymphatic drainage may be useful.  

Hello,Thank you for sharing the information, it is a pleasure for me to answer your question.
Following the recommendations of your surgeon is very important. The recovery takes around 4 to 6 weeks, you must perform lymphatic drainage massages, for me more, and you can continue your normal activities, perform light exercises, then increase the routine without any problem
the total recovery of the procedure takes from 6 months to a year, it is advisable to wait 6 months between each surgery, to avoid risks, your surgery is very recent, have a lot of patience
I hope this answer will help youMy best wishes for you ...