To make an assessment regarding the outcome of a plastic surgery procedure, we generally always need to see proper before and after pictures. If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took. Without knowing what you look like before the procedure? We don’t know what your candidacy was for the procedure. It’s not uncommon for people to have the thickness of subcutaneous fat change throughout the lower abdomen. The fat thickness tends to be very thin in the groin area and the thickest around the mid abdomen. In order to have a low set scar. There may be a mismatch between the thickness of subcutaneous fat at the incision line Because the area where the fat gradually became thicker has been excised. This is one of the potential problems when setting the scar low. Plastic surgeons have the ability to remove subcutaneous fat from the upper skin edge in order to have a better subcutaneous fat thickness match at the incision line. Having a contour, irregularity at the incision is dependent on multiple variables. It varies based on each individual persons, unique anatomy and fat distribution, where the incision is placed into some extent how the operation is performed. I generally recommend patients choose providers for cosmetic procedures that are permanent and irreversible very carefully. I typically recommend patients do this by first, having multiple in person, consultations with providers in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who have similar body characteristics to your own. An experienced provider should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures they’ve actually done. It is important to recognize that each individual patient seeking this procedure will have their own unique candidacy for the operation. Not everybody seeking tummy tuck. Surgery is an ideal candidates. Patients who are excellent candidates for a plastic surgery procedure have the potential of having excellent outcomes. They can also have outcomes that are less than ideal if the procedure is not done as well as it could have been. Individuals who are not excellent candidates do not have the potential for excellent outcomes, regardless of who does the procedure. Understanding your own candidacy, for the procedure is an important part of high patient satisfaction after the procedure. Explaining an individual patients candidacy for the procedure is an important part of the consultation process. Likewise, being board-certified in plastic surgery with years of experience, and an overall good reputation does not mean somebody has mastered any one single procedure. I generally recommend patients have multiple consultations before selecting a provider. The biggest mistake patients make is having only one consultation, which is pretty much eliminates the ability to choose the better provider. There’s no correct number of consultations needed to find the right provider. The more consultations you schedule the more likely you are to find the better provider. It is important to ask providers to specifically show you before and after pictures of previous patients who look like you do.(previous patients who were similar candidates). Bring pictures of yourself to use as a reference during the consultation and whenever reviewing before and after pictures. Overall, your results are probably fairly average. I’ve seen better and I’ve seen worse. When plastic surgeons do liposuction in conjunction with a full tummy tuck, there are very different approaches to how the liposuction is done. Doing quality liposuction of the waist, love handles, and back typically requires repositioning the patient either to their side or face down. Doing this in conjunction with a tummy tuck is technically difficult, Time intensive and can potentially increase chances of problems and complications. Some providers are also reluctant to do aggressive, liposuction in conjunction with a tummy tuck for safety reasons. If somebody’s interested in having more than one procedure done at the same time than I recommend they vet providers for each of the procedures they’re having scheduled. In other words, if you’re scheduling a full tummy tuck with Liposuction, then you should ask providers to show you pictures of patients who had the same combination of procedures during your consultation. Reviewing as sufficient number of before, and after pictures should give you a good understanding of what results look like in the hands of each provider and what your results are likely to look like. Did you ask the provider to show you examples of Liposuction work? It’s not unusual for plastic surgeons to focus most of the effort on the primary procedure, which is often going to be the tummy tuck and simply go through the motions of doing some liposuction in conjunction, but not focus on Liposuction as a formal procedure when these are done in conjunction. On top of this, the number of plastic surgeons who have truly mastered Liposuction is relatively small. Doing quality liposuction on a regular basis, turns out to be far more difficult than most people realize. In regards to skin, excision, and avoiding dog ears patients should recognize that there is only a certain extent of skin excision possible without repositioning the patient. The surgeon simply can’t reach onto the back of the patient without turning them during surgery. Turning patients during surgery is a fairly complex Procedure that typically involves six people and can take 30 minutes. The nursing staff and anesthesiologist are typically not big fans of surgeons turning patients multiple times. It can be done and sometimes it should be done. For patients who need an extended tummy tuck it should be made clear during the consultation. If the provider is planning on, turning you during the procedure and exactly how far back the car is going to go. Before even considering making an assessment or recomendations for potential improvements to your outcome, I think it would be pertinent to have access to better information specifically, seeing a complete set of proper before and after pictures. Follow up with your provider and share your concerns with him or her. Ultimately your surgeon is responsible for the outcome of the procedure and the patient is responsible for selecting that provider. If you want to proper second opinion consultation, then schedule those as in person consultations with other plastic surgeons in your community. For second opinion, consultations come prepared bring with you a complete set of proper before and after pictures and a copy of your previous operative report. These are all available from your current providers office if you request them. As a reference of what I consider quality tummy tuck results, you can check out dr Eleonore Zetrenne, M.D. s website. This is in my opinion how a well designed tummy tuck scar should look. Please recognize that without seeing before pictures it’s not appropriate to make an assessment regarding the outcome. I’m guessing in comparison to what you look like before your outcome shows some pretty remarkable improvements. For those who want quality liposuction of their backside, this is generally better done as a separate procedure either before or after the tummy tuck. Best, Mats Hagstrom, MD