Not Enough Tightening and Skin Removal from Tummy Tuck?

Question

I am 48 yrs old and have had 5 full term births. I am 5'9' tall and weigh about 140 lbs. I had a full tummy tuck on 2/2/09, mainly because the skin above my belly button was wringled. When I bent over, my tummy would sag.

	I'm now almost 2 months out from surgery and my upper abs are sticking out, not sure that is 'swelling.' When I bend over, my tummy still is saggy-looking, and when I sit, my tummy still hangs over my jeans. Also, when I sit and suck in my tummy, you can see the wrinkly skin. Will this tighten up over time?

	I asked my doctor and he said the only way to get rid of that is to make a vertical cut up my tummy. That just doesn't sound right to me. I think maybe he didn't take enough skin and maybe he didn't tighten the muscles enough. What is your opinion?

Brent Moelleken, MD · Answer

It is difficult to evaluate your concerns without examining you directly.  If you are two months postop, it is possible there is still swelling present that may subside.  Also it is possible that there is fat present that might benefit from liposuction.  It's usually a bad idea to perform aggressive liposuction during a tummy tuck, especially in the central abdominal area, due to a high risk of complications.
In general, if a full tummy tuck was performed, your concerns sound a bit unusual.  If a mini tummy tuck was performed, that could explain the upper abdominal bulge (if the fascia was not tightened) or the extra skin still present.
In some patients who have had a great deal of weight loss-- and 5 full term pregnancies could fall into that category-- the elastic fibers of the abdominal area skin are stretched and ripped.  It's not possible to restore those ripped elastic fibers, so there may always be a slight amount of looseness when the patient bends forward that it may not be possible to correct.
Your board certified plastic surgeon can hopefully answer these questions for you and guide you through any additional procedures that may help you further, if any are even warranted.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding the results of your tummy tuck.

Based on your description, it sounds like you are experiencing some concerns with the amount of tightening and skin removal from your tummy tuck procedure. Given that you are almost two months post-surgery, some degree of swelling is still normal, and final results may not yet be fully apparent. However, there are a few points to consider regarding your concerns.

Firstly, it is not uncommon for patients to notice some residual skin laxity and wrinkling, especially in cases where significant weight fluctuations or multiple pregnancies have stretched the skin and abdominal muscles. Your doctor mentioned the possibility of a vertical cut, which refers to a Fleur-de-Lis abdominoplasty. This procedure can help address excess skin and improve contour by removing skin both horizontally and vertically. While it does involve a vertical scar, it can provide more comprehensive results for individuals with significant skin laxity.

If you feel that your current results are not satisfactory, it might be worth discussing the following points with your surgeon:

Skin Removal and Muscle Tightening: Ensure that adequate skin removal and muscle tightening were performed during your initial procedure. Sometimes, the extent of skin and muscle repair needed may not be fully appreciated until after surgery. If insufficient tightening or skin removal occurred, a revision surgery might be necessary.

Swelling: At two months post-op, swelling can still be present, contributing to the appearance of your abdomen. This should gradually improve over the coming months. Using compression garments and following your surgeon's post-operative care instructions can help manage swelling.

Laxity and Wrinkling: Residual skin laxity and wrinkling can sometimes persist after a tummy tuck, particularly in patients with significant skin redundancy. If this is the case, a revision surgery or additional procedures, such as a Fleur-de-Lis abdominoplasty, might be recommended to achieve a smoother contour.

Follow-Up Consultations: If you are unhappy with your results, schedule follow-up consultations with your surgeon to discuss your concerns in detail. A thorough physical examination and review of your surgical plan can help determine if further intervention is necessary.

Second Opinion: If you are unsure about your surgeon's recommendations, seeking a second opinion from another board-certified plastic surgeon can provide additional insights and options for addressing your concerns.

It's important to communicate openly with your surgeon about your dissatisfaction and explore potential revision options if necessary. Addressing your concerns early can help ensure you achieve the best possible results from your tummy tuck.

Good luck. I hope this helps answer your question regarding the results of your tummy tuck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Emmanuel Mallol Cotes, MD · Answer

Thank you for your question. To provide a valid medical opinion I will need to see pictures of you body from different angles. I would suggest to be treated by board certified plastic surgeon with experience in this procedure, to get the best desired results.
Respectfully,Dr. Emmanuel Mallol Cotes.-

Otto Joseph Placik, MD · Answer

Skin elasticity is a major factor in determining the final result. Pulling tighter is not always the best solution because pulling too tight can cause the skin to die. So it comes down to a judgement call.

Steven Wallach, MD · Answer

It is diffiuclt to answer this question without evaluating you in person.  Everyone's body is different. You also did not geive details like your height and weight.

Pat Pazmino, MD, FACS · Answer

Tummy tucks are a very popular and effective way to contour the abdomen. During the surgery, we lift up the skin and fat and assess the status of the muscle. It is looseness in the muscle, we may tighten this layer with suture. Finally, we replace the skin and fat and close this layer. Patients usually have tightness in the skin and fat layer.
	If you notice some extra skin and some looseness, it is possible that your tummy tuck was closed without too much tension. One advantage of this is to allow your tummy tuck to heal without tension or difficulty. If you are concerned and would like additional tightness, it is always possible to perform a revision to tummy tuck where more skin and fat can be removed and the tissue tightened. Your best bet is to work with a board-certified plastic surgeon who has a great deal of experience with abdominoplasty and body contouring techniques. They can assess your tissue and determine how much can be safely removed.

	To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Robert M. Freund, MD · Answer

I have this discussion with many patients. I can pull out every drop of excess skin and pull until you are folded like a flip phone, but loss of elasticity will still make your skin fold when you are bent over or sitting.
The key point is - how do you look when you are standing? If everything looks good, then you are good!
As for the upper abdomenal swelling, without the benefit of pictures or an exam, this can be the result of swelling or excess skin - which one would only be a guess.

Robin T.W. Yuan, MD · Answer

At 5'7" and 140 pounds, you are probably not over-weight and after 5 pregnancies, I can safely assume your skin has be over-stretched so that its internal elasticity is minimal.
There are different types of abdominoplasties.If we assume that you had the full abdominoplasty and have a scar around the belly button, then this usually removes skin from the lower portion of your abdomen. This means that the upper abdominal skin is tightened less than the lower abdominal skin. The less aggressive the tuck, the less tight the upper abdomen although the final result result is dependent on how much laxity existed in the upper abdomen pre-op.
Also, the more the skin is "decompressed" by removing fat or by tightening the muscles, the more the skin will appear loose. Thus, if muscles were tightened alot, this might improve the contour or shape of your torso, but the overlying skin might seem looser. You have essentially proved this by sucking in your stomach and causing more, not less, skin laxity.
In addition, all bets are off when you sit since this effectively takes the skin off tension and stretch and allows its intrinsic elasticity to appear. That is why one almost always has "loose" skin and folds when sitting after a tummy tuck. Removal of these folds while sitting is not the goal or expectation of abdominoplasties.
Finally, it may or may not be true that a vertical incision is either necessary or will solve your problem.Certainly the skin tightening with just a horizontal incision is only in one dimension so the two dimensional laxity (horizontally and vertically) that normally occurs with pregnancy may need horizontal tightening. However, the same concerns may persist, just to a lesser degree and the vertical scar is usually more unsightly. Remember that some problems do not have good surgical solutions.

Richard P. Rand, MD, FACS (retired) · Answer

In doing a tummy tuck, your surgeon has removed all of the extra skin they can so that when you stand up straight, there isn't any loose skin in the lower abdomen. Sitting down, all bets are off because some people just have less skin elasticity and this isn't corrected by surgery. Occasionally, a patient will come along whose abdomen is very tall and narrow and in these people much more skin could be taken out with a vertical scar than a horizontal one. None of these people would want the vertical scar though. If you are not comfortable with your surgeon's answers, maybe you should check with another for an evaluation.

Not Enough Tightening and Skin Removal from Tummy Tuck?

Answers (9)