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.

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