What could be causing my swelling 6 months after extended tummy tuck, liposuction, muscle repair and mons lift? (photos)

Hello generous262,019,
Thank you for your inquiry about the persistent swelling six months after undergoing an extended tummy tuck, liposuction, muscle repair, and mons lift. Based on your history and photos, it is indeed unusual to experience significant swelling at this stage in your recovery. The presence of loose skin in your upper abdomen, as you described, indicates that this may not be swelling but rather excess skin that needs to be addressed.
To effectively manage this issue, there are a few surgical options:
Reverse Tummy Tuck: This procedure would involve removing excess skin from the upper abdomen, helping to achieve a tighter appearance.
Revision Tummy Tuck: This approach could further tighten any loose skin and refine the results of your initial surgery.
Vertical Incision: Although less commonly recommended due to the visibility of the resulting scar, a vertical incision from the sternum to the belly button could be a way to remove excess upper abdominal skin.
Liposuction might not be advisable as it could potentially exacerbate the loose skin issue. It's important to thoroughly discuss these options with your plastic surgeon to determine the best course of action based on your specific needs and aesthetic goals.
Remember, post-surgical changes can vary greatly among individuals, and your surgeon will have the best insight into your unique case.
Wishing you the best in achieving your desired results.
Sincerely,

An in person evaluation is needed to determine the cause of the contour that concerns you. It could be residual subcutaneous fat. If so, further liposuction should improve it. It could be lax skin in which case a revision would be needed to address it. It also could be visceral (internal) fat. This is not corrected with liposuction or a tummy tuck as it is behind the muscle wall. Weight loss will improve it.

There are a variety of different reasons why someone may have bulging of their upper abdomen after a tummy tuck.
It could be due to excess visceral, fat individuals who are barrel chested, failure to dissect the muscle fascia from the skin and fat layer high enough on the abdomen, and overly aggressive muscle tightening of the lower abdomen.
Based on the information given, it doesn’t appear like visceral fat was a major problem in the before pictures.
If you still have skin laxity of your upper abdomen, then most likely, the outcome is the result of failure to dissect high enough on the abdominal wall up onto the rib cage during the procedure. Plastic surgeons very in how far up they separate the skin and fat layer from the muscle fascia.
This dissection is required to get skin tightening from the procedure.
Ideally, the dissection should be done well over the rib cage close to the infamy fold.
If this was not done, then, patient will be left with a skin laxity above the area that was not dissected and this can create fullness. The point of dissection is also the point where muscle tightening can begin.
We can’t really give you an accurate assessment with incomplete information.
Your surgeon did the procedure and should be able to decipher why your outcome looks the way it does.
Thereskin laxity above the area that was not dissected and this can create fullness. The point of dissection is also the point where muscle tightening can begin.
We can’t really give you an accurate assessment with incomplete information.
Your surgeon did the procedure and should be able to decipher why you’re outcome looks the way it does.
There are four variables that determine what the abdomen looks like.
In other words if somebody doesn’t like the way, their abdomen looks it is usually because of one or more of four different tissue variables.
The four valuables that determine what the abdomen looks like are.
1) abdominal skin laxity typically due to previous pregnancies or weight loss.
2) excess subcutaneous fat.
3) muscle separation from previous pregnancy.
4) excess visceral or intra-abdominal fat.
The problem is always going to be one or more of those for variables. Different differentiating which one is causing the problem is fairly straightforward. Differentiating a lack of sufficient dissection during surgery is a little tricky, but clues like skin laxity of the upper abdomen would be a pretty giveaway.
To get a more accurate assessment, I suggest scheduling in person second opinion, consultations with other plastic surgeons in your community.
For second opinion consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your operative report.
Those should all be available from your current provider if you request them.
If you want quality assessment, then you need to provide quality information.
This should add a minimum include a complete set up before and after pictures. Ask your surgeon to forward the pictures they took at a minimum.
Best,
Mats Hagstrom, MD.