Lower Abdomen Pooch After Tummy Tuck

Liposuction of the tissues above the incision are not generally performed at the time of the initial procedure due to concerns with interfering with healing. You may want to discuss performing liposuction with your surgeon at this point in time

Hello Projectbeautiful. Thank you for reaching out with your concerns about the persistent pooch in your lower abdomen following your tummy tuck 9 months ago.

It's not uncommon for patients to have concerns about the contour of their abdomen following a tummy tuck, especially if there are areas that do not seem to match their expectations or pre-surgical goals. Here are some considerations and steps you can take to address this issue:

Swelling: At 9 months post-operation, most of the swelling should have subsided, but it's not impossible for minor swelling to persist, especially in the lower abdomen where fluid tends to collect more readily. However, it's more likely that what you're seeing now is close to your final result.

Residual Fat Deposits: If the area is still firm and there is no muscle separation, the pooch could be due to residual subcutaneous fat. This is something that liposuction could potentially address. Liposuction can be used to refine the results by removing stubborn fat pockets that a tummy tuck may not have fully corrected.

Skin and Tissue Settling: Even though most healing happens in the first few months, the tissues and skin continue to settle and adapt up to a year or sometimes longer after surgery. This process can slightly alter the initial post-operative appearance.

Surgical Technique: The technique used during your tummy tuck and how your incision was closed could also influence the contour of your lower abdomen. Sometimes, the way the skin is redraped and sutured can create a firmer or more pronounced area along the incision line.

Next Steps:

Follow-Up with Your Surgeon: It's important to discuss this concern with your plastic surgeon. They can evaluate the area to determine if what you're experiencing is residual swelling, excess fat, or a result of how the surgical tissues were manipulated.

Consideration for Liposuction: If the issue is due to residual fat, your surgeon might recommend liposuction as a complementary procedure to refine the contours of your abdomen further.

Review Before and After Care: Ensure that you are following all recommended post-operative care instructions, including wearing compression garments if advised, to support the best possible healing and settling of tissues.

Patience and Monitoring: Continue to monitor the area as it can still change slightly with time. Taking periodic photos can help you see if there is gradual improvement.

Your surgeon will be your best resource to determine the appropriate action, whether it be additional time for natural resolution, liposuction, or other interventions. It’s also valuable to ensure that your weight has stabilized since fluctuations can affect the results of your surgery.

I hope you find a satisfying resolution soon.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

The concerns you have about the fullness of the lower abdomen could be from a number of different things including swelling or additional fat. I encourage you to return to your surgeon for an evaluation. At 9 months post op you are far enough out from surgery to consider liposuction if it is warranted.

A lower abdominal bulge after a tummy tuck can be several things.  I would go back to your surgeon to be evaluated.

Tummy tuck surgery is a very popular and effective way to contour the abdomen. During this surgery, your surgeon will typically tighten your muscle layer. It is possible that some of the bulging that you are seeing may be loosening of the muscle repair. Visit with your plastic surgeon and let them know of your concerns. They will examine you to help determine if the swelling is from the loosening of the muscle or is a collection of fluid or fat. This bulging may be easily corrected with a small revision surgery.

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:
 

Dear ProjectBeautiful,
I do see the "pooch" in the picture you posted, and truthfully it can be caused by several different reasons. The simplest way to get a straight answer is to visit your surgeon and ask them what they think is the cause. But here are some thoughts:
1) The pooch seems to be right above where I'd guess your incision is located. The upper abdominal skin tends to have a thicker fat layer than the mons region in some patients, and this can create a discrepancy. This could be easily addressed with liposuction.
2) You could have a persistent fluid collection under the skin flap (a seroma), which could be drained in the office (I doubt this possibility - you would probably notice a fluid wave at some point)
3) There maybe persistent edema in the skin flap - you can assess for this by noticing how visible the skin indentations from elastic clothing are on the front side (under the belly button), and the back of your body (assuming you did not have a circumferential procedure, or flank lipo). If you see a more marked "dent" that sticks around for a while on the front, that is a sign that you still have post operative edema.
4) You could have laxity of the lower abdominal muscles (but you say it is firm, so unlikely)
5) You might be as tight as can be achieved, but are limited by intraabdominal contents (the liver, stomach, bowels and fat located around them as a cushion). Your surgeon can only tighten the outside as much as the inside contents allow.
With this list and the guidance of your surgeon, I hope you will find a solution!

As Dr. Bogdan so accurately explained, there are many factors that play into how flat your tummy will be after a tummy tuck. Some of these are limitations placed on the result by your body's starting point. Some patients have too much fat within the abdominal cavity to be flat until they lose that fat. The intraabdominal fat is not removed in a tummy tuck. There can be fluid collections (seromas) that can cause prolonged swelling and an ultrasound can determine if you have that. There could be some fat under the skin above the scar that used to be in the upper abdomen and could be removed with liposuction. Muscle repairs can come loose if the tissues weren't good or were too thinned out by pregnancy (this should be rare).
Finally, some surgeons are quite honestly better than others. Unfortunately, there are even surgeons who do tummy tucks who are not real plastic surgeons but don't tell the patients that disturbing fact. If you trust your surgeon, go back for another evaluation because your healing should be complete by now.