Lower Abdomen Pooch After Tummy Tuck

After my Tummy Tuck 9 months ago, I still have a pooch in my lower tummy. I can suck it in, but it is still noticable. I know there is no muscle damage or separation because it is still very firm. Is this an area that will need Liposuction? The pooch is pretty much along my incision line. Can it still be just swelling?

Doctor Answers 5

Lower abdominal pooch after tummy tuck

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!

Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

Lower abdominal bulging after a tummy tuck

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:

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 101 reviews

Bulge above tummy tuck incision.

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

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Not all tummies become totally flat from a tummy tuck

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.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Lower abdominal fullness

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

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.