Hello trestar614. Thank you for your question regarding whether the pouched look 4 weeks after a tummy tuck is just swelling. At four weeks post-op, it is quite common to experience swelling. Swelling can persist for several weeks to months after a tummy tuck, which can cause the area to appear pouched or bloated. This is a normal part of the healing process as your body adjusts and recovers from the surgery. However, it's important to continue following your surgeon's post-operative care instructions, including wearing compression garments, staying hydrated, and avoiding strenuous activities that could exacerbate swelling. If you have any concerns or if the swelling seems excessive or is accompanied by other symptoms like severe pain, redness, or fever, it is crucial to reach out to your plastic surgeon for an evaluation. Patience is key during the recovery period, and in most cases, the swelling will gradually subside, and your final results will become more apparent over time. Good luck, and I hope this helps answer your question regarding swelling and the pouched look after a tummy tuck. Sincerely, J. Timothy Katzen, MD, FASMBS, FICS