6 months post-op - What is causing the bulge, visceral fat or sutures loosened? (Photos)

I recommend performing a Tc scan and then you can know if the muscle repair it’s open again, or if it’s fat that you need to remove with liposuction.

Dear Gorgeous8005,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello @Gorgeous8005, thank you for your question and showing you pictures. I understand your concern. It is important to take into account several aspects among which is the surgical technique applied, and to evaluate if there is something else at a systemic level. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD FACS

You need an examination to be sure, but I suspect it is visceral fat. I would suggest going back to your surgeon and being examined.

It's difficult to tell from your photos if the bulge that concerns you is visceral fat or insufficient muscle plication. If you lose weight and the contours improve then it was from visceral fat. If it doesn't improve then it may be the muscle plication. Unfortunately surgical intervention is generally needed in order to address that.

Hi, Gorgeous8005 ! Thank you for your question and photos.
Even if the muscles are repaired, sometimes the bulge can still be there, because of the increased intraabdominal pressure, as the visceral fat is still there. I would recommend you to loose weight, so the visceral fat will reduce and intraabdominal pressure will reduce. So your bulging will be gone most probably. Your scars are fresh, so it still needs time to settle. It is good that it hasn’t turned out to be a keloid.

Based on your photos, you have a very common deformity after a poorly performed muscle tightening, called "muffin top deformity" resulting from tightening the lower abdomen more aggressively than the upper while the reverse should occur, upper more than lower.
To address your concern, you need to redo your TT.You would likely benefit from a high definition tummy tuck using high definition VASER liposuction. The tummy tuck procedure would comprehensively remove excess skin and fat in the abdominal region. The abdominal muscle would also be 'tightened' to create the appearance of a flatter stomach. A Skype or FaceTime consultation with a tummy tuck specialist will help you get an accurate recommendation and pricing.

Respectfully,
Arian Mowlavi MD, FACS

There are three reasons someone’s abdomen will bulge after a tummy tuck.
The first and most common reason is excess visceral fat. This can almost always be detected preoperatively impatience with excess visceral fat should be told to lose weight before the procedure or they will bulge after muscle tightening.Your preoperative picture shows fairly clear evidence of excess visceral fat though sometimes muscle separation has a similar appearance. In your case this is almost for sure caused by visceral fat and weight loss should fix the problem. For individuals who have a High percentage of visceral fat substantial weight loss is needed for the intra abdominal contents to fit properly in the new smaller adamant created by the procedure.
The second reason for the abdomen bulging is people who are barrel chested. Barrel chested individuals often have bulging of the upper abdomen with muscle tightening. The muscle tightening will create a beeline between the sternum and the pubic bone. If the sternum sits significantly forward compared to the pubic bone then muscle tightening causes the upper abdomen to bulge more than the lower abdomen after the procedure. It doesn’t appear that you have around thorax or have a barrel chested body type.
The third reason for bulging after a tummy tuck is insufficient muscle tightening. This is usually rare.
I suggest you try weight loss first. Take comparison pictures at different weights and see if weight loss improves your abdomen. If it does then continue with the same until you’ve achieved the look you want.
Having excess visceral fat is in someways a contraindication to doing aggressive muscle tightening unless the patient can get control over there BMI and lose sufficient amount of body fat first.
Best,
Mats Hagstrom MD

Hi and welcome to our forum!From your photos, I note preoperative abdominal fullness and postoperative abdominal flatness. There is a transverse healing hypertrophic scar at the lower abdomen, and an apparent older anterior vertical midline abdominal scar. The muscle repair appears to be intact. There appears to be a small-moderate fat repository of the anterior upper abdomen vs. residual vertical skin laxity. A physical examination is required to differentiate. Both can be surgically corrected.Visit a board certified plastic surgeon for evaluation and discussion.Best wishes...