Upper Abdomen Skin Still Loose After Tummy Tuck? (photo)

Congratulations on your massive weight loss. You should be very proud of yourself having lost all that weight and significantly increasing your life expectancy. Six weeks after an abdominoplasty or tummy tuck is too early to determine the final results. I would continue compression with an abdominal binder or a girdle.  I would continue to watch what you eat. I would continue to exercise. After about four months from your abdominoplasty or tummy tuck, I would reevaluate your upper abdomen.  I believe your skin will contract and shrink wrap around your upper abdomen. If it does not,  there are surgical alternatives.  Based on your photos, I would suggest high definition VASER liposuction. This liposuction technique can create a six-pack on your abdomen and I believe would look great. If you still have excess hanging skin above your umbilicus, you may need an incision that goes from the lower sternum or xiphoid to the bellybutton .  This incision would pull the skin together and remove any laxity. Do not lose hope, but rather congratulate yourself on your weight loss and your reconstructive surgery after massive weight loss. Sincerely, Dr. Katzen

Bariatric or massive weight loss patients tend to have skin that is very loose with too much elasticity. This can lead to disappointment with the final surgical result. Your tummy tuck looks fine but your skin has now stretched back out. The only solution for this is to redo the tummy tuck removing more skin. There are several ways to do this with different incisions. Even with further surgery, you will probably never have very tight skin so don't be disappointed.

The photograph demonstrates significant laxity of the skin when the abdomen is flexed. The striae in the remaining skin bespeaks poor quality. Although not reported in the history, my guess is that the redundant skin leading to an abdominoplasty is a function of significant weight loss.

    While the redundancy in your midline can only be corrected with a vertical incision, you can always take more skin from a tummy tuck after you heal.  Realize though that this tends to raise the scar and pull the pubic area higher.   This may be appropriate for you, but the surgeon performed a nice tummy tuck.  Good luck.

There are multiple vectors involved here and as yur surgeon explained, your skin was tightened vertically (up and down). It was not tightened horizontally (side to side). This can be accomplished but it involves a long up and down midline scar. It can be done but you need to carefully consider the scar.

What you are describing and the results in the photos is a situation that is very common. I would advise you that the result is very good and it is true what your PS has told you about the limitations. There is no way to fully tighten the skin to the point that it's also tight when you bend down. Best wishes - Dr. Aldo.

The standing photo shows what looks like a nice outcome, but not revealed in the photo is the horizontal excess. A vertical TT would remove some of the excess, but the negative is a vertical scar that will be apparent. It will not completely remove the excess, and any forward bending at the waist will show exaggerated excess. This is true for all patients, but more noticeable in massive weight loss patients. 

Thanks, and best wishes. 

Thank you for the question and the photos. There is limitations to tummy tuck especially when performed after significant weight loss. The skin elasticity is somewhat reduced and the skin does not retract as much. You could have  vertical skin excision an option to tighten the skin in the midline. Best wishes.

Thank you for the question and pictures.

Yes, there are limitations as to what can be achieved with tummy tuck surgery given your history of significant weight loss and resulting loss of skin elasticity. Additional improvement of your surgical outcome may require additional surgery (for example vertical excision of skin),  with its associated downsides, risks/complications.

 I hope this helps.