I hate my results, what do I do? $21,000 later (Photo)

Without a formal exam, there is a chance I stand corrected, but you were never really a good candidate for a tummy tuck because of excess intra-abdominal fat deposition, aka visceral fat. This fat is inside your abdomen and behaves like a stent, preventing abdominal flattening normally seen with abdominal wall tightening. This is something that should have been diagnosed and discussed prior to surgery. With regards to execution of surgery, there was no reason to stage liposuction, which should have been performed at the time of the tummy tuck. Finally, it's clear that deflation in the waist/hip area from liposuction created a functional excess of skin in the region, which necessitated a longer skin excision around the sides. My recommendation is weight loss (that is the ONLY way to reduce intra-abdominal fat) prior to any consideration of a revision tummy tuck.

Hello and thank you for your question regarding what to do after back and flank liposuction.

If you were dissatisfied with your results, I would suggest focusing on further weight loss. I recommend aggressive diet and exercise regimens, coupled with weight loss medications such as Ozempic and Zepbound. These medications have been proven to be effective in eliminating visceral fat, which may be contributing to your concerns.

I believe that most of your fat accumulation is likely due to visceral fat, rather than significant subcutaneous fat. With additional weight loss, you can expect to achieve excellent results. Once you've shed perhaps 15 to 20 pounds, you may consider additional liposuction or even a back lift procedure. A back lift can be performed horizontally across the back or vertically from the armpit down the side.

Losing more weight will significantly improve the appearance of your abdomen. I hope this addresses your concerns regarding post-liposuction recommendations.

Sincerely,

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

There is no doubt that in experienced hands you can expect significant improvement. Combination of revision abdominoplasty to correct skin redundancy and liposuction would be my recommendation. A weight loss is always beneficial. Good luck.

Thank you for your question and photos. I sympathize with you and agree that your results are not good. I believe the main reason is that you were not a good candidate for a tummy tuck in the first place. Your surgeon should've told you that and explain what you could expect. First, you do have lots of intraabdominal fat also known as visceral fat. The omentum or fat apron that drapes over your intrabdominal organs is thick. You should've been warned that you will not achieve a flat abdomen. Second, the liposuction you had is suboptimal. Third, your incision is very high and you are also left with a large pubic fat pad. Fourth, the umbilicus looks like a "Target" sign.
You ask what you can do going forward? I would suggest loosing weight, to get your BMI 25 or below. The next step would be redoing your whole body contouring with a full tummy tuck, lower your incision to the pubic bone level, remove the pubic excess skin and fat pad, VASER liposuction 360 degrees and redo your belly button. All this will not be cheap, costs will be 20-25K+. Do not fall into the trap of little "touch ups" or revisions. These will be disappointing, cost more money (again, badly spent) and will not give you the desired results. As a Total Definer surgeon, I do these surgeries in our certified office surgical suite under deep intravenous sedation.
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

You have, at least on the one view, a small dog ear which can easily be trimmed. You have internal fullness which is addressed with weight loss. However, EMSculpt can also be done to help address the muscle and encourage some fat reduction internally.

From the submitted photos it does appear that the liposuction contoured your back and the tummy tuck removed excess skin and corrected abdominal wall laxity. There are some small dog ears that could be addressed to improve the results. It appears the abdominal contour is related to visceral fat, which is the internal fat behind the muscle wall. This is addressed through weight loss as liposuction nor a tummy tuck can lessen it. I encourage you to discuss your concerns with your surgeon.

Plastic surgery outcomes are generally based on the patient’s candidacy for the procedure combined with the skill and the experience of the provider. Understanding your own candidacy for the procedure is an important part of understanding what your potential outcome is going to look like. There are four tissue variables that determine what the abdomen looks like. In other words, if somebody doesn’t like the way, their belly looks it is always because of one or more of four different tissue layers.
The four variables that determine what the abdomen looks like are as follows.
1) abdominal skin laxity due to previous pregnancies age or weight loss2) excess subcutaneous fat3) muscle separation from previous pregnancy4) excessive visceral, or intra-abdominal fat
A full tummy tuck primarily treats, abdominal skin, laxity, and muscle separation. For that reason you can rule out those two variables. Subcutaneous fat may be removed with liposuction and is usually reduced by pulling the skin and fat layer tight just like a rubber band becomes thin when it’s pull tight. That leaves as being the single variable which is causing your abdomen to bulge.
Obesity and weight loss are the problems and weight loss will fix the issue. there is no surgery for excess visceral or intra-abdominal fat so revision surgery isn’t going to help you without weight loss.
Differentiating these variables and making an accurate assessment, for each person is fairly straightforward and plastic surgeons should be able to differentiate all of these variables and help patients understand their own candidacy for the procedure during consultations. Individuals who have access visceral fat should be told that they may not have a flat abdomen without weight loss during the consultation. Visceral, fat and muscle separation can have similar appearances before surgery. Differentiating the two is fairly straightforward and can be done by any experienced plastic surgeon.
Successful weight loss will improve your results substantially.
I suggest taking a set of baseline pictures. Work on weight loss and take reference pictures with each quantum loss and weight. For example, if you lose 10 pounds that take a set of pictures and keep doing this for every interval of weight loss achieved. You could then have a good understanding of what your results look like based on each weight. You’ll eventually get an understanding of where you need to be weight wise to have the desired outcome.
Unfortunately, surgery cannot correct excess visceral, fat or modest obesity.
Best,
Mats Hagstrom, MD