8 Weeks Post OP...Do I Look Swollen? I Have Gained Weight Again, And Have Excess Skin Still? (photo)

Although much of your post-op swelling has resolved by 2 months post-op, your scars are still pink and immature, and your abdominal tissues still have some lymphatic swelling that will gradually resolve over several more months. However, this swelling is relatively minor compared to the degree of residual protrusion you are showing in your photographs.

This can be due to several factors, including one commonly not considered by patients--residual intra-abdominal fatty tissue. In most tummy tuck patients, the abdominal skin is loose and the muscles stretched (usually from pregnancy, but also after massive weight loss or other causes), and a tummy tuck will tighten the muscles (plication or muslce "repair") and remove the excess skin. This also involves a new skin opening for the umbilicus (causing the scar you and most patients have with a full tummy tuck) and the hip-to-hip scar. The abdomen is flatter because of the tighter abdominal "container," as well as the tightened skin/fat flaps. The thinner you were pre-op, the thinner the subcutaneous fat layer beneath the skin.

Let's say, however, we have a patient who carries a lot of "extra" weight not just in her subQ fat, but also in her abdominal contents (mesenteric and omental fat) and has a rounded or protruding belly on this basis. A tummy tuck in this kind of patient will end up failing to create a significantly-flatter abdomen because of the intra-abdominal contents trying to be squeezed into a tighter (muscle-tightened) abdominal container. Sort of like trying to put a 12-gallon head into a 10-gallon hat! It won't fit, and the same problem occurs with tummy tuck patients with excess INSIDE fat--either the muscle repair tears through, or the attempt to tighten the abdominal wall just doesn't work that well against the tension of the intra-abdominal contents. It does look as if you still have a bit of loose skin, but that is not the reason for your protruding abdomen.

It's either the scenario I discussed above regarding your "inside-the-abdomen" contents (which your surgeon should have addressed in the pre-operative evaluation, and discussed with his/her recommendations), or it's loss of plication sutures (tearing through). Or perhaps both:( 

You could still have some excess skin and fat, but this degree of protrusion is usually one of the two things noted above.

In a few patients, constipation and/or bloating can cause this degree of protrusion, but you would certainly be aware of difficulties in this department, and then the "fix" is relatively easy.

Seroma is unlikely at 8 weeks, but this too is something your surgeon can easily diagnose and treat.

Bottom line--go see your surgeon and see what is going on. It would be wise for you to see your pre-operative photographs as well. Ask your surgeon or his nurse to see them. This may help you understand the answer! Best wishes!

Thank you for submitting your question. Swelling after a full abdominoplasty will last for many weeks after surgery.  Final results take 6-12 months. Some patients with excessively lax skin may develop laxity after surgery. Rest assured if the laxity persists in 6-12 months, a revision can be performed. Discuss concerns with your Plastic surgeon.

In eight weeks you should see the major difference.  You will have some changes but minimal in my opinion.  I would like to see your abdomen flatter and tighter.

Swelling is common at this stage of recovery. Tips on swelling:wear your compression garment as advisedcut back on sodiumdon't sit around all day - walk around to promote circulationdrink plenty of water and go to the washroom regularlyThis doesn't look like it will be your end result. It's way too early to see that, yet.

If you were made of cloth those lateral ripples would never go away.  But your skin has an elastic quality to it and over time these generally smooth out. You are still very early in the post operative healing period.    From your photos it appears that you will get a nice result.   Your plastic surgeon is in the best position to understand your surgical procedure and judge the result based upon your pre-operative anatomy and condition.  

Based upon the posted photos you do look swollen. Or the muscle repair failed, or there is a seroma/hematoma. Best to be seen ASAP. 

At this point, most swelling would be resolved but it can still get better for up to 1 year. Without seeing your "before" picture, it is hard to say how much improvement you gained. Discuss your concerns with your plastic surgeon.

Your abdomen is quite prominent for two months after tummy tuck, and most would agree we would prefer a better contour. Swelling to this degree is unlikely at two months. Try to check how things shift when you are flat on your back. If your abdomen is flat in this position and no longer convex then the issue is poor muscular tone and a less than effective rectus repair. If you can pull your stomach in then posture and strengthening may help.
Best of luck, peterejohnsonmd.com

At eight weeks out, most of your swelling has faded, but you should still expect a significant amount to resolve in the next year or so. 

In looking at your pics, you seem to be rounded. Are you constipated?  Did you have trouble on waking from anesthesia (i.e., popped sutures).  Although more improvement is expected, I am not sure you will get a significant improvement to make you happy, but only time will tell.  Do have a frank discussion with your ps.

sek

Thank you for your question and photos. 

As always, it is best to be seen in person ( by your plastic surgeon) for precise diagnosis and treatment.

Abdominal wall "swelling" after tummy tuck may be related to:

1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.
4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.

I hope this helps.