Tummy Tuck Revision

A tummy tuck can result in various unacceptable outcomes that can be secondary to a poorly performed tummy tuck or your intrinsic wound healing process, skin tone, and elasticity. Some of the most common causes of a revision of the abdomen after a tummy tuck are the following:

1. Umbilical distortion

   There are many ways in which the umbilicus can be distorted with a tummy tuck. Some of the changes that can occur after surgery are the following:

• Umbilical stenosis. This occurs when the umbilicus gets very small after surgery. The circular design of the umbilicus combined with the forces of wound contraction causes a decrease in the umbilicus size.
• Elongated slit look. This is the most common aesthetically unpleasant look after a tummy tuck. This results from excising too much skin increasing the tension of the closure. When the new belly button is created, the vertical pull of the skin causes the shape of the belly button to change from a round to an elliptical and elongated shape.
• Enlarged umbilicus: This can occur for various reasons including stretching of the skin in a radial direction due to an intrinsic laxity of the skin. It can also occur if the new umbilicus is not designed to a proper dimension. A belly button should be no larger than 1.5 cm in its horizontal as well as vertical dimension.
• Obvious scar around the umbilicus. If the belly button is not made deep enough, the scar around it will be very obvious.

2. Scar revision

   With any surgery, you will need to accept the scars. The scar’s final look and outcome will depend 95% on how you heal and the genetics of the scar formation. Now, there are certain maneuvers that the surgeon can do to make the scar look much better. Regardless, scar thickening and malposition, can be a significant problem. The scar should be located as low as possible. If the scar lies high in the abdomen, then, you will not be able to wear clothes as low as you might want. In addition, even though the scar might be low, it is not symmetric enough. One side can be higher than the other side, which can also compromise the look and the clothes that you might want to wear. Correction of scar malposition can be accomplished depending on the amount of residual skin and skin tone.

3. Residual deformities

   Most residual deformities after a tummy tuck are preventable. Some of the most common deformities are the following:

• Inadequate tissue removal
• Dog ears
• Residual fat deposits
• Epigastric bulging

   Inadequate tissue removal is most likely due to poor surgical planning. The skin overall elasticity is one of the most under-evaluated factor when removing the excess skin. The more elastic your skin is, the more skin needs to be excised while at the same time keeping a symmetric scar and also a low location of the scar in the abdomen.

   Dog-ears can be common if the amount of tissue removal is inadequate at the time of closing the scar on the sides. A dog-ear is the result of a significant lack of soft tissue excision, which allows the tissue to bunch on the sides. This condition can be avoided by performing liposuction on the sides and also extending the incision a little longer.

   Fat deposits can be very distressing for the patient. The most common areas that require revisionafter surgery is the mon pubis. If liposuction is not performed in this area, you will have a flat abdomen but an unsightly bulginess that will be aesthetically unpleasant. In addition, the flanks require extensive liposuction to diminish the waist line and avoid excessive fat bulginess.

4. Epigastric bulginess:

   Insufficient suturing of the abdominal wall muscles above the belly button can give you bulginess in this area that affects your abdomen negatively. Suturing the abdominal wall from the most inferior aspect of the chest to the lowest part of the abdomen can prevent this bulginess. In addition, the suturing needs to be done tight enough to prevent this aesthetic complication.

5. Unsatisfactory overall tummy tuck appearance

   In many situations, the tummy tuck has to be done again by elevating the abdominal skin and recreating the abdominal contour. Although this is possible, you need to be aware of the fact that the abdominal scar will be higher than normal because excess skin has been previously excised during the first tummy tuck.