How to Fix a Bad Abdominoplasty with Revision Surgery

Though a vast majority of post-abdominoplasty (tummy tuck) patients are thrilled with their results for years to come, there are instances when some level of dissatisfaction occurs. 

From unsightly scars and uneven skin to asymmetrical results and misaligned skin flaps, issues stemming from surgical mishaps, post-surgical changes in body shape, or idiopathic causes can negatively impact results and leave patients heartbroken.  

If your previous tummy tuck surgery did not deliver the results you expected or left you with issues you never expected,  a revision abdominoplasty could be the answer.  

In this guide, I will cover common causes for post-surgical dissatisfaction, review the revision procedure, and go into detail about downtime, potential risks and challenges, and the recovery process.

Related Post: Dr. BB’s Guide to Belly Button (Umbilicus) Beautification And Abdominoplasty.

Understanding Revision Abdominoplasty

Revision abdominoplasty is a specialized type of surgical procedure designed to repair, correct, or improve unsatisfactory outcomes of a prior tummy tuck. Whether due to a poorly performed initial procedure or changes in body shape after the surgery, this follow-up procedure aims to correct the issues and enhance the appearance of your abdomen.

The primary goal of revision abdominoplasty is to remove excess skin and fat, re-tighten abdominal muscles, and address any scarring or contour issues from the first tummy tuck. It can involve a variety of techniques, including scar revision, liposuction, and muscle repair, depending on the patient’s specific issues.

Common Reasons for Revision Abdominoplasty

Reasons for revision surgery often include further liposuction, dog ears,  and unsightly scarring. The procedure may involve using the same incision as the original surgery or a new incision when necessary to achieve the most optimal results. 

Using these techniques to address prior complications is essential for achieving desired outcomes in revision abdominoplasty.

Many patients seek revision abdominoplasty due to unsatisfactory initial tummy tuck results. Dissatisfaction can stem from various factors, including a botched surgery, post-tummy tuck complications, scar visibility, poor wound healing, and changes in body shape subsequent to the original surgery. Understanding these reasons can help you determine if revision surgery is the right option for you.

Common reasons for undergoing revision abdominoplasty can be broadly categorized into three groups, each presenting a unique set of challenges and considerations.

1. Poor initial results
2. Post-Abdominoplasty Changes in Body Shape
3. Post-surgical complications

Common Reasons for Undergoing Revision Abdominoplasty 

Poor Initial Results

Lack of Liposuction

An abdominoplasty generally excises loose skin, repairs muscle separation, and removes adipose tissue (fat). When an abdominoplasty is performed without liposuction during the initial procedure, the results are generally not as smooth and attractive as they could be. Many times, these patients come back for abdominal liposuction. 

However, in cases where extensive liposuction is needed, the results can be less than ideal. The reason for this is that once the fat is removed, further loose skin may appear on the abdomen. A revision tummy tuck that includes liposuction may be the solution.  

Poor Scar Placement

It is crucial to place the incision correctly to achieve a good result. Placing the incision in a way that allows it to be concealed by normal clothing is important. It’s important to note, however, that healing processes vary from patient-to-patient. Excess scar tissue can be removed and carefully re-stitched to give it a more refined appearance during revision surgery.

Diastasis Recti (Muscle Separation)

Many new mothers and post-weight loss patients suffer from separated abdominal muscles along with loose skin. Also known as diastasis recti, surgical correction may be needed when ab muscle repair exercises fail to correct the problem. Signs of torn abdominal muscles may include a bulge on the front of the abdomen or abdominal weakness.

Misaligned Skin Flaps

When stitching the skin closed after a tummy tuck, the goal is to make the skin flaps line up perfectly. However, sometimes the initial surgery may result in uneven skin flaps, leading to an uneven scar that can be both aesthetically displeasing and uncomfortable. 

Revision surgery for an uneven scar involves carefully removing the old scar tissue and meticulously re-stitching the skin to ensure better alignment and a smoother, more natural appearance. This procedure not only improves the visual outcome but also enhances the patient’s comfort.

Belly Button Appearance

It is not uncommon for the belly button to have a strange appearance after abdominoplasty surgery. There are several reasons that can be the cause:

• Navel placed too high or too low
• Poor shape of the umbilicus 
• Raised scars
• Stricture (a narrowing of a passageway)
• Umbilical hernia

Most belly buttons are of an oval shape, not round. In addition, there is normally a small hood of skin at the top of the umbilicus. Though belly button shapes vary from person-to-person, it is these features that give the navel a more natural appearance after tummy tuck surgery. 

Inappropriate Surgical Technique

Not selecting the correct abdominoplasty technique initially can lead to unsatisfactory results, especially in post-weight loss patients. One of the most frequently encountered examples of this is when a patient is left with a significant amount of loose skin following a full or extended abdominoplasty that did not adequately address the extent of skin laxity. 

Fleur-de-Lis Abdominoplasty is a more comprehensive technique that allows for more extensive removal of excess skin, correctly contouring of the abdominal area, and ultimately provides the desired outcome that the initial surgery failed to achieve.

Read more: Exploring Fleur-de-Lis Abdominoplasty (Tummy Tuck)

Post-Abdominoplasty Changes in Body Shape

Significant weight gain or loss and pregnancy are major factors that can alter the results of a prior full tummy tuck surgery. These changes can affect the skin’s ability to retract, leading to the need for revision surgery. Weight fluctuations can result in more loose skin and affect the overall contour of your abdomen.

Subsequent Pregnancy

It is highly advised that patients wait to undergo a tummy tuck (abdominoplasty) procedure until their final pregnancy. However, life doesn’t always go as planned. If you had a tummy tuck when you were planning not to get pregnant again, but later changed your mind, you may end up with loose skin after that pregnancy all over again.

Though it is not normally dangerous to get pregnant after a tummy tuck, pregnancy will stretch the skin. And the risk rises with every year, as ageing skin has less elasticity. A revision abdominoplasty to remove loose skin after pregnancy is an excellent solution.

Re-gaining and Losing Weight

Significant weight loss (defined as 5 BMI levels) often results in loose skin around the abdomen, thighs, arms, and other areas. After undergoing a tummy tuck, it’s crucial to maintain a stable weight as fluctuations in weight can lead to skin stretching which does not retract on its own. 

If you’ve had a tummy tuck before reaching a stable weight and then continue to lose more weight, you may end up with additional loose skin. Revision abdominoplasty can help address the excess skin on the abdomen that occurs after further weight loss.

Note: Abdominoplasty (tummy tuck) surgery is not a replacement for weight loss surgery, the purpose of which is to address excess skin left after significant weight loss.

Touching up a Previous Abdominoplasty

As we age, our skin gets thinner, weaker, and looser, and produces much less elastin than it did in our youth. This is the case whether one has a tummy tuck or not. Though abdominoplasty permanently removes excess skin on the abdomen, it will not stop the skin ageing process.  For patients who’ve had a tummy tuck 10-20 years earlier,  a touch-up may be needed to tighten loose skin.

Minor tummy tuck issues, though still disconcerting,  can normally be corrected through small refining procedures while major tummy tuck issues often require a full re-do.

Abdominoplasty Dog Ears

Revision surgery is important not only for aesthetic reasons but also for overall health and well-being. An issue that can normally be prevented with proper planning and design, folds of skin that develop on the scar after surgery, known as dog ears, can be particularly bothersome and require revision. 

Similar to the appearance of a small dog’s ear, this condition occurs when excess skin is present at the ends of the incision. Correction of dog ears involves a simple removal of this excess skin. Performed under local anesthesia, this revisional procedure involves minimal pain, discomfort, or downtime

Excess Fat

One of the simplest issues to address, residual excess fat can be removed using liposuction. Small areas of fat can be removed under local anesthesia, while larger liposuction revisions are commonly performed under sedation.

Wound Healing Issues

Normally occurring because of poor blood flow issues related to the patient’s health, problems involving poor wound healing may require surgical repair.  

Pseudobursa

Two layers of scar tissue that form around a seroma,  a pseudobursa can be managed with liposuction or revision abdominoplasty.  If the pseudobursa is located near the incision, a minor revision will suffice. A large pseudobursa will often benefit from a full tummy tuck revision for complete removal and correction.

Belly Button Issues

Small belly button issues can occur due to poor healing or surgical design flaws. Though most belly button issues can be corrected under local anesthesia, larger belly button issues sometimes require a full tummy tuck revision or an umbilicoplasty combined with abdominoplasty.

Post-Surgical Complications

If you’re considering abdominoplasty, you may be weighing feelings of excitement against apprehension. Tummy tuck (abdominoplasty) procedures carry risks, from seroma and pain to blood clots and haematoma. Development of these complications varies based on several factors, including the type of procedure performed, medical history, and lifestyle. 

Infection

One of the most significant risks following an abdominoplasty, an infection may necessitate revision abdominoplasty surgery in certain circumstances, particularly when it leads to complications that cannot be resolved with non-surgical treatments.

1. Persistent or Severe Infection: When the infection doesn’t respond to antibiotics or drainage and poses a risk to the patient’s health or the surgical outcome.
2. Wound Dehiscence: If the infection causes the surgical wound to reopen or delays healing significantly, surgical intervention may be required to re-close the wound properly.
3. Necrosis: Infection causing tissue death (necrosis) may require surgical removal of the affected tissue to prevent further spread and to promote healing.
4. Seroma or Abscess Formation: If the infection leads to the accumulation of fluid (seroma) or pus (abscess) that cannot be effectively managed with drainage alone, revision surgery might be needed.
5. Scarring or Contour Irregularities: Infections can lead to excessive scarring, fibrosis, or uneven contours, which may require revision to restore the desired aesthetic outcome.
6. Implant Infection (if applicable): In cases where an implant (like mesh for muscle repair) becomes infected, it may need to be removed, often requiring a revision surgery.
7. Fistula Formation: Rarely, infections can result in an abnormal connection between the wound and an internal organ or the skin surface, necessitating surgical correction.

Haematoma

A haematoma (collection of blood under the skin) may require revision abdominoplasty surgery in the following situations:

1. Large or Expanding Haematoma

If the haematoma is substantial or continues to grow, it can place pressure on surrounding tissues, compromise blood supply, and increase the risk of tissue damage or necrosis. Surgical intervention may be needed to evacuate the haematoma and prevent further complications.

2. Persistent or Non-Resolving Haematoma

Smaller haematomas often resolve on their own with time and conservative management (e.g., compression and observation). However, if the haematoma persists or shows no signs of improvement, surgical evacuation may be required.

3. Infection

A haematoma can become infected if not addressed, leading to an abscess or cellulitis. If infection occurs, revision surgery may be needed to remove the haematoma and treat the underlying issue.

4. Wound Dehiscence or Tissue Necrosis

A haematoma can cause the surgical wound to reopen or lead to tissue death due to impaired blood flow. In such cases, revision surgery may be necessary to debride the area, remove the haematoma, and close the wound properly.

5. Significant Cosmetic or Functional Concerns

Haematomas can lead to contour irregularities, asymmetry, or visible lumps under the skin. If these issues are significant, they may require surgical correction during a revision abdominoplasty.

6. Impact on Recovery

If the haematoma impairs healing or causes prolonged pain, stiffness, or restricted movement, surgical intervention might be recommended to restore normal function and expedite recovery.

7. Timing of Intervention

Early Revision  : If identified within the first few days, a haematoma may be evacuated in a minor procedure rather than a full revision.

Delayed Revision: If the haematoma has resolved but left behind scar tissue, contour deformities, or other issues, revision surgery may be scheduled once the patient has healed from the initial procedure.

Seroma

A seroma (a collection of fluid that builds up under the skin after surgery) may require revision abdominoplasty in the following situations:

1. Chronic or Recurrent Seromas

If the seroma persists or recurs despite conservative treatments such as aspiration, compression garments, or drainage, revision surgery may be necessary to eliminate the underlying cause.

 2. Significant Fluid Accumulation

If non-invasive measures fail, a large seroma that causes discomfort, tension, or visibly distorts the surgical outcome may require surgical correction. 

3. Infection or Abscess Formation

If the seroma becomes infected and leads to an abscess, it will require drainage and possibly revision surgery to remove infected tissue and repair the affected area. 

4. Tissue Adhesion Problems

Seromas can develop due to improper adherence between tissue layers after surgery. If this issue is identified, revision surgery may involve creating stronger adhesion between the layers using sutures, mesh, or other techniques.

5. Contour Irregularities

In cases where a seroma causes noticeable contour deformities or asymmetry, revision abdominoplasty may be required to restore a smooth and natural appearance.

6. Fistula Formation

Rarely, a seroma can lead to the formation of a fistula (an abnormal connection between tissues or to the skin surface). This would require surgical intervention to address.

 7. Non-Resolving Cavities

Seromas may persist because of unsealed dead spaces where fluid collects. Revision surgery can eliminate these spaces by re-draping the tissue or reinforcing the closure with sutures or adhesive materials.

The Revision Abdominoplasty Procedure

The revision abdominoplasty procedure involves several steps, starting with a thorough pre-procedure evaluation, followed by the surgical techniques used during the procedure, and concluding with the recovery procedure. Each step is critical for achieving the desired outcomes and ensuring a smooth recovery.

Pre-procedure Consultation

It’s vital to select a reputable, skilled, and experienced surgeon to perform revision abdominoplasty, as this procedure can be more complicated than the initial operation.  A surgeon with a proven track record in revision surgeries can minimize risks and ensure positive outcomes.

As powerful as the result of a tummy tuck can be, poor planning, incorrect decisions, or just plain bad luck can lead to less-than-stellar results.

During your pre-procedure consultation, your surgeon will:

• Evaluate your Health: By conducting a thorough assessment of your overall health, pre-existing conditions, and risk factors will help to determine suitability for revision surgery.
• Take Photos: Photos provide the surgeon with a visual record of the patient’s appearance and assist in the documentation of specific areas of concern such as muscle separation or excess fat.
• Discuss Surgical Options: The surgeon will review your options and the techniques available to achieve the desired outcomes. 
• Outline Scar Placement: Additionally, the surgeon will outline the potential incision placement and potential for scarring. 
• Plan Treatment: Your surgeon will recommend a treatment plan and review the surgical approach, expected outcomes, and the recovery process. 
• Review Risks and Complications: Finally, the surgeon will detail potential risks involved and prepare you for possible complications that may arise. 

Revision Abdominoplasty Techniques

Revision abdominoplasty can be more invasive than the original procedure due to the complexity of correcting previous outcomes. 

Mini Abdominoplasty

Many new moms are unhappy with the excess skin on their lower abdomen following a cesarean birth. A mini tummy tuck is a less invasive and less expensive alternative to a full tummy tuck and also has a shorter recovery time. It’s no surprise that many women opt for a mini tummy tuck for these reasons. 

However, some women who initially choose a mini tummy tuck later wish they had opted for a full or extended tummy tuck to address more loose skin. In such cases, they may undergo revision surgery a few years after the initial procedure to achieve the desired results. It’s important to note that a mini tummy tuck only addresses lower abdominal skin and does not address loose skin on the upper abdomen. If you later decide to address loose skin on the upper abdomen, a revision Full abdominoplasty should be considered.

• Scope: Targets only the lower abdomen, below the belly button.
• Skin Removal: Limited to a small area of excess skin.
• Muscle Repair: Typically involves minimal or no muscle tightening, depending on the patient’s needs.
• Scarring: A shorter, low horizontal scar, usually easily concealed by underwear or swimwear.
• Ideal Candidate: Best for individuals with mild skin laxity and no significant muscle separation or excess skin above the belly button.
• Downtime: Quicker recovery compared to full tummy tucks.
• Limitations: Does not address issues above the belly button or significant muscle laxity.
• Revision Surgery Likelihood:
  • May require revision if skin or muscle laxity above the belly button becomes noticeable.
  • Higher likelihood of patient dissatisfaction due to its limited scope.

Full Abdominoplasty

A full tummy tuck (abdominoplasty) is a surgical procedure designed to remove excess skin and fat from the abdomen while tightening the underlying abdominal muscles. It typically addresses the area from the lower ribcage to the pubic region, improving core strength and creating a smoother, firmer abdominal profile. This procedure is often chosen by individuals after significant weight loss or pregnancy to restore their midsection’s appearance.

• Scope: Addresses the entire abdomen, both above and below the belly button.
• Skin Removal: Removes excess skin across a broader area, including from above the belly button.
• Muscle Repair: Includes significant tightening of the abdominal muscles (rectus diastasis repair).
• Scarring: A longer horizontal scar across the lower abdomen; may include a small scar around the belly button.
• Ideal Candidate: Suitable for individuals with moderate to significant skin laxity, muscle separation, or changes from pregnancy or weight fluctuations.
• Downtime: Longer recovery compared to a mini tummy tuck.
• Limitations: Does not address vertical excess skin or extreme weight loss cases as well as a Fleur-de-Lis procedure.
• Revision Surgery Likelihood:
  • May require revision if laxity persists above the belly button or muscle tightening is inadequate.
  • Lower revision rates compared to a mini tummy tuck, as it addresses more concerns comprehensively.

Fleur-de-Lis Tummy Tuck

The lower likelihood of revision surgery after a Fleur-de-Lis tummy tuck compared to a mini or full tummy tuck is largely due to the comprehensive nature of the procedure and the specific needs it addresses. 

Here’s why:

Targeted Skin Removal and Contouring

A Mini or Full Tummy Tuck focuses only on the lower abdominal area (mini) or primarily on horizontal skin laxity (full). These procedures do not address vertical excess, which might leave some areas inadequately tightened, potentially necessitating revisions.

Fleur-de-Lis removes excess skin both vertically (up and down) and horizontally (side to side). This dual-plane approach allows for a more tailored contour, particularly for individuals with significant weight loss, extensive loose skin, or unique body shapes.

Ideal for Complex Cases

Patients with massive weight loss or significant skin redundancy often require more extensive contouring. A Fleur-de-Lis approach caters to these needs better than mini or full tummy tucks, which might not sufficiently address all problem areas, leading to dissatisfaction or the need for further adjustments.

Comprehensive Muscle Repair

Fleur-de-Lis procedures typically include extensive rectus muscle plication (tightening of abdominal muscles), which improves the core’s structural support and reduces the chance of residual laxity that could demand revision.

Scar Considerations

While the Fleur-de-Lis technique results in more noticeable scars (a vertical scar in addition to the horizontal one), patients who opt for this procedure are generally prepared for this tradeoff in exchange for optimal results.

In contrast, some individuals undergoing mini or full tummy tucks may feel dissatisfied with the outcome if skin or contour issues persist, potentially leading to a revision.

Custom Fit for the Patient’s Needs

A fleur-de-lis tummy tuck is chosen when the surgeon anticipates that a more traditional approach might not fully meet the patient’s goals. This proactive decision reduces the likelihood of undercorrection, which is a common reason for revisions in less extensive procedures.

Read more: What Abdominoplasty Do I Need? Exploring Your Options.

VASER Liposuction

A revision tummy tuck revision techniques include removing excess skin and fat, retightening muscles and fascia, and using liposuction to remove residual fatty deposits. Dr. Beldholm uses techniques like VASER liposuction for effective fat removal, especially during tummy tuck revision surgery. Scar revision surgery aims to make a tummy tuck scar less noticeable.

Recovery Process

The tummy tuck recovery process after revision abdominoplasty usually requires a longer period compared to the initial surgery. Most patients can resume light chores in 2-3 weeks, but full recovery can take several months. Pain medication and antibiotics are typically prescribed to manage pain and prevent infection.

Wearing compression garments for six weeks post-surgery is essential for enhancing recovery and reducing complications. Avoiding strenuous activities for at least six weeks ensures proper wound healing and avoids complications.

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

Managing Expectations and Emotional Well-being

Managing expectations and emotional well-being is crucial during recovery. Patients often face fluctuating emotions like excitement, anxiety, and impatience during recovery. Professional support is recommended for those struggling to manage their emotions post-surgery.

Self-care activities and open communication with friends and family can significantly improve mood and emotional well-being. Realistic expectations regarding surgical outcomes are essential for maintaining emotional health.

Getting it Right the First Time

In an ideal world, everyone would get perfect tummy tuck results after just one surgery. Sadly, things don’t always work out that way. It’s these patients who are more likely to come in for a revision abdominoplasty.

Dr Beldholm’s Final Thoughts

I want to emphasize that revision abdominoplasty is a highly effective solution for addressing complications or less-than-satisfactory outcomes from a previous abdominoplasty. By understanding the common reasons for needing revision surgery, the intricacies of the procedure, and the potential risks and challenges, you can make a well-informed decision about your next steps.

Selecting the right surgeon is crucial for achieving the best possible results. My extensive experience in performing revision surgeries has shown me that with the right approach and support, patients can achieve the abdominal contour they originally desired.

Revision surgery, like all operations,  has its share of complications and challenges. One of the main issues that must be addressed is the original scar left from the initial surgery.  Further, if you are seeking revision with a new surgeon, it is hard to be 100% certain how the first surgeon performed. That can make revision surgery a bit more challenging. It’s very important to see a qualified surgeon that is experienced in revision abdominoplasty.

Managing your expectations and maintaining open communication with your surgical team are key factors in a successful outcome. Together, we can work towards achieving the results you hoped for, ensuring your journey towards a better abdominal contour is both safe and satisfying.

Frequently Asked Questions

What is a tummy tuck revision procedure?

Revision abdominoplasty is basically a second abdominoplasty aimed at correcting issues or enhancing results from a previous surgery. If your first surgery didn’t quite hit the mark, this could be the solution!

What does the revision abdominoplasty procedure involve?

Revision abdominoplasty involves evaluating your situation, using techniques like liposuction and scar revision during surgery, and a recovery period that can take a few months. It’s all about fine-tuning your results for that better look!

What are the risks of revision abdominoplasty?

Revision abdominoplasty carries risks like infection, anesthesia complications, and a greater chance of surgical issues than the first surgery. It’s something to seriously consider before going for it!

References

1. Impact of surgical consultation on outcomes in hemodynamically supported High-Risk percutaneous Coronary Intervention: insights from PROTECT II randomised study. (2016, May 1).
2. Kahramanca, Ş., Kaya, O., Azılı, C., Güzel, H., Özgehan, G., & İrem, B. (2013). The role of general surgery consultations in patient management. Turkish Journal of Surgery/Ulusal Cerrahi Dergisi, 29(1), 20-24.
3. Thilen, S. R., Woersching, A. L., Cornea, A. M., Lowy, E., Weaver, E. M., & Treggiari, M. M. (2018). Surgical speciality  and preoperative medical consultation based on commercial health insurance claims. Perioperative Medicine, 7. 
4. Sorensen, M. J., Bessen, S., Danford, J., Fleischer, C., & Wong, S. L. (2020). Telemedicine for Surgical Consultations – Pandemic Response or Here to Stay?: A Report of Public Perceptions. Annals of Surgery, 272(3), e174.