AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2700 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Education/Credentials Dr. Engler graduated from Yale University (undergraduate) and the College of Physicians and Surgeons of Columbia University (medical school). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York.
Question QUESTION: Hi, I am a 45 year old who had one c-section then a significant weightloss post lymes disease treatment (70 pounds) with minimal skin sag-then another pregnancy where i stayed in great shape and went V-BAC. I developed distasis hernia during that pregnancy, but was able with ab exercises to keep it in check--my stretch marks were quite marked and finally i decided on a mini-tummy tuck because i was in such good shape. After the initial surgery, i developed a huge seroma in the upper abs and dog ears on my scar--the skin was rather tight though--8 months later i had a revision that partially corrected the dog ears, some vulvar lipo to remove the protrusion that had developed and lipo on the seroma area where the dr. said he removed quite a bit of fluid and fatty tissue (though i had NEVER had any fat on my stomach before)...now i am 4 years out and the skin has never adhered to the stomach wall, i cant wear a bathing suit and i am noticing fatty pockets all over my stomach where none existed before--i eat right, exercise, massage my skin, my stretch marks are back and the skin is starting to sag again. I dont want to have another invasive surgery, but would love suggestions of other methods to either improve or eliminate this issue...i have ROLLS when i sit down and before my stomach was flat when i held it in with just some loose skin--any suggestions would be greatly appreciated! BEST regards and thanks in advance for your attention...Alex
ANSWER: from Dr. Alan Engler
www.bodysculpture.com
Hi Alexandra,
I'm sorry for the course you've had so far. I can't help but wonder if you wouldn't have been a better candidate for a full tummy tuck - in view of the 70 pound weight loss - than the mini, but that's beside the point at this moment.
It really comes down to how much extra skin you have, and where. If the excess is above the belly button, then you may need a full tummy tuck, even at this point; if it's below, you may now be able to get away with a mini (or modified; ie, a lesser procedure). But it's hard to think of something that can address the way you look now aside from a surgical procedure. I'm not aware of any other methods that can address the excess of tissue that you have now. Having developed the seroma to that extent means that your skin became stretched out again; it's similar conceptually to having gained and then lost another huge chunk of weight, and the skin has only a limited ability to contract.
So - no great suggestions, but to go back to square one and reassess the way you look forgetting the previous surgery that you've had. It may come right back to more surgery, however much you don't want that to be the case.
Sorry about that, but I'm not sure what else to suggest at this point,
Dr. Engler
www.bodysculpture.com
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QUESTION: Thank you so much doctor. You really explained to me WHY the skin that used to lay so flat on above my belly button is now stretched out--i never really thought of the seroma as stretching the skin, but ofcourse, you are right. Thing is, i have no more money for elective surgery, so i guess i am going to have to live with it, and i wouldnt want to go back to my first dr. anyway. Not that he was bad, its just the whole thing left a bad taste in my mouth. I am assuming then that things like laser lipo or thermage would not be appropriate? thanks again and thank you so much for answering questions for folks--so many PS sites are just rah rah for the surgery and no one wants to even mention the possible problems...
Regards, Alexandra
Answer Hi Alexandra,
I think it highly unlikely that laser lipo or Thermage can accomplish what you want, or even provide a significant step in that direction. I cannot, of course, say anything for sure without being able to examine you but, based on what you say and descibe, that's my sense.
