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Plastic Surgery/a theory about too tight TT. Can it be true?

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Expert: Alan M. Engler, MD, FACS - 6/22/2009


Question

don't know that these
Had my kids at home, suffered from migranes, fell 10 feet straight down..tore ligaments in my leg needed 1 year of physical therapy. I did physically hard work for 20 years of my life. I know pain, discomfort and am not a sissy.

I'm 65..went in for a "not tight" tummy tuck. I just wanted all the loose skin removed. The rest of me is saggy so I wanted a match. I ended up with a super tight job...skin and muscles for the first 3 months.I could barely stand straight ten days after surgery and that's only if I clasped my hands behind my back.  And six months later, the muscles still hurt somewhat..feels tender. Skin below the line of tummy tuck (hip to hip) area 4-5 inches wide it feels like someone's sewing machine got away and it was overstitched -very tight. For four 1/2 months I could not turn over in my sleep without waking up from the pinching/pain of skin or underlying muscle. It feels like I'm wearing too tight pants  cutting into me all the time. But it doesn't look like it.

Upper & lower looks good when I'm standing up, but if I lean forward an inch..the upper abdomen starts sagging and if I bend over more it falls away. The skin seeming looser and poochier than before surgery.. It's also all wrinkly (worse than before)...on one side there is a circle of 4" diameter that is flat and adheres well (like my lower abdomen)...it seems the rest of the skin did not adhere to the underlying fat like the lower abdomen. Plus when I sit down wearing clothes that are not tight at all (I've always hated tight clothes) my upper abdomen hangs over my belly button -while lower part is flat...have those same rolls as before the surgery.  I believe that my skin over attached in some areas and not at all in others because I could not straighten out during my healing. I do stretches everyday to try to loosen my lower tight area..but it still feels like my skin is going to rip apart when I stretch to get a glass off a high shelf. I don't feel free in moving, walking, to dance to do yoga. I used to walk 5 miles a day. That's irritating to do now. Is it possible that lipo for the upper problem coupled with this time wearing a garment will fix the looseness on top so the skin can adhere properly.  And is there a way to separate the skin tight on my hips ...so it can re heal too. There's really no fat there to lipo.

I did not have lipo with TT because at my age I really didn't want to go through more pain.

Thank you for reading this e-mail.
Best Wishes...Dottie   Please do not use my full name anywhere.

I am going to see my doctor on Friday...I have waited 6 months before complaining..because that supposedly was the witching hour.

Answer
from Dr. Alan Engler
www.bodysculpture.com

Hi Dottie,

It is very difficult for me to say for sure what is happening but it sounds to me like you're basically correct in your assessment.  Much of the lower tissue (below the belly button) has adhered to the underlying muscle and fascia to a greater degree than the upper tissue has.

It's hard for me to explain the pain you're having though it sounds like it's getting better.

But the larger issue is what to do about it and, ironically, it may actually make sense to have a little lipo of the areas that have not adhered well.  I suspect that that's because there was relatively more fat there, or left there, that prevented it from healing as tightly as it might have.  The problem with this is that you may have a little excess skin there after the lipo - at 65 there is not typically maximum elasticity of the skin (nothing personal, of course).

You will obviously have to discuss all thing with your PS.  It can be  difficult to get all of the abdomen to adhere since that depends on what your anatomy was like beforehand.

Again, I'm sorry that I don't have any magic words of wisdom; hopefully your PS will be able to provide a simple and acceptable solution to get you where you want, and wanted, to be.

I hope that this helps, and good luck,

Dr. Alan Engler
www.bodysculpture.com

Alan M. Engler, MD, FACS

Expertise

Dr. Engler has answered over 3100 questions as a volunteer expert for AllExperts. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, skin cancers, cysts, 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"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is www.bodysculpture.com. Thanks for "Likiing" Dr. Engler on Facebook - http://www.facebook.com/pages/New-York-NY/Alan-M-Engler-MD-New-York-Plastic-Surgery-and-Aesthetics/107206405967267?ref=ts&__a=8

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 (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). 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, and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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