“Other surgeons say it’s a complicated revision.”
That quote comes off a RealSelf question I received this summer from someone who’d had a diastasis repair and still wasn’t satisfied with the appearance of their belly. I could have pulled that sentence out of a half-dozen other messages I get, too.
For most patients a tummy tuck is a one-and-done kind of deal, but revisions do happen. And the questions people ask me about them fascinate me, because they reveal things that tummy tuck brochures won’t.
Five such questions, then, lightly edited for publication and stripped of any identifying information (three are from this year, one from 2023 and one from 2019), along with my answers, also slightly adapted for the page.
“My diastasis was repaired and I still bulge. Is muscle re-tightening worth it?”
Answered on RealSelf, Jul 2026.
Often when patients have pregnancy or go through gaining and losing weight we stretch not only the separation between the two muscles called diastasis but also stretch the entire abdominal wall fascia (the connective tissue that is attached to and supports the muscles). Core exercises can help strengthen the muscle but will not address the laxity of the fascia. From your pictures it looks like you may still have laxity of the fascia. Sometimes this is hard to appreciate because when you are laying down it appears much better. It also looks like you still have a little bit of extra fat (this layer of tissue sits between the skin and the muscle called subcutaneous fat).
I would consider a revision to address these areas of concern. When I perform tummy tucks for patients that have previously had a repair of the diastasis I will do what I call a triple plication. This involves plicating the fascia from the sternum (breast bone) down to the pubis to bring the two rectus muscles and their fascia back together, and plicating the oblique muscles and fascia to the lateral edge of the rectus muscles. This essentially creates an “internal corset” or “waist trainer.”
“A revision tummy tuck five years later: what is my risk of necrosis?”
Answered on RealSelf, Jun 2026.
The biggest risk to flaps is not reopening a tummy tuck. The biggest risks are nicotine (even small amounts from a patch, gum or vape), uncontrolled diabetes, aggressive undermining of the flap, aggressive liposuction of the flap, and closing too tightly. Delay actually helps the blood supply!
If a patient is healthy, nonsmoker etc. The risks go way down. I would avoid nicotine for several weeks before hand, eat a protein rich diet as recommended by your doctor, avoid gaining weight between now and your procedure. I would discuss with your doctor making sure the entire flap is not aggressively undermined or liposuctioned at the same time.
“Eight months out, my belly button started draining a little smelly fluid. What should I do?”
Answered on RealSelf, May 2026.
Delayed drainage from the belly button after an abdominoplasty can be from a number of causes. In my experience most commonly this represents a stitch abscess from an infected permanent suture that was placed during the plication of the muscles. Other times there can be a cyst or sinus that forms around a permanent suture that was placed in the deeper layers. Less commonly there can be a more chronic infection in the deeper layers around the area where the muscles were repaired.
Management is dependent on the cause of the drainage but antibiotics alone are unlikely to resolve the problem. Most of the time identifying the cause and removing the permanent suture or draining or excising a sinus or cyst will resolve the problem. See the surgeon who did your procedure for an in person evaluation.
“Almost eight years after my tummy tuck. Do I have dog ears?”
Answered on RealSelf, Dec 2023.
Without preoperative photos and an in-person exam it’s difficult to comment. From your description, it sounds like you have some fullness (combination of skin and fat) at the ends of your tummy tuck scar. Hip dips can accentuate this fullness. Liposuction can help contour the area by removing fat, but fullness from skin cannot be liposuctioned away.
Often in these situations a revision operation lengthening the tummy tuck scar to remove skin is recommended to optimize the waistline contour. Hip dips can also be treated to optimize the hip and waist contour. Fat grafting is sometimes helpful in these situations as well.
“Tummy tuck revision or just lipo?”
Answered on RealSelf, Jan 2019.
Photos don’t show enough information to determine if you have mainly fat that you can pinch in your lower tummy (liposuction could be enough), or if your tummy is firm and there isn’t much you can pinch (plication may be indicated). I would revise the entire length of the scar as well as the dog ear on the left and the fold on the right to make it thinner and better looking.
Your previous surgeon did well keeping the scar as low as possible so that it could be covered by your undergarments. This can make it look like the belly button is a little high. The belly button position can’t be changed up or down much more than a centimeter in a tummy tuck as it’s still connected to the abdominal wall.
What I Would Tell a Colleague
Don’t forget that the midline rectus diastasis repair is not the whole abdominal wall. That fascia that you see stretched out lateral to the rectus muscles? Plicate it (oblique plication) and your patient will notice the difference in their contour.
Don’t be afraid to go back and revise a flap. Five years down the road, your flap’s blood supply will be coming from the sides and be well established. Your flap won’t necrose from reoperation, it will necrose if you do too much lipo on top of that, if your patient smokes, if you put too much tension on closure, etc.
Bulges happen. Make sure you know where that bulge is: have your patient stand up, crunch, pinch that bulge, do an ultrasound to make sure there’s no fluid collection. Then you’ll know if it’s amenable to lipo, needs a plication, needs an extended incision, or just needs a suture taken out.
The full set, including the 15-month bulge after a mini tuck and the c-section shelf, is in the surgical version of this roundup on Agullo Plastic Surgery, and the procedure itself is on the tummy tuck page. Earlier posts cover what lipo and a tummy tuck cost, panniculectomy versus tummy tuck and my three rules for recovery at home.
Why Choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, did my plastic surgery fellowship at the Mayo Clinic, and teach as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Many of the tummy tucks I do are revisions of surgery done elsewhere, in the US and in Mexico.
Ready to Talk?
Call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com/appointments. More of my answers are on RealSelf. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.