This is VERY Normal to have the mons become swollen, bruised and enlarged following abdominal surgery.  Everything drains downward and the catch all is the mons. This area will often become enlarged and discolored and stay that way for quite some time.  You also can have a vessel in that area bleed a fair amount with the placement of the drains.  This is very common and will fully resolve.  If you had liposuction of this area, it is more likely to have manifest swelling.  Hardness would reflect either clotted blood or scar tissue inseting following the liposuction.  In all cases, it will resolve.

Pain control following any procedure is critical. I recommend the patient’s take Ibuprophen 800 mg every 6 hours and add to this 1-2 Vicoden or equivalent narcotic as needed. The Ibuprophen will reduce the need for the narcotic by up to 50%.  It is important to be up and moving and control the pain well. The pain will resolve on it’s own.

You can start massage to the area of hardness in 2.5- 3 weeks following surgery/ or drain removal (which ever is last) if your doctor agrees with that.

Good luck!

At this point, 2 weeks following abdominoplasty & liposuction, you can expect to have ongoing swelling and limited contraction of the skin in the treated areas.  The swelling will not be able to drain adequately as the entire lower abdominal wall flap has been cut and your body has not reestablished the lymphatic drainage yet.  My recommendation is to wear your abdominal garment ( I like Design Veronique as they have very uniform compression with an opening to go to the bathroom) as much as possible for 6 weeks to 3 months ( which ever your doctor recommends).  This will help to eliminate the dead space, reduce swelling and help the tissue to adhere down and contract uniformly.  You will see the worst of the best at 6 months.  The body lays down internal reactive tissue to help the healing and scarring of the operated areas in the 1st 6 weeks and then takes a break for 6 weeks, so between 3 months & 6 months you will see improvements in shape, decreased edema formation etc.  It takes a full year to see the final result.  I recommend you focus on eating lots of protein and let the tissue contract and try not to judge the  result or expect marked change for 3 months post op.  Your body takes time to induce the contraction of the tissue.  If you still feel that things are just not right at 8-12 months, consider revision with  your doctor.

The result of the abdominoplasty is not negatively affected by having extra weight and will only improve with ongoing weight loss.  You do not need to achieve your ideal weight prior to surgery. The surgery itself has a remarkable result and will improve your self esteem, allow you to see the benefits of your exercise and is often helpful for exercise because you are carrying less tissue and exercise is easier.  If you look at our pre and post op photos on our web site you can see the remarkable difference that the surgery will create.  This is truly inspiring for many patients or allows patients to engage more enthusiastically and successfully.  That tissue below the umbilicus/belly button, is the area which tends to accumulate most of the fat.  By tightening the muscles, the front -to back / side view is narrowed.  To lose weight after abdominoplasty will thin the flap that remains and the result will only improve.

In general the markings for the tummy tuck may vary from surgeon to surgeon.  I like to have the patient bring in their favorite bikini or undies to the surgery so that the markings can be placed to end up within this area.  What has to be understood is that skin and fat of the tummy is being removed from the belly button to the pubic area. The upper belly skin/fat flap will be stretched down to the incision.  This may cause the incision to rise up a little during the healing process.  This does add a tiny bit of variability and the potential for the scar to rise a little.  Typically this will still be within the area of the bikini.  However, if the scar is a little high, it is possible after a year to lower that scar further down.  This is done on people who have had scars placed too high by another physician, or whose style has changed over the years with new positions of the bathing suit as fashions change.  This is a very important issue to be considered. It is very important that you look at the results of the doctors you interview to be sure you like the position of the scar with the technique that they choose.

Your photos are too dark to see.In general if you have not had kids you typically have not had stretching of the fascia between the muscles.  If you do sit ups- the muscles are usually well aligned as well.  Physical exam will determine if the muscles are aligned in the midline and need to be tightened.

My favorite compression garment is by Design Veronique.  I am very particular about my garments because I believe it is very important for the area of surgery to have uniform compression but not too much compression so the flap of belly skin can re-establish a good blood supply. The garment will also provide comfort and stability to the entire belly which will be appreciated for the first 3-6 weeks post op, especially as the nerves reestablish and become hyper sensitive to motion.  The pain is less also if the swelling is minimized.  I recommend you call the company directly and talk through exactly how to do your measurements with them, and allow them to recommend the best size according to your preoperative measurements. By doing this, typically your garment is correctly sized, and if not,  they will replace it, since they made the recommendation.  Although there are hundreds of garments on the market- they do vary in quality and style.  Regarding quality, I have yet to find a garment that provide uniform compression, ease of use, a bathroom opening and ease of closure as good as the Design Veronique.   I have seen patients with cheaper garments that develop bulges of swelling in the areas around the surgical site which add concern and delay in a nice end result.  A uniform compression garment will also limit the potential ring of compression and deformity in the the surgical area that could happen from the waist band of the pants worn post operatively.  The garments which extend to the upper thigh are easier to use and more comfortable than the ones which end at the groin.  The garment should have an opening to go to the bathroom so you will not have to take the garment on and off.  Also, I like the designs which have a uniform central flap which clips on both sides so central flap does not have any zipper that may compress on the surgical flap (the belly).  This design is easier to close and makes it possible for the patient to work with without help.  I like black garments because they can be washed and do not show any blood stains that may be present.  Typically I have my patients get the style which extends to just below the breast, unless they are having a breast procedure as well.

I hope you have showed this to your surgeon already, if not, you should.  Any time there is redness you want to be seen right away because if this is a small infection you want to get it treated with antibiotics immediately.  You can have the open area swabbed and cultured for bacteria.  It is not unusual to have a little area which separates or a stitch that spits, but it does need to be treated properly to have it heal as effectively and quickly as possible by starting the correct treatment as soon you can.  Most likely it is a suture which your body has not broken down so it is trying to spit it, however, never assume anything and go to your doctor!

You can lose weight either before or after the surgery.  You have excess skin both above and below the belly button and you appear to have a separation of the muscles of the belly due to the stretching from pregnancy- this is called a diastasis of the rectus abdomens muscle which causes you to have a wider dimension from front to back.  In order to pull these muscles together, you need to elevated the abdominal skin flap from the pubis to the rib cage.  Only with this repair will the width of the body be made narrower from the side view.  It does not help you at all to lose weight before the surgery but may make it better for the surgeon.  I don’t think it really matters if you lose weight before or after. I have patients who do both and they all benefit from a well done abdominoplasty regardless. You may however find that if you lose weight and do sit ups you will not feel you need any surgery at all.  The sit ups will help the rectus abdominus muscles to come closer to the midline and pull  your belly inward and since you do not have a huge overhang, weight loss may be all you need.  The issue is really, are you up for it?? Your entire body will look better as well and you will feel better about yourself. Good luck!

The most likely reason for the thin skin is that this area was very stretched during pregnancy around the belly button which has no fat to begin with.  The result is good and you are healing very well.  The dog ears can only be treated with excision.  I would caution against fat grafting because this is very expensive, leads to potential irregularity and the result can be very unreliable.  If it bothers you a lot I would recommend you consider advancing the flap further down as much as possible.  You could excise the skin but this would leave a vertical scar which with your healing may not be too bad, but vertical scars typically heal much worse than the transverse scars.  If you take out the stitch you may have a separation of the diastase repair which could also cause irregularity of contour.  But you could find out what type of suture was used. Some, like Prolene are hard and more easily palpable, whereas others are softer and could be less bothersome, such as Ethibond. So if you do not have a soft suture, you could replace it with a soft, permanent suture.  The dense area are likely fat which reestablished the blood supply slowly because they are at the end of the flap.  These can be excised if you re-advance the flap, but I would recommend deep massage which would break down the scar and allow the areas to remodel, flatten and desensitize. Lot’s of options!! Best to go back to your doctor to see if your doctor has ideas for a revision that can be done to resolve the problems.