A tummy tuck, also known as abdominoplasty, is a surgical procedure that removes excess fat and skin from the abdomen and tightens the abdominal muscles. While a tummy tuck can dramatically improve the appearance of the midsection, some patients are disappointed to find they still look slightly “boxy” or square-shaped afterwards.
What causes a boxy appearance after a tummy tuck?
There are a few reasons why a boxy or square shape may persist after a tummy tuck:
- Remaining fat deposits – Even with liposuction used during surgery, small pockets of fat can remain along the flanks or love handles. These areas can still protrude slightly and prevent the patient from achieving an hourglass silhouette.
- Bulky abdominal muscles – Some patients have naturally bulky abdominal muscles that are tight and boxy in shape. The surgeon can only remove excess skin and fat but cannot change the actual shape or contours of the muscle.
- Scar placement – All tummy tucks involve a long incision made across the lower abdomen. If the scar extends straight across, it can make the lower abdomen look rigid and boxy. A skilled surgeon will place the incision very low so it can be hidden by underwear.
- Swelling – Significant swelling and inflammation occurs after any major surgery. It takes several months for this swelling to completely resolve and the final contour to become visible. The upper abdomen in particular may appear swollen early on, adding to a boxy appearance.
- Poor abdominal muscle repair – Part of a tummy tuck involves tightening and repairing the separated abdominal muscles. If the internal sutures are not properly placed, the abdominal wall can still bulge outward and look boxy.
How long does it take for swelling to go down?
It’s normal to experience significant swelling and fluid retention for the first 4-6 weeks after a tummy tuck. Here is the general timeline for swelling resolution:
- First week – The abdomen will look severely swollen and distended. This is normal and expected.
- 2-4 weeks – Swelling improves gradually but the abdomen may still protrude and feel firm or numb.
- 1-3 months – Most swelling resolves but some subtle fullness may remain around the flanks and waist.
- 3-6 months – Remaining swelling continues to improve. Some patients see changes up to one full year later as the skin and tissues completely heal.
Swelling can be managed by wearing the compression garment as directed, getting gentle massage or ultrasound treatments, avoiding salt, and being patient as the healing process runs its course. With time the swelling will dissipate and the true contours will become visible.
What can be done to improve a boxy appearance after tummy tuck?
Here are some options that may help improve a boxy look after a tummy tuck:
- Wait at least 3-6 months – Allow time for all the post-surgical swelling to resolve before assessing if additional improvement is needed.
- Improve nutrition and exercise – Losing remaining abdominal fat through proper diet and core exercises can slim the waistline.
- Massage or ultrasound – Helps break up scar tissue and reduce residual fullness or firmness in the abdomen.
- Laser skin tightening – Can be used to further tighten and refine the skin around the midsection.
- Fat transfer – Injecting fat along the waist can help create a smoother, more hourglass contour.
- Revision surgery – In rare cases, a secondary tummy tuck is needed to address remaining fullness, loose skin, or poorly positioned scars.
Most patients are able to achieve their desired result within 6-12 months after a tummy tuck through a combination of time, conservative treatments, and healthy lifestyle choices. But for those who still appear boxy after the swelling has resolved, a surgical revision may be recommended.
What results can be expected from a tummy tuck revision?
The goal of a tummy tuck revision is to improve contour deformities and help the patient finally achieve their desired aesthetic outcome. Potential improvements include:
- Slimmer waist – Excising leftover stubborn fat pockets along the flanks.
- Less boxiness – Release of rigid scar tissue and proper suturing of inner muscle layer.
- Hourglass shape – Repositioning of old scars into a more natural curve.
- Symmetrical result – Adjustments to correct any asymmetry between sides.
- Smoother contour – Using liposuction or fat grafting to blend transitions.
However, there are limitations to even revision surgery. The surgeon cannot alter one’s natural rib cage structure or width. And risks such as scarring, fluid buildup, and wound issues can occur again. Realistic expectations are important for any secondary procedure.
What are the risks specific to a tummy tuck revision?
A revision tummy tuck involves many of the same risks as an initial abdominoplasty, including:
- Bleeding and fluid buildup (seroma)
- Infection
- Poor wound healing and wider scars
- Loss of skin sensation
- Asymmetry in results
However, some additional risks arise due to it being a second surgery:
- Higher chance of seroma occurring
- Thinned out abdominal skin more prone to tearing
- Difficulty elevating and redraping the skin flaps
- Damage to the abdominal perforator vessels
Revisions also tend to involve a longer and more complex procedure. This leads to increased anesthesia exposure, more blood loss, higher cost, and longer recovery. The surgeon must carefully evaluate if these increased risks are justified for any aesthetic improvements gained.
What is the recovery like after a tummy tuck revision?
The recovery process for a revised tummy tuck will be similar to the initial surgery but often more difficult. Here are some things patients can expect:
- Hospital stay 1-2 nights
- Drainage tubes 2-3 weeks
- Abdominal binder 4-6 weeks
- Activity restriction 4-6 weeks
- Pain and soreness for several weeks
- Swelling may persist for 6-9 months
- Potential wound separation or infection
- Slower return to normal activities and exercise
Having realistic expectations about the prolonged recovery time and following all postoperative care instructions meticulously will be crucial to smoothing the healing process. Patients should also be prepared for the possibility of needing a third revision if the desired cosmetic outcome is still not achieved from the redo procedure.
How can I maintain my results after a tummy tuck revision?
To help ensure lasting results from a tummy tuck revision, patients should:
- Wear compression garments as directed for several weeks
- Use silicone scar treatments religiously for 6-12 months
- Avoid weight fluctuations greater than 10lbs
- Maintain core strength via regular exercise
- Eat a balanced, nutritious diet
- Avoid behaviors that weaken the abdominal muscles like smoking, coughing, or heavy lifting too soon after surgery
- Be diligent about skincare and sun protection of scars
Considering a repeat tummy tuck revision if weight changes, pregnancies, or aging cause recurrence of abdominal laxity over the years. Avoiding significant weight gain through diet and exercise helps support optimal results long-term.
Will insurance cover a tummy tuck revision surgery?
In the majority of cases, insurance will not cover either the initial abdominoplasty or a revision procedure afterward. This is because a tummy tuck is considered an elective, cosmetic surgery by most plans. Revisions are occasionally covered when:
- Medically necessary to correct a serious deformity or functional impairment
- Part of reconstructive surgery after major weight loss or childbirth
- Needed to correct a major complication like wound dehiscence from the first tummy tuck
However, minor aesthetic concerns like a persistently boxy shape or small contour irregularities after a tummy tuck are not considered medically required improvements by insurers. Patients should speak with their surgeon’s office and insurance provider to understand their options for coverage and cost. Most will need to pay out-of-pocket for revisional abdominoplasty procedures.
Conclusion
A boxy or square abdominal shape is a common concern after tummy tuck surgery. Factors like swelling, remaining fat, and muscle anatomy play a role. Allowing time for complete healing first is advised. Non-surgical treatments can also provide mild improvements. But in some instances, a revision tummy tuck is recommended to comprehensively address a boxy contour and achieve the desired rejuvenated physique. This involves carefully re-operating to excise tissue, re-drape skin, and suture layers properly. It has added risks compared to initial surgery and an extensive recovery. Maintaining a stable weight pre and post-revision helps ensure optimal results are sustained long-term.