NOTICE: Ask Dr. Garcia is intended for educational and discussion purposes only. It does not constitute a formal medical evaluation nor consultation. No doctor-patient relationship has been formalized by this communication. If you desire such, please feel free to call and schedule an appointment. Otherwise, please be advised that all information that has been given here should be cleared with your primary care physician before changing or instituting any therapy. Explanation of off-label use of substances may be discussed here in but does not reflect an endorsement nor promotion of such off-label use. All responses are done personally by Julio Garcia.

• I had an ETT 6 months ago and my skin is getting loose and I have a muffin top. My doc told me an ETT would remove all the hanging skin below and above the belly button and my hips would be lifted and I would no longer have the loose wrinkly skin on hips/stomach. I am not happy with my results and I am going for a BL/BA with this doc in June and I don`t know how to tell him I am not happy because I think he`ll say it looks alot better then pre op. HELP!

  Answer:  in most cases the doctor will usually do a touch up in order to get you closer to the desired result. Loosening of the skin after an ETT is common and touch ups are pretty much expected in about 5-10% of cases. I think and honest discussion with him prior to your next surgery will be welcomed by him. JG 3.30.12

• hello dr. Garcia, 10 months after full abdominoplasty i am still hollowed between legs and sides above with an raised pubis and a waist also hollowed between stomach and belly, weight gain does not help, there is no fat any more on the waist, my waist is as tiny as it is not normal. i am a petite figure, pants dont fit any more, hips are larger then before and then with all the hollows as i described, it is completely abnormal, would this get better with masages from a specialst to reduce the internal scar tissue, what can i do? thanks for reply

  Answer:  you might need some fat injections to give you a better contuor. The massages might help a bit. Best of luck. JG 3.8.12

• Hi dr. G! I have had two c-sections. (5 1/2 years ago and 1 year ago) I had a TT with muscle repair and an umbellical hernia repair 4 weeks ago. My PS said that the hernia was as big as a tomato and he had to move some fat around to fill in a hollow space under my belly button. I was not prepared for the amount of swelling that I am experiencing and I did not realize it would take so long to heal. As of now, I have a deep crease below my belly button. My PS says that he may have to go back in and cut the skin and sew it back together. My question is, have you ever seen anything like what I have described? Also, how long should I expect to be swollen? I can`t wear my normal clothes yet... Will my stomach ever be flat?? I spent a lot of money to have a pretty belly again and I`m afraid it`s not going to be flat. :(

  Answer:  it can happen in cases where the hernia has thinned the tissue out. revisions are not uncommon under those circumstances. The greater the amount of work that is required to perform the tummy tuck, the longer the time for healing I am afraid. In time it should all get better. Hang in there. JG 3.8.12

• I am considering abdominoplasty, I have lost over 50lbs since have twins & a single child & I have too much skin! My question is this; I have a small hernia from a c-section type surgery removal of a large cyst. Can these two surgeries be done together? fixing the hernia & a tummy tuck? or do I need to fix the hernia first? and if I do, how long should I wait before a tummy tuck?

  Answer:  yes, those surgeries can be combined. Best of luck. JG 3.2.12

• Hola Dr. Me hize una mini dermo, lipo y aumento de senos en Venezuela Octubre 14 2011, todo salio muy bien, regrese a USA en Octubre 29 segui todas las indicaciones al pie de la letra, la herida se ha curado muy bien casi ni se ve, pero empeze a notar Que alrededor de mi ombligo se miraba hinchado, mas del lado izquierdo y hacia abajo, diria Que 2 cms alrededor, circular, bueno me comunique cob el Dr. Y me dijo Que me hiziera Masajes y ultrasonido, Que me ayudaria, ha pasado in mes y Lo estoy haciendo 1 vez a la semana, el me dijo Que no use mas la faja Porque me puede estar afectando mas...fui a un cirujano aqui y trato de extraer, pero casi no salio nada, y me dijo Que Masajes, y talvez con velashape me podria ayudar...estoy preocupada nose Si seguir haciendo los Masajes y ultrasonido, y nada mas esperar o buscar otra opinion, Si sigue pasando el tiempo y se pone peor? Ya viene el verano y la verdad es Que se.nota la diferencia en mi abdomen plano...Que me recomienda?

  Answer:  si los masajes no han ayudado, lo puedes parar. Si no se mejora, alomejor debes de ver otro cirujano, a veces el cirujano nuevo no quiere aceptar un paciente qual se opero en otro lugar, y a el le calle los problemas.Bueno suerte. JG 2.29.12

• Hi dr Garcia, Is it tru that after abdominoplasty with liposuction from certain areas, pubis, hips and stomach middle line, the body stores fat in other places whithin one year like arms , breasts or back , this even when the weight stays the same. I heard that the body needs a certain amount of fat and that if fat is removed from certain areas it will go to other areas to keep up with the amount that it needs, resulting in deformed body composition. to less fat in some parts and too much in other parts. Can it go to the face as well ? What can be done to prevent or to correct this. thanks for explanation.

  Answer:  the fat removed with liposuction is permanently removed, so if you continue to eat above your minimal daily requirement of calories, then you will store fat, and since the original first places for the fat to go to are gone, the fat will find a new place to be stored. It only happens if you over eat though. Your weight staying the same means you actually gained weight since you lost fat from the liposuction, so there was a fat gain you have that has not been appreciated. The body does not need a certain amount of fat. In some cases, after menopause, the body is low in estrogens and your body can make you can gain intra-abdominal fat in an attempt for that fat to make estrogens, but it will not cause fat gain in other areas. Fat gain in the face is weight controlled, not influenced by liposuction.I think you need to get your body fat tested and then start on a smart eating program and exercise program and lose some fat while gaining muscle. All the best. JG 1.26.12

• dr garcia, i just had a scar revision from a bad abdominoplasty scar. I have the impression that a piece of skin, where there was scar tissue is loose now and my belly seems bigger looser then before, do i have to wear a compression garment again ? is this normal i dont fit in my clothes at the moment. I also had a new breastuplift with replacement of implants, second time, i have less pain, but my breasts have the same size as before although they were replaced by smaller implants. Could this be swelling again, i dont feel that much swelling, why do i have less pain then the first time, is there something wrong, less sensation ??? Thanks for reply.

  Answer:  they likely had to release the surrounding tissue on the tummy to allow the wound edges to come together, so that explains the scenario, but that will all settle down with time. As to the breasts, I think it is likely swelling too, which will also go down in time. All sounds normal for what you went through, just got to hang in there. JG 12.28.11

• I am presently 5 months post-op following a full abdominoplasty w/liposuction, and have two concerns. First, I have had a band of very firm tissue (internally) at the suture line, which has resolved everywhere but at the mons pubis. My surgeon believes it will continue to improve with time, but the mons remains puffy and the firm tissue seems resistant to go away completely. Assuming this firm area will eventually soften, will this relieve some of the puffiness of the mons (which I believe is due to some fluid retention)??? Second, and probably of greater concern is that at approximately 8-9 weeks post-op, I foolishly attempted to lift a 40-lb bag of dog food into a shopping cart, and felt searing pain in the left-midline upper abdominal area. My surgeon had told me that the rectus abdominis was significantly separated to the far lateral sides of my abdomen due to years of obesity and two pregnancies, one of which was a twin gestation, and that he did some “heavy suturing” to reconnect the two sheets of muscle. I discussed my lifting ‘injury’ with my surgeon, and he seems to feel that since there is no bulging or evidence of internal bleeding, that the muscle will heal normally. However, it has been over 3 months since I injured the site, and I continue to have considerable pain with the area very sore with even the slightest pressure. I am unable to sleep on my side without a pillow firmly tucked against my upper abs, or without my abdominal binder in place. Although I trust my surgeon and am overall VERY pleased with the aesthetic results of the surgery, I was hoping you could provide some reassurance that this will heal and will eventually stop causing me pain. Thank you so much for your time.

  Answer:  I believe as the firmness in the mons area softens, it will also shrink in size. Edema of the mons can take a long time to resolve. As to the pain after the lifting, if the fascia where the sutures were placed partially tore, that can take a number of months to feel better due to the constant movement and function of the muscle. I agree with your surgeon`s perspective and that it will likely go away and heal without any significant problem. Hang in there and I wish you the best. JG 12.6.11

• Hello, Dr. Garcia. 2 years ago, I had a circumferential body lift. The scar on my abdomen is wide and red, but the scar on my back is almost invisible and hairlie thin. My surgeon at the time told me she closed the top layer of the back in a quick-dissolving suture because it tends to leave thin scars and because back scars are never thin otherwise. (It did spit a few of the sutures out but that is, I understand, a known an anticipated complication with that particular suture material.) She used a slower-dissolving suture on my abdomen on the theory that it would be thin anyway, but of course, it didn`t work out that way. I`ve since moved across the country and would like to have the abdomenal scar revised. What is the name of that fast-dissolving suture that my previous surgeon used o the final layer of my back incision so that I can discuss this intelligently with a new surgeon? Thank you for your help.

  Answer:  might be Monocryl, but the redness and width of the scar might be related to the degree of tension upon closure and not the type of suture. JG 12.4.11

• Hi Dr Garcia. I am 16 days post op from a tummy tuck and lippo. I have been able to get myself to stand up straight since week 1 but am still have trouble standing up straight after I`ve been sitting down for 20 mins or so. My belly gets so tight that its uncomfortable at first so I walk hunched over for a minute or so. Is this normal? Or should I be alarmed?

  Answer:  It can be normal, the more skin that was removed and the tighter the repair of the muscles was, the longer it will take, but a little stretching out every day will get you back to normal sooner. JG 10.27.11

• Hello Dr Garcia. I had smart lippo and tummy tuck done and am a little over 2 weeks post op. I have this big dip on right side that don`t look anything at all like my left side. It looks more visible to me each day. Will this completely go away after the swelling is gone? I`m afraid my sides is going to look uneven permanently:-(

  Answer:  hard to say without seeing you, but at this point one can hope that it is mostly due to uneven swelling, which can happen. I think you need to see your surgeon for the routine follow ups and see what they say, as they can see you in person. All the best. JG 10.26.11

• I`m 16 weeks post tt. took ultrasoud,with dx of 4 x 8cm area compatible with organizing hematoma located anterior to the left hip,which communicates with small open wound approx. 1cm deep. Had previously used guaze packing, before ultrasound. Doctor now says do not pack, and just allow it to close. He has aspirated twice. 40cc the first time and 20 cc the second time. I am wearing a compression garment except while sleeping. Will this eventually all go away as he suggest, or am I facing surgury

  Answer:  I think if you continue to aspirate any fluid in there, then the capsule can close off sooner and you can avoid surgery. It would be hard for you to pack the entire 4X8 cm area, so you were likely just plugging up the more superficial part. I wish you the best. JG 10.7.11

• HI Dr G Hope this finds you well. I`m now 6 weeks post op from Abdominoplasty, healing going well my incision is a fine pale line but just underneath my incision line I am spitting a few staples, my surgeon used these not to close the skin (this was glued) but to close tissues. I have been spitting one for about 4 weeks that has been painful and has come to what looks like a big red pimple,the others are just a bit red but are not painful. My surgeon is a long drive away and has told me it will pop out on it`s own and when it does just to treat it with Iodine and loose dress it . The thing is it has been ages now and though it looks like it will pop should I wait ,will it do any harm for me to wait for me to let them pop on their own....or should I go and get them taken out by the surgeon?but will it take many trips. Do they need to be right near the surface of the skin to get them out? Thanks Dr Garcia in advance, great site. Just wish you lived in my country!!

  Answer:  I think in order to get the best scar, a trip to the surgeon is warranted, and they should be able to remove all of the problem staples in one setting. All the best. JG 7.13.11

• About how long does it typically take internal dissolvable sutures to dissolve (abdominoplasty)? And about how long does it typically take for the hard, stiff quality of swollen tissue to soften? 4 wweks? 6 weeks? Thanks very much for your kind help, Dr. Garcia.

  Answer:  depending on the type or brand of absorbable sutures, it can be 6 weeks to 3 months. As to maximal softening of the scar tissue, most of it is in 3-6 months but there can be continued changes for up to one year. JG 7.1.11

• Thank you for your quick reply to my question below about the hematoma. My next appointment with my surgeon is on July 20. Anything I should do to help the blood to liquefy in the meantime? And is there anything in particular that I should watch for that would warrant a call to his office before July 20? I`m not too worried about this but I don`t want to be careless either. (What is the worst case scenario with a hematoma like this? Necrotic tissue?) Thank you again so much for your generous time.

  Answer:  warm moist heat and massage, and if it gets softer, I suggest you see him sooner.The worst case scenario is that the tissue below the skin will necrose and leave you with a depression form the subcutaneous tissue loss. Hope that helps. JG 6.27.11

• Hi, Dr. Garcia. I had a butt lift last week and had quite a bit of post-op bleeding on one side, which finally stopped with 3 hours of manual compression. I am, of course, swollen and bruised but my left hip has a large spongy ball of tissue (halfway between the size of a baseball and a golf ball) protruding from it. I saw my surgeon today and he ruled out both a hematoma and a seroma. He tried to aspirate it but only got a tiny amount of blood on multiple sticks. He told me that it`s probably blood that`s just infiltrated the tissue and that it will take 4 or 5 months to dissolve on its own. Does this sound right to you? Could it be something else? Anything I can/should do to hasten its dissolution? He didn`t offer my any suggestions -- just told me to watch it for signs of infection. In the meantime, even the compression garment can`t disguise this. It looks like I have a tumor on my hip! Thank you very much for your help.

  Answer:  I still believe it is a hematoma, that is just not liquified enough yet for him to be able to aspirate it, and I think repeat visits are indicated. Once the area is softer and the hematoma is more liquified, it likely will be able to be aspirated, although sometimes a regular needle is not big enough and they have to use small liposuction cannulas.All the best. JG 6.27.11

• Hi Dr Garcia I had a full Abdominoplasty 3 weeks ago with muscle repair, the surgeon removed 2 LB of skin , lipoed very little out for contouring as I had very little body fat at 122 LBs and said I had slight muscle separation which was corrected. He said my muscles were very toned as I am an elite marathon runner. I am a great shape and he is known for pulling you very tight, I`m only just getting upright. The slight concern I have ,and I do understand it is very early in the healing is that I have a very deep grove/crease that runs up from my belly button vertically up to my bra band. He did the quilting technique so I had no drains and very little swelling , I can see my muscles now like I have done a million sit ups. He said it will flatten out somewhat but it is good to have a crease there as it really gives definition to the abs...to be honest at the moment it looks odd and if I really stretch the skin out flat with my fingers the grove is still pretty visible. I was told by the nurse that this is all due to the quilting stitches that need to dissolve. Could my compression garments contribute to this? Have you heard of this being a byproduct of this technique? Could it be down to my toned muscles being brought together and be permanent? sorry for all these questions so early but you have always been an honest opinion and a star! Thanks Dr G

  Answer:  do not think the compression garment is making it any worse, and with quilting sutures, it is common, I see it my patients, especially thin ones. In time, as the sutures dissolve and you start moving around, that crease will improve, just takes some time. Hang in there. JG 6.23.11

• 4 months after full tummy tuck, my once flat belly but with excess skin is now sticking forward, higher then it should be , the scar is very high and i am hollowed out uneder the scar between the legs and with a bulging pubis. Can a correction be done anyway to resolve this issue, i am also hollowed under the ribs. Thanks for reply.

  Answer:  might need some defatting of the tissues and then hopefully that will nto only smooth the high points down but also allow the scar to be moved downward for you.I would give it 10-12 months though for the skin to become as pliable as possible before attempting it. All the best. JG 6.10.11

• How soon after a butt lift can the scar be revised? My surgeon and I agree that my scar is too high and needs to be lowered. Wondering when it`s safe/advisable to do that. Thanks so much!

  Answer:  In your case, it cannot be done until there is enough loose skin above the scar to be able to move it down, likely year or more.Best of luck. JG 5.24.11

• 2 months after tummy tuck, the puboc area is lifted too high, also my whole tummy seems much higher then before, leaving me with a tinned out area under the scarline, as the skin is streched ouy there and much thinner then above the scar. under the scar is it like skin over bone and above the scar all the fat seems concentrated as wgere it was more even distributed before. It looks weird like with indents at the sides under the scar with elevated bulging pubic area in the middle. Will it stay like that forever. Will the fat lower again where it should be. Is this a nomal condition.

  Answer:  I think in time that will all get better, the swelling that will sit right above the scar can take up to one year to go away, and as that does go away the difference in thickness should get better and likely the scar will also drop in the pubic region. Best of luck. JG 5.16.11

• 2 months after abdominoplasty still this pulling sensetion inside, how long does it take to feel normal again ? Above the pubis area there are some hairs that are growing inside the skin, creating some bulging on several places, is it nessesary to open those spots and remove the hair. thanks

  Answer:  it can take 6 months on rare occasions, all depends on how much skin was removed and how much adherence there is of the skin to the underlying tissues. I think seeing your surgeon to allow those hairs to be lifted out is the best option. I wish you the best. JG 4.25.11

• Dr Garcia, is it possible that my tummy is bloating (after tummy tuck) from the HGH creating water retention in the muscles or somewhere intraabdominal. If so what can be done about it. I feel better with the injections mentally but the bulging tummy is horrible, in the morning it is better but during the day when i drink and eat i feel my whole body bloating. Is the water retention because of skin laxaty ? I try to figure out. Thanks for advice.

  Answer:  have not seen that occur. I don`t think the HGH is making you bloated. JG 4.11.11

• Due to the skin removal during tummy tuck, the fat in my lower belly and stomach is more concentrated, too much skin was removed and therefore my belly and stomach is bulging up, because too much fat concentrated. Before when i took a fold of skin is was like half en inch and now it is more then one inch fat under the skin. So my muscles which were visible before are now covered by this concentyrated fat layer. Pubis and tighs are not going down, they were eleveated and pubis still sticking forward. I can not wear tight clothes any more with all the bilging in stomach, belly pubis and tighs, before the tummy tuck i had no problem with that. is this a normal condition ? More bulging belly, ALL THE FAT FROM THE SIDES IS PUSHED FORWARD. Does this condition only improves when the skin gets more loose with aging, other possible remedies.

  Answer:  it does improve, but very slowly, sorry. JG 4.10.11

• What is the reason for the tick bulging noduled skin above the scar from a tummy tuck. On the underside of the scar the skin is flat , above it , the skin is raised, 7 weeks after tummy tuck. What can be done to improve, is this normal condition, Will it stay this way, does some kind of lasers can be used to improve also for the redness, maybe IPL ? Thanks.

  Answer:  that is edema or swelling from above the incision that settles there due to gravity, but it will decrease in time and flatten out. IPL can be used to help speed the fading of the redness. JG 4.3.11

• With the tummy tuck, the skin on the hips was draped forwards, to tighten, now the fat that was previously on the hips is on the front of my lower belly, making it much more rounder then before, before the hip bones were visible, now i am as small as round, very noticible, it created more an appearance of a circel, how do i get rid of this issue, i am much too small on the hips and too round in the middle of the lower belly, probably it is a procedure used to create an houtglass figure for heavy woman, which i was not before, the tummy tuck made me rounder in lower front belly, it is not an improvement at all. all the contents of my belly seems concentrated now, in a too tight skin, what can i do to fix this issue. all the fat in the belly in concentrated forwards. Doer this settle by its own , my clothes don´t fit me any more, i am as round as small. Also in the stomach area. Above the scar there are hard nodes, bulging, The skin has been stiched a bit wrinkeled, due to the draping forwards, does the skin adapts or contracts back to get rid of the wrinkling, with the bulging underneath ? Is this a common issue, I was already so small before, did not need this, also the surgeon has done some liposuction on the hips i am afraid, so this also contibutes to be even smaller and rounder then before. Does the fat comes back where it was, do i get rid of the too round appearance ? Also my mucles are bulging out stomach area and lower belly, due too the tighetening is guess ? Do abdominal exercises help with this ? I will probably never see my hip bones again, due to the concentrated fat that is covering the area . Also my tighs are much fullerdue too the skin tighetning pulling them up as i told you before. Any solution ? My body had changed for the worse.

  Answer:  without seeing you in person, it is difficult for me to say what has happened, but in time the skin will loosen, no way to tell how much and how fast though. JG 3.31.11