“From your photos, it seems that you still have abdominal wall laxity, and when you lay down, this looks like it’s corrected. It also seems like you still have some excess subcutaneous fat between the skin and the muscle.”
That is Dr. Frank Agullo, founder of Southwest Plastic Surgery, reviewing photos from a recent virtual consultation. The patient had her tummy tuck years ago, somewhere else. She healed fine. The bulge stayed anyway, and she wanted to know if her first surgeon botched it.
Usually the answer is no. The first operation just did not go far enough, and the standing-versus-lying comparison in her photos is what proves it: a bulge that vanishes on the bed points to the abdominal wall, not to fat alone.
Why the First Operation Fell Short
“I see patients like you routinely, where the diastasis was repaired, that’s just the separation between the rectus muscles,” Dr. Agullo explains. “But during pregnancy, or when patients gain weight and then lose it, the fascia is stretched throughout the abdomen, not just between the rectus muscles.”
A standard tummy tuck repairs the midline. The stretch is everywhere. And the gym cannot make up the difference: “Performing core exercises will strengthen the muscle, but will not tighten the fascia.” The practice has covered that principle before in its post-pregnancy fascia repair explainer.
The Retightening: Triple Plication
The fix Dr. Agullo recommends for these patients is the technique he is known for. “That’s why I often recommend performing a triple plication, where I plicate from the sternum to the pubis, bringing together the fascia of the rectus, and I also plicate the obliques to the lateral edge of the rectus. This is called a triple plication, which in essence creates an internal corset, or waist trainer.”
He has published on the triple plication and performed it for more than seventeen years. His shorthand for patients comes from a store shelf: “If you look at any waist trainer at any store, you’ll see that there are multiple seams in the waist trainer. Essentially, most surgeons are just making a waist trainer with one seam, versus using multiple seams, in this case three, to bring in the waistline.” For a revision patient, the two extra seams retighten the fascia the first operation never touched and add the waistline it never attempted.
The Rest of the Plan
Revision at Southwest Plastic Surgery treats everything the photos reveal. Residual fat between the skin and muscle is addressed with liposuction of the abdomen, waistline, and lower back. Renuvion J-Plasma is often added for skin tightening, and scars that widened or sit too high are improved in the same operation. Larger plans fold into full body contouring.
An Easier Recovery Than Expected
Dr. Agullo injects Exparel as a TAP block, numbing the abdomen for three days; half of his patients report no pain at all. Recovery matches a primary tummy tuck: about two weeks to normal activity and six weeks to full exercise. Patients feel the tighter abdomen immediately, and this time it holds while standing.
Start With Two Photos
Standing and lying down. If the bulge disappears when flat, the wall is the likely culprit, and the practice can usually give an honest virtual assessment through the tummy tuck revision page.
About Dr. Agullo
Dr. Frank Agullo is a double board-certified plastic surgeon, Mayo Clinic fellowship trained, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, a Castle Connolly Top Doctor for thirteen consecutive years, and a published author on the triple plication technique.
Schedule a Consultation
If your tummy tuck left the job unfinished, send the two photos. Call (915) 590-7900, text 1-866-814-0038, or book online at Southwest Plastic Surgery. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Dr. Agullo wrote two companion pieces: the revision editorial on drworldwide.com, and the clinical guide on agulloplasticsurgery.com, where his tummy tuck revision page also lives.
