August 12, 2026 | Uncategorized
A patient emailed me photos through my tummy tuck revision page. Tummy tuck a few years ago, different surgeon, healed fine. Still bulging. This was my answer to her, and I am reprinting it because I end up writing some version of it almost every week:
“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.
I see patients like you routinely, where the diastasis was repaired, that’s just the separation between the rectus muscles. 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. Performing core exercises will strengthen the muscle, but will not tighten the fascia.
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.”
That paragraph is basically the whole revision consultation. Three pieces worth pulling apart.
The Lying-Down Test
Standing, her abdomen bulges. Lying down, it looks corrected. That difference is the finding. When the abdomen flattens on the bed, the wall is what gives way on standing, not fat alone. Anyone can run this test at home tonight. Two phone photos, standing and flat on your back.
Why the First Repair Was Not Enough
Her first surgeon repaired the diastasis down the midline. That repair is probably still holding. The problem is everything around it. The fascia stretched across the whole wall, out over the obliques, and a midline-only repair leaves all of that laxity right where pregnancy put it.
She also spent two years doing core work on a trainer’s advice. It strengthened the muscle. It did not tighten the fascia. It never could.
The Triple Plication Revision
I have published on the triple plication and performed it for more than seventeen years. Brazilian plastic surgeons described it long ago, but a lot of surgeons never implemented it into their procedures, which is why so many revision patients have never heard of it.
If you look at any waist trainer at any store, you’ll see multiple seams. Essentially, most surgeons are making a waist trainer with one seam, versus using three to bring in the waistline. In a revision, the two extra seams retighten the wall the first operation left loose, and they add the waistline definition a midline-only repair cannot create.
Completing the Contour
The wall is half the revision. The excess subcutaneous fat between the skin and the muscle is the other half, so my revisions include liposuction, especially of the anterior abdomen, waistline, and lower back, often combined with Renuvion J-Plasma for skin tightening. Scars that healed wide or sit too high are revised in the same operation.
Recovery
Revision patients expect a harder recovery than their first surgery. Mine usually find the opposite. I use Exparel injected as a TAP block, numbing the area for three days, and fifty percent of my patients experience no pain whatsoever. Recovery runs about two weeks to normal activity and six weeks to exercise, running, jumping, and heavy lifting, the same as a primary tummy tuck.
Is a Revision Right for You?
Start with two photos, standing and lying down. If the bulge disappears when you lie flat, abdominal wall laxity is likely, and a triple plication revision can correct it. Send them through the tummy tuck revision page and we can usually give you an honest answer virtually.
Why Choose Dr. Agullo
Double board certified. Mayo Clinic fellowship trained. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor thirteen consecutive years. Published on the triple plication technique that most revision candidates were never offered the first time.
Ready to Talk?
If your tummy tuck stopped short of the result you wanted, the completion exists. Call (915) 590-7900, text 1-866-814-0038, or book a consultation online. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Companion reads: the editorial version on drworldwide.com, and the practice overview at swplasticsurgery.com.
