Q. I am 28 years old and had twins about 1 year ago. After delivery, my stomach was a mess, loose skin and stretched muscles. I have been working my buns off for the last 6 months trying to return my tummy to the way it was before pregnancy and it is just not happening. I still have skin that sags around my belly button and I still look like I am 3 months pregnant. My weight is back to what it was before getting pregnant, but I hate my tummy.  How can I tighten my skin?

A. Twin pregnancy can be very tough on your tummy because of the stretching that occurs carrying 2 babies. Often the skin stretches beyond its capability of re-tightening, and what is left is loose skin. The most common location is in the lower abdomen, the area around the umbilicus and the upper middle abdomen. This loose skin may tighten up somewhat in the first 6 months or so after delivery, but unfortunately, especially in twin births, the skin may not ever return to the pre-pregnancy condition. Sadly, all the exercise in the world will not tighten skin. That is not to discourage you from doing your exercise, that is very important. After about a year, any skin tightening that is going to take place has probably already happened. Another unwanted effect of some pregnancies, which you may also be experiencing, is that the abdominal rectus muscles and fascia (the covering over the muscles) stretches. It is possible to re-tone the rectus muscles, but the fascia covering the muscle often remains stretched, which can look like the abdomen has a pooch. Finally, these same rectus muscles can sometimes actually move apart from one another due to pregnancy, and this creates a gap or separation in the midline of the abdomen which in turn creates a midline bulge when you tighten your core, like when you do sit-ups. What you see is a raised ridge in the middle of the abdomen from just below the sternum to the pubic bone. This is called diastasis recti, meaning separated rectus muscles. A diastasis usually will not improve significantly either, regardless of exercise.

What can be done about these issues? First, before doing any type of corrective surgery you want to be sure you are finished having children. Pregnancy after a tummy tuck can reverse the positive results of the surgery. Next, try to be in the best shape you can and as close to your “happy weight” as you can be. The next step is to see a board certified plastic surgeon to talk about options for correction. A tummy tuck is the one procedure that will tighten the muscles and the skin and return your abdomen close to a pre-pregnancy appearance. The tummy is never exactly the same, but the results can be close. The surgery requires making an incision in the lower abdomen (where a c-section scar would be placed). The recovery is about 2 weeks before you can return to work and about 6-12 weeks before going back to the gym. There are rare but serious risks with tummy tuck surgery which you should discuss in detail with your plastic surgeon. Good luck and congratulations on your twins.

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