Prospective clients often look at before and after pictures on the internet in order to best determine the right surgeon for them, and some tend to notice a bulginess that appears in the upper abdomen after a tummy tuck. This is a common result of several causes. First, there can be a significant amount of fat in the upper abdomen after surgery. Surgeons tend to be conservative in performing liposuction on the upper abdomen, as taking away too much fat can cause significant problems with skin loss on the lower abdomen. Based on the patient’s anatomy, the location of the blood vessels is important in determining the degree of aggressiveness during liposuction. When dissecting, the surgeon must be careful with the blood vessels in order to protect the blood supply to the abdomen. It is a mistake to cauterize all the blood vessels that are going to the skin. For this reason, vessels should be preserved as much as possible. In some patients, the blood vessels are not always visible or tend to be cauterized in order to tighten the abdomen. In the event that there is no significant blood supply to the skin, liposuction is performed lightly, which can result in developing some fat after surgery. Patients must realize that surgeons cannot determine the location of the blood vessels or the amount of blood supply through physical examination alone to determine the thoroughness of the liposuction procedure. Second, visceral fat is also a factor. Visceral fat accumulates around internal organs, including the liver, stomach, and bowels. It is no surprise that when a patient has a significant amount of visceral fat, there will be more resistance when it comes to tightening the muscle. Most of the internal organs are located in the mid to upper abdomen, in addition the abdominal muscle attached to the chest wall, which provide resistance when the plication is performed. For this reason, surgeons must be careful in tightening the muscles in the upper abdomen. This can cause significant changes in the patient’s respiration after surgery, creating metabolic changes due to a change in lung capacity. This is why surgeons advise patients to lose weight prior to undergoing a tummy tuck procedure.