15 years post lipo sculpting - can these irregularities be fixed? (photos)

Question

Lower right is appendix scar which I'm fine with. Can these irregularities be fixed?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding liposculpting irregularities and if they can be fixed 15 years later. Yes, these areas of irregularity can be fixed. This would entail using a VASER liposuction device to cut the scar tissue from the inside. This can be done to the liposuction port sites. Your indentations and irregularities are due to over-suctioning and possibly even the creation of a scar on the abdominal wall. This scar tissue needs to be released and can be done simultaneously as liposuction. It would take much, but I think it would significantly improve your anterior abdominal wall. Therefore, my vote is VASER liposuction with scar release. I hope this helps answer your question regarding whether lipo sculpting irregularities can be fixed 15 years later.

Daniel Barrett, MD · Answer

Dear devora2001,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Felix Omar Márquez, MD · Answer

Hello, thanks for your question and photos. As you may know, the best answer depends on a physical exam. By the pics, you could have a Mini Tummy Tuck to repair your skin. Consult a board-certified plastic surgeon in your area. Good luck!

Camille Cash, MD · Answer

Contour irregularities on the abdomen post liposuction can sometimes be addressed with massage or compression soon after surgery.  However 15 years after you will likely need to consider a tummy tuck to address your concerns.  See a board certified plastic surgeon near you for a consultation.

Mats Hagstrom, MD (license on probation) · Answer

Like all other aspects of medicine the first step is to make an assessment or diagnosis.
Poor results from Liposuction are generally due to uneven fat removal leaving people with an unnatural and uneven fat distribution. This is almost always at least part of the problem when people are unhappy with Liposuction results. The second variable is how much fat was removed or if the first procedure was overly aggressive.
Delivering consistent quality liposuction results is more difficult than most people believe. The number of plastic surgeons who can do liposuction well consistently and predictably is a minority.
In general there are four variables that determine what someone’s abdomen looks like. These are skin laxity, subcutaneous fat excess(in your case uneven distribution), muscle separation from previous pregnancies and lastly excess visceral or intra-abdominal fat.
Your abdomen looks pretty typical and it doesn’t look like any of those variables are significant problems but you do appear to have mild skin laxity or this could be simply loss of skin elasticity due to age.
Skin laxity lowers candidacy for liposuction results.
Individuals with significant loose skin simply don’t see the same quality liposuction results that individuals with tight elastic skin do.
In this way liposuction results can gradually worsen as age takes its toll on skin. 
To make an assessment regarding your fat distribution I usually put the skin under gentle tension and then palpate or simply feel the fat layer with my fingers sliding up and down the abdomen. It’s always easier to get an accurate understanding of fat distribution by putting the skin under dental tension. creating an even fat distribution from one that has been made uneven because of previous poorly done liposuction is difficult.
It’s hard enough starting with an even fat distribution and keeping it even at the end of the liposuction procedure. Taking an uneven fat distribution and making it is many times more difficult.
The contour irregularities are completely lost once the numbing solution is added and surgery begins.
Treatment options generally comes down to revision liposuction(removing more fat), Fat grafting(adding fat harvested from other areas) or a combination of the two.
For some individuals converting the procedure to a skin tightening operation may be a suitable option this is especially true for individuals who are a good candidate for skin removal surgery in the first place.
A tummy tuck or a mini tummy tuck could potentially improve the outcome and in your case would also remove your appendectomy scar.
There are no non-surgical options that can improve your outcome.
As I mentioned earlier, correcting this is very difficult and it becomes more difficult if the primary procedure was done aggressively. 
Usually some improvements can be had. To maximize the result often requires a couple of sessions of attempting to even out the fat distribution especially if fat grafting is involved. Sometimes good improvements can be had with a single procedure but the most revision work is difficult, complex and only partial improvements are achieved with a single procedure.
Perhaps the most important bottom line take-home message is that the potential amount of improvement is relatively small, there’s a very real risk of making things worse with the revision surgery and the number of plastic surgeons who can do this type of work well is small.
I try to encourage all people interested in Liposuction to be extremely selective when it comes to choosing a sufficiently talented provider for any liposuction procedure.
I recommend patients do this by having multiple in person consultations.
Before even starting people should get very familiar with what quality liposuction results look like especially on individuals who have similar body characteristics to your own.
During each consultation ask each provider to open up their entire portfolio of before and after pictures showing you as many pictures as possible of previous patients who had very similar body characteristics to your own. Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as they had hoped for.
Being shown a handful of preselected images most likely representing the best results of a providers career is insufficient to get a clear understanding of what average results will look like or how many of these procedures that surgeon has actually performed. 
For reference and experience surgeon should have no difficulty showing you at least 50 set of before and after pictures of commonly performed procedures like abdominal liposuction. Highly experienced surgeons will have hundreds or even thousands of before and after pictures of this common procedure.
Look very carefully at all the results making sure there are no skin contour irregularities in any of the treated areas. you should also ask the provider to show you or tell you what areas were treated and what areas were not treated. look very carefully a transition zones between treated and untreated areas. there should essentially be no evidence of having had liposuction with the exception of the tiny incisions which should be strategically placed. Abnormal contour irregularities are a clear sign that a provider does not have sufficient skill to deliver consistent quality results on a regular basis.
Take notes during consultation documenting both the quality and quantity of before and after pictures shown. 
Surgeons may be apprehensive to open up their portfolio and show you anything other than their “best of” collection of results. Patient need to be advocate for themselves and recognize if you are paying for the procedure and you are entitled to get sufficient documentation of competency, skills and experience to have a clear understanding of what average results look like in the hands of each provider. Continue having consultations until you feel very comfortable you found the most talented and skilled provider for this procedure.
Liposuction results vary more than any other plastic surgery procedure based exclusively on who did the operation. plastic surgeons have a wide variety regarding competency in liposuction and attitudes towards Liposuction very greatly as well. Sone view liposuction as a simplistic procedure with a low learning curve. Surgeons with that attitude will never master the operation and will continue delivering substandard results their entire career.
Those who recognize that mastering body contouring using liposuction and or fat transfer is far more difficult than it seems at first and are willing to put in years of dedicated experience being critical of their own results and always working towards improving will eventually master the procedure. With doing thousands of procedures surgeons can get to the point where they can deliver consistent quality result predictively every time or close to it.
The process of finding a provider for revision work is more or less the same as finding a provider for Primary Liposuction.
The biggest difference is going to be that providers will not have the same number of before and after pictures for revision of work as they do for primary Liposuction. revision work also varies dramatically based on who did the first procedure so it’s a little hard to measure quality a revision work. 
Generally speaking the surgeons who are best at revision work are going to be the same surgeons who are the best at the primary procedure.
If fat transfer is involved and recommended as a solution for improving your outcome then you need to vett surgeon jus as thoroughly for fat transfer results.
Fat transfer results can look very impressive early after the procedure but early results do not represent final results. Fat transfer result should never be judged earlier than three months from the date of surgery. If someone shows you revision work with that transfer then you need to always confirm how far out the after pictures were taken from the date of the procedure.
Whether it’s worth having revision surgery for you depends on how much your current situation bothers you, how much you’re willing to go through knowing that a partial improvement it’s probably the best you can expect.
To minimize the chance of making things worse do you need to put in a significant amount of effort in finding the right provider.
Personally I don’t believe you can do that without having multiple in person consultations.
I would be reluctant to move forward with any provider who believes improving your outcome will be easy. 
I would be especially reluctant if they recommend using energy devices like VASER. And how the “device” can “magically break up the scar tissue”.
A single picture is not sufficient to make a quality assessment so to even know how much improvement may be possible you definitely need in person consultations. You also need consultations to find the right provider. if you want to move forward start looking for plastic surgeons in your community who seem to do a substantial amount of liposuction and seem good at it and start vetting providers. 
Best, Mats Hagstrom MD

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