Uneven skin after arm liposuction - what can be done to fix it? (Photo)

Question

I had arm Lipo 5 years ago and the results are lumpy and uneven. I am extremely self conscious about showing my arms at this point and would like to know what can be done to fix it.

Arif Eroglu, MD · Answer

Hello; performing for Liposuction on the outer arms; it requires both experience and technology. After Liposuction process realized with the classical method; it would not be surprising for observing dimples on the outside of the arms. Because, tissues are located in that area; it is quite tight and an ultrasonic device such as vaser is used; if tissues are not loosened; it is not possible to get fat from them homogeneously and while fat can be taken from some places; it cannot be removed from some places as well and pitting may occur. By applying for 2 or 3 sessions of autologous micro fat injection; pitting images can be reduced.

Brian May, MD · Answer

I'm so sorry to hear you're unhappy with your prior surgery. Unfortunately, one of the most common complications from liposuction is contour irregularities such as what you're describing. Additionally, the skin of the upper arms is unforgiving with liposuction and contour irregularities left during liposuction can be more notable in this area of the body than in some others.
It is difficult to tell from photos, but revision liposuction may be an option to improve your arm contour and help blend/smooth the remaining fat. Another potential treatment option includes fat grafting to the area.
I recommend you consult with a board-certified plastic surgeon who specializes in liposuction to discuss options they feel will most appropriately address your areas of concern. Unfortunately there is no easy fix for this but you and your surgeon should be able to come up with a plan to help improve your contour and hopefully make you feel more comfortable/less self conscious!

Connie Hiers, MD, FACS · Answer

Sculptra injections could be helpful to help smooth and contour that area of your arms. Please go to someone who does a fair amount. It will take a few sessions.

Francisco Rodriguez Rosario, MD · Answer

saludo,Me gustaria ver foto de ambos brazos con el mismo estirado, enviame foto de ambos brazos estirado para darte un procedimiento mas certero 
gracias

Camille Cash, MD · Answer

Contour irregularities can occur after liposuction.  Fat grafting is sometimes beneficial to improve poor outcomes.  You may also find some improvement through Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.

Mats Hagstrom, MD (license on probation) · Answer

Del del consistent quality Liposuction results turns out to be far more difficult than most people realize.
The number of plastic surgeons who mastered this procedure is in reality. Very small.
Most plastic surgeons. Think they’re far better at Liposuction than they actually are.
The process of vetting, plastic surgeons, and finding the right provider is inherently complex and far more difficult than most people appreciate.
 Unfortunately Liposuction is fairly definitive procedure. It should be considered as permanent and irreversible.
The ability to improve the outcome of poorly done. Liposuction depends on a number of variables.
The first is the patient candidacy for the procedure in the first place, and the second is how the first procedure was performed.
 if the first procedure was done in an aggressive manner that left a very uneven distribution that correcting the outcome becomes very difficult.
The more fat that was removed from the first procedure or the more aggressive. The first procedure was the more difficult it comes to improve the outcome.
 if there’s no fat left to work with then it just becomes very very difficult.
There are two approaches to improving and uneven outcome left from poorly done Liposuction.
One approach is to do more Liposuction to try to match the areas where the fat is thicker to the level of the overt treated areas.
 This works well for those who were not treated aggressively during the first procedure.
The second approach is to build up fat in the overt treated areas with fat grafting.
Order for fat grafting to be successful there has to be a sufficient amount of host tissue to support the grafted tissue.
 This again means that areas were aggressively over treated, leaving virtually no subcutaneous fat between the skin and muscle may not have sufficient host tissue to support grafted fat in a meaningful way.
When that’s the case, fat transfer does not survive and the amount of improvement can be pretty disappointing.
 we can usually get some fat to survive but for challenging cases patients need to be aware in order to get a reasonable looking outcome. The process may take multiple rounds of fat transfer typically done six months apart.
It’s very hard to predict how many sessions of fat transfer are needed, but I would say 3 to 4 procedures over two years is probably , a fairly typical scenario.
It is unlikely your arm will be restored to a normal appearance with a single revision procedure.
There are no non-surgical options that will give any type of realistic quality outcome.
Revising, poorly done plastic surgery outcomes is very complex, and technically difficult.
Doing this kind of work well, especially the ability to deliver predictable outcomes to assess predictably who is going to benefit from the treatment or having a good understanding of how many treatments may be necessary is a skill few plastic surgeons have.
The best plastic surgeons for doing revision work are generally the same plastic surgeons could do the best primary procedures.
The single exception to this is for individuals who need fat transfer when that’s the case providers need to be vetted in regards to both Liposuction and fat transfer skill.
 Finding the right plastic surgeon is difficult and many people simply do not do a particularly good job at vetting plastic surgeons or understanding how to find the right provider.
Find the right provider I suggest patient start the process by making a list of plastic surgeons in your community who seem to have a lot of experience With liposuction and fat transfer.
I highly recommend patients always rely on in person, consultations and avoid virtual consultations, especially for complex situations.
Schedule an in person consultation with each of the providers on the list you made.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients with similar body characteristics to your own.
 For primary procedures and experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Obviously for revision work providers will not have as much experience as for Primary work, but you need to vet the provider, so ask them to see examples of both primary and revision work is probably indicated.
Being shown on a handful of pre-selected images, representing the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like for how many of these procedures they’ve actually done.
Hopefully the provider will have some history of doing revision work, and should be able to show you some examples.
For fat transfer it’s important to realize that early fat transfer results can look very impressive, but do not in anyway represent long-term final results.
 Always confirm the timeframe of when after pictures were taken when reviewing the results of fat transfer.
Fat transfer after pictures need to be taken at least 3 to 6 months after the procedure in order to be representative of what the actual results look like.
There’s no correct number of consultations needed to find the right provider.
The more providers you interview the more likely you are to find the better provider.
The biggest mistake patients often make is having only one consultation and then scheduling surgery.
Having only one consultation, basically eliminates the ability to choose a better provider.
During each consultation, you should be looking for provider who understands the complexity and difficult nature of this type of revision work.
Providers who have no evidence of previous successful cases and are optimistic about this being fairly easy to fix, or that some special technology device is going to be significantly useful are probably the providers you want to avoid the period.
 a plastic surgeon will recognize that this is a difficult situation that is at best. Going to give you partial improvements and may require multiple procedures in order to get a reasonable quality outcome in the end.
If you don’t find a provider who has the skill an experience, then recognize that any attempt at revision can easily make things far worse.
In the end, whether they going through this process is justified or not depends substantially on each individual person.
It is inherently, time-consuming, frustrating, expensive and inevitably has a certain level of risk involved.
The best way to maximize your chances of having quality improvements is to focus all your efforts and provider selection.
There’s no correct number of consultations needed to find the right provider.
For primary procedures like having arm or abdominal liposuction, I usually encourage people to have five or six consultations before selecting a provider.
There is simply so much discrepancy in Liposuction skill among plastic surgeons.
 Being board-certified in plastic surgery with years of experience in an overall good reputation does not mean somebody has mastered any single procedure especially not Liposuction.
I think one of the biggest problems is that patients sometimes assume that because someone has certification and some positive reviews they must know how to do this procedure.
People simply do not appreciate how hard it is to do. Liposuction well on a consistent basis.
 Arms are fairly technically challenging areas to treat and is one of the areas I specialize in.
It is taken me decades to get to where I am in regards to delivering the type of results I currently can.
You can look at my before and after pictures on my profile on this website to see what arm liposuction results should look like at least in my opinion.
 I am in no way trying to capture patience. I have plenty of work and my goal at this point in my career is to serve as a patient advocate minimizing patient being left disfigured and helping people have as much positive plastic surgery outcome as possible. Primarily avoiding pitfalls that can lead to fairly bad disappointment.
I wish I could be more optimistic.
There is room for improvement, but getting there will not be easy.
Best,
Mats Hagstrom, MD

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