Lumpy back 1 year after liposuction - what can be done to help smooth this out? (photos)

Question

My back was super smooth before I had liposuction to graft some fat for my breasts . Now it’s very irregular looking. It’s been almost one year since I had lipo done around my waistline and some in my back . What could be done to fix this ? What’s the best way !? Thanks

John Michael Thomassen, MD · Answer

These irregularities are due to scarring between the dermis and the underlying fascia.  Sometimes using a power assisted liposuction device without suction, these areas can be broken up and smoothed out.  You may see a degree of improvement but not complete resolution.

Daniel Barrett, MD · Answer

Dear Lipslikesugar,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

For the areas with dents, a fat transfer or Sculptra injections can be done to give more volume. For the lose skin, minimally invasive skin tightening with radiofrequency, like ThermiTight, can be done to help tighten and smooth your skin.  These two treatments would not be done at the same time.  I would try skin tightening first.

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe.
Most plastic surgeons are not as good at the procedures as they think.
Liposuction should be considered a permanent and irreversible procedure.
For that reason patients need to be very careful when choosing providers.
I recommend patients do that by having multiple in person consultationsw. During each consultation you should ask each provider to open up their entire portfolio of before and after pictures.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as the had hoped. 
Being shown a handful of sample pictures which represents the best results of a providers career is insufficient to confirm that the provider has mastered the procedure. Make sure you ask providers to show you pictures of previous patients who had similar body characteristics to your own. Make sure you verify lots of before and after pictures of every area you’re having treated. 
The back is in my opinion a relatively easy area to treat but for providers who don’t have skill and experience it may not be. The back also has substantial amounts of skin laxity (especially with your arms in a down position). Loose skin can be a deterrent for getting quality liposuction results.
It’s very difficult to create an even fat distribution once it’s made uneven through poorly done Liposuction.
Revision work is many times more difficult than primary Liposuction.
Since your provider lacked a skill to do quality primary Liposuction he or she is not the right person to attempt doing any revision work.
Trying to improve on outcomes generally comes down to revision liposuction, fat grafting or in some cases converting the procedure to a skin tightening operation.
None of those options are really good options in your case.
You don’t have much fat to start with in the first place and what you have now is uneven because it was treated aggressively and not in an even fashion.
Simply doing more liposuction to harvest fat to attempt to grafting into the defects may not make sense. If you do do you need to absolutely make sure the provider can do further liposuction with quality outcomes. 
Individuals who don’t have sufficient fat for fat transfer should probably look at alternatives especially when implants do so much better for breast augmentation than fat transfer.
There are no nonsurgical options that will help your condition.
Whether revision surgery is worth it or not is something you’ll need to discuss with providers.
To find the best provider you’ll have to do substantial numbers of in person consultations.
You’ll need to try to vet providers to try to find who has the most amount of experience and skills.
For reference and experience provider should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures like primary liposuction.
It’s unlikely you’ll find providers that have those kind of numbers when it comes to revision work.
Taking care of other providers unhappy patients can be a thankless job so some qualified providers may also turn you down.
To get an accurate assessment of what can be done and at the same time vet providers to find the most experienced and talented one I recommend simply scheduling lots of consultations.
You can start the selection process by judging how many quality Liposuction pictures each provider has on their website.
If they have very few quality liposuction and before and after pictures then they are not the providers to consider in the first place.
Fat transfer is very difficult as a treatment for previous overly aggressive liposuction.
Very little fat survives because the area that needs the volume has no host tissue to support the graft. This generally means in order to build up volume up where it’s needed grafting needs to be done on multiple times.
Quality revision work often requires multiple rounds of isolating individual problem areas as to requiring either Liposuction or fat grafting to create an even fat distribution.
It’s unlikely this can be accomplished with one procedure.
If you’re in the hands of someone who lacks sufficient skill and experience the problem can easily become worse.
If you decide to move forward you’ll have to first find a sufficiently skilled and experience provider.
That provider should have a collection of before and after pictures that reads like a telephone book, be very honest and set realistic expectations.
Unless you feel very comfortable you found a sufficiently skilled provider I suggest simply waiting and scheduling more consultations.
This type of work is very difficult and making progress requires skill and even then what can be achieved can be subtle.
Best,
Mats Hagstrom MD

Lumpy back 1 year after liposuction - what can be done to help smooth this out? (photos)

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