I had a BBL 3/26/16 - Now I have fat necrosis! what do you suggest the best treatment is? Will it get better in time? (photos)

I had a CT Scan done that indicates a large disc-shape area of apparent panniculitis/fat necrosis in the posterior intferior subcutaneous fat of the right cheek, in addition to trauma or injection. It measures 5cm in thickness and 15cm in diameter. My right cheek is much larger than my left. Will my body heal on it's on after time? Will my cheeks be the same in size after time? Will the disc-shape area get smaller after time? What suggestion do you suggest as far as treatment?

Doctor Answers 4

I had a BBL 3/26/16 - Now I have fat necrosis! what do you suggest the best treatment is? Will it get better in time?

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Even under the best of circumstances, about half of grafted fat does not survive long term. This dead fat liquefies, turns into oil cysts, and eventually is reabsorbed, leaving behind hard scar tissue and/or calcifications. (This is also why fat grafting for breast enhancement is neither natural nor advisable, IMHO--the scar tissue and calcifications can interfere with the mammographic detection of breast cancer. But that's another topic.)

For BBL patients, even more of the fat dies if the grafted fat is simply injected in large blobs rather than careful multiple tiny tunnels designed to make maximum contact of the grafted cells with living tissue. Big globs of fat might look full and round initially, but the majority of pooly-placed fat will simply die, turning into the big zone of fat necrosis you describe.

That is not to say your BBL surgeon was bad or used poor surgical technique, BUT it COULD mean that. Was s/he a "real" plastic surgeon certified by the American Board of Plastic Surgery, or some other "board?"

Dead fat must either be reabsorbed over a very long period of time, or be surgically aspirated, removed, or otherwise treated, especially if it become infected, which yours fortunately does not appear to be by description.

Other than wasting your money and causing the discomfort of sitting on a glob of dead fat until your body can reabsorb it dead cell by dead cell, fat necrosis is simply dead tissue inside your body. (That's why it takes so long to go away, and why even rotten surgeons can fool their BBL patients into thinking they had a good procedure--it somehow must be the patient's "fault" or that sometimes "the fat just melts on its own." By then they're gone with your money.)

Unless your buttock cheek develops significant tenderness, redness, or drainage (these, along with fever and chills eventually, signify infection), then time will indeed make this better (but NOT back to "normal") over many months. If infection develops, then surgical intervention will be necessary.

Probably not by the surgeon who caused this mess in the first place. Seek ABPS-certified plastic surgeons who actually have experience and expertise in this, not some self-proclaimed "expert" whose background has nothing to do with plastic surgery. Best wishes! Dr. Tholen

BBL & Fat Necrosis

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Hello and Great Question.  I appreciate the time you are spending researching this procedure.  My name is Dr. Matthew J. Nykiel.  I am a Board Certified Plastic Surgeon, a Fellowship Trained Cosmetic Surgeon, and a Butt Augmentation Specialist.  
A risk to fat transfer is Fat Necrosis.  Fat Necrosis has a very scary name.  Fat necrosis is simply firm tissue from fat that did not completely "Take".  Therefore, the fat did not remain soft and fluffy and instead turned hard.  You should discuss this with your surgeon so that he/she can direct you on the best course.  Typically, in my practice, I allow a period of time (a minimum of 3-6 months) for the tissues to mature prior to intervening.  The options range from minor procedures in the office to returning to the operating room to remove the hard tissue.  An in person consultation is needed to determine the extent of the fat necrosis.  
Please reach out if you have any further questions.  Best of Luck!   Sincerely, Matthew J. Nykiel, M.D. #RealSelfTopDoctor #RealSelfCoreDoctor “THE” Butt Doctor Board Certified Plastic Surgeon Cosmetic Fellowship Trained Surgeon

BBL fat necrosis

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Thank you for your question.  I am sorry for your unfortunate post operative complication.  I would make sure there is no sign of infection which may require a very small incision and culture of the deep tissue.  This may require treatment with oral antibiotics or intravenous antibiotics.  I would wait at least one year for total healing to occur before undergoing further correction. I hope you find this information helpful.  Best wishes in your recovery!


James Fernau, MD, FACS

Board Certified ENT

Board Certified Plastic Surgeon

Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS

I had a BBL 3/26/16 - Now I have fat necrosis! what do you suggest the best treatment is? Will it get better in time?

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I would definitely recommend seeing your plastic surgeon as they will know best what to do as they are familiar with you. Fat necrosis can feel hard to the touch which is likely why you underwent the CT scan. You body will absorb a certain amount of this fat and therefore, the size of the fat necrosis will decrease over time. I would try to be patient and let things settle down. If after several months it is still bothersome, you can liposuction the fat necrosis out. This will likely create a divot in your right buttock and asymmetry. Try to be as conservative as possible for now. If this area becomes infected, then it will have to be removed.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.