what can I do to remove scar tissue from liposuction? 1.5 yr post op (photos)

Question

I got a BBL about a year and a half ago and have a significant amount of scar tissue under my skin on my stomach, which gives it a pretty uneven look when I'm in certain lighting. I was wondering what options I have available to break down this scar tissue and smooth out my stomach?

Semih Yildiz, MD, FEPOBRAS · Answer

From the photos, there appears to be abdominal contour irregularity and shadowing after liposuction, but an exam is needed to know whether this is firm scar tissue, residual fat, skin laxity, or tethering under the skin. At 1.5 years, most healing has matured, so massage alone usually has limited ability to change a significant contour problem, although it may help if there is still tightness or focal firmness.

Useful options depend on what is found on exam. Small tethered areas may improve with subcision or scar release, sometimes combined with fat grafting. Residual uneven fat may need careful revision liposuction, while loose skin may need skin tightening or a tummy tuck-type procedure rather than more lipo. Energy devices can help selected mild cases but are not predictable for deeper contour defects. I would start with your original surgeon or a board-certified plastic surgeon experienced in revision liposuction, because over-treating the abdomen can make irregularities worse.

Sergei Kalsow, MD · Answer

It is a hard problem to treat.  The skin under the belly button is very sensitive to getting these irregularities.  The surgeon would have to fix that with fat transfer.  He would use a marker to outline all the dents, numb them with lidocaine, then take fat from elsewhere in the body and try to fill every one of those dents.  If the skin expands it should get smoother.  Might require more then one treatment, but I think improvement is possible.

Daniel Barrett, MD · Answer

Dear andrea813,
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

You could have some very carefully done fat grafting or try Sculptra injections to help restore lost volume.

Camille Cash, MD · Answer

I'm sorry to hear of the contour irregularities you've experienced since your procedure.  You can try massage to break up scar tissue.  A tummy tuck may also help.  I encourage you to meet with a board certified plastic surgeon to discuss your concerns and learn more about options.

Darryl J. Blinski, MD · Answer

Nice posted photos. They demonstrate grade 3-4 fibrosis. What type of lipo was done? Vaser, Smart Lipo, Laser lipo? J-Plasma? These all cause severe fibrosis internal scarring! I offer redo lipo using the S.A.F.E. lipo techniques to release the fibrosis with topifoam aggressive compression, multiple sessions of massages. Then after 2-4 months injections of Radeisse/Sculptra combinations into any residual dents. Fees from $5,000 for redo surgery, Fees from $4,000-$12,000 for injections. Best to virtual consult with...

Douglas Taranow, DO, FACOS · Answer

You have a very difficult situation. There is both excess skin (not that hangs) and contour irregularities.  Options include a mini abdominoplasty (like a C-section scar) to remove skin and pull the lower belly skin down. Releasing some of the scar tissue under the skin and performing fat transfers to the dented areas (technically challenging) may be indicated.

I have seen countless noninvasive treatments touting smoothing results yet I have not seen many 6+ month follow up photos showing permanent improvement.  Beware of noninvasive treatment promises. 
A physical examination would answer these questions more accurately 
Best wishes 
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

Liposuction should be considered a permanent and irreversible operation.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe.
Number of plastic surgeons despite proper qualifications training and good intent who can deliver consistent quality Liposuction results without any skin a contour irregularities is actually quite small.
Unfortunately a substantial number of plastic surgeons think of Liposuction as a simplistic procedure that does not have a significantly high learning curve.
Mastering this procedure requires a strong commitment to always becoming better and doing thousands of procedures.
Treatments should be based on a clear understanding of what the problem is.
In your case you are very little subcutaneous fat, the fat distribution is uneven and because your first procedure was done aggressively you also now have a lot of scar tissue.
I mentioned earlier that Liposuction should be reviewed as a permanent and irreversible procedure.
Correcting the results of poorly done liposuction is difficult and often not possible.
This is especially true if the original procedure was done aggressively and irregularly.
There’s no way to reduce scar tissue and any surgical intervention well if anything create more scar tissue.
There’s no single one procedure that can correct your abdomen, make it look normal or reverse it back to pre-liposuction.
The treatment options to create some improvement come down to revision Liposuction(removing more fat), fat grafting(attempting to add the fat), and for some individuals converting the procedure into a skin tightening operation like a full tummy tuck.
The last option is a good alternative for individuals who are good candidates for a tummy tuck in the first place and have significant skin laxity. if you have tight skin and a tummy tuck is not indicated than fat transfer and revision liposuction typically done as a combination is the only option.
Revision liposuction is many times more difficult than primary liposuction.
This means that any surgeon attempting to improve your old, but doesn’t have substantially better skill then your first surgeon is more likely to make things worse rather than better.
This means that any surgeon attempting to improve your old, but doesn’t have substantially better skill then your first surgeon is more likely to make things worse rather than better. during revision work each small area of imperfection is typically assessed as either having slightly excess fat or being devoid of fat. Fat can be grafted into thin areas and small amounts of fat are removed from the fuller areas to try to even out the contour. To do this and actually create a significant improvement is technically difficult in the number of providers who can make significant improvements rather than making things worse is quite small.
Fat transfer or grafting fat has major limitation because the areas were you need volume are now completely devoid of host tissue supporting tissue graft. this means that only very small amounts of fat can potentially survive areas that have no tissue acting at post tissue to support the graft.
Taking an even fat distribution and reducing it down and leaving it even is hard enough. For example, your surgeon was not able to do that.
To take an uneven surface and then make it even is many many times more difficult.
Requires very meticulous work and almost always require multiple procedures.
Detail oriented highly skilled surgeons can make gradual subtle improvements on these type of outcomes but no one single procedure can completely fix the problem.
If you fail to find a sufficiently skilled provider any attempt at revision can easily make things worse.
The process of finding the right provider can be challenging.
My suggestion for patients interested in any plastic surgery procedure is the following.
Start by finding providers who have good reputations for the procedure you’re interested by having a lot of quality and quantity of before and after pictures on their website.
Next schedule multiple in person consultation with each of these providers.
Always avoid virtual consultations and whenever possible avoid traveling long distances for elective surgical procedures.
Bring pictures with you of your own torso taken the same way plastic surgeons take before and after pictures.
Ask each provider to open up your portfolio and show you their entire collection of before and after pictures for the procedure you’re interested in.
Ask providers to only show you pictures 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. all plastic surgeons have a variety of outcomes and it’s fair game to ask to see them.
Recognize that being shown a handful of preselected images most likely representing the best results of a providers career is completely in adequate to get a clear understanding of what the average results look like or how many of these procedures anyone surgeon has actually performed.
For reference and experience surgeon should have no difficulty showing you at least 50 send some before and after pictures of commonly performed procedures like abdominal liposuction or the BBL.
Look very carefully at each and every before and after pictures making sure there are no skin contour irregularities anywhere. ask the surgeon to review the pictures with you asking them to find out areas treated in areas not treated. look very carefully at transition zones between treated and on treated areas to make sure they look completely natural.
Providers who failed to show you sufficient quality and quantity of before and after pictures or continue to show you pictures of patient so don’t have similar body characteristics to your own I’m not showing you the information needed.
I suggest patient start with a minimum of five consultations and consider scheduling many more unless they feel very certain they found the right provider for whatever procedure they’re interested in.
There’s a substantial percentage of Wellington ended well trained board-certified plastic surgeons with years of experience who simply aren’t good at Liposuction.
Mastering this procedure is far more difficult than most people believe.
There’s more variation from liposuction results than any other plastic surgery operation.
When searching for a provider to do revision work the process is more or less the same. The biggest difference is going to be that they will not have as many before and after pictures of revision work.
For a vision work you need to be even more selective so this may require scheduling a lot of consultations.
You should also recognize that to make progress and make real improvements will most likely require multiple procedures.
Some very talented providers may also be apprehensive to take on revision work.
Taking care of patients who’ve been disfigured by other providers can be extremely time consuming and isn’t always the most fun type of work.
I’m sorry that this happened to you. There’s no easy way to fix this.
Your job is defined as efficiently skills and experience provider to try to make first an accurate assessment and then give you treatment options to move forward and improve your outcome.
Anybody who claims this is easy or that some simplistic procedure can make things better should be highly avoided. 
When in doubt slow down and schedule more consultations.
Best,
Mats Hagstrom MD

what can I do to remove scar tissue from liposuction? 1.5 yr post op (photos)

Answers (8)

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