What can I do to correct hyperpigmentation and Indentations from liposuction scars? 11 months post op (photos)

Question

I had lipo April 2022, my scars are still hyperpigmented and I’ve noticed a couple of them are indented in. What are my options at this point? These indentations are horrible and I’m really self conscious about them

Semih Yildiz, MD, FEPOBRAS · Answer

At this stage, persistent dark marks and small indentations are usually treated as scar-quality and skin-contour problems rather than normal swelling. The photo appears to show a small hyperpigmented lipo access scar with some surface depression, but an exam is needed to tell whether the indentation is tethered scar tissue, fat loss, or skin texture change.

For the color, strict sun protection plus prescription fading creams, chemical peels, or laser treatments may help depending on your skin type. For the indentation, options may include massage if still firm, subcision, a small amount of filler or fat grafting, laser resurfacing, microneedling, or scar revision. Start with your original surgeon or a board-certified plastic surgeon/dermatologist so the cause is identified before choosing treatment.

J. Timothy Katzen, MD, FACS · Answer

Hi Jojooooo. Thank your for your question regarding how to fix indentations left from liposuction and how to fix skin hyperpigmentation after liposuction. Indentations or uneven contours after liposuction are possible complications that can occur due to uneven fat removal or insufficient skin tightening. Similarly, hyperpigmentation (darkening of the skin) is a common side effect of liposuction. Here are some possible solutions to these issues:
Consult with a board-certified plastic surgeon: The first step is to seek the opinion of an experienced plastic surgeon who can assess the extent of the indentation or hyperpigmentation and suggest the appropriate treatment options.
Revision liposuction: If the indentation is small, your plastic surgeon may perform a revision liposuction procedure to remove additional fat from the surrounding areas and redistribute it to the indented area.
Fat transfer: For larger indentations, fat transfer can be performed to add volume to the depressed area. This procedure involves removing fat from another area of the body (such as the abdomen or thighs) and injecting it into the indented area.
Dermabrasion: Dermabrasion can be used to treat hyperpigmentation by removing the top layer of skin that is discolored. This is a minimally invasive procedure that can help even out the skin tone and texture.
Chemical peels: Chemical peels are another option for treating hyperpigmentation. This involves applying a chemical solution to the skin that causes the top layer to peel off, revealing new, unblemished skin underneath.
Topical creams: There are a variety of topical creams and ointments available that can help reduce hyperpigmentation. These products typically contain ingredients such as hydroquinone, retinoids, or kojic acid, which can help lighten the skin.
It's important to note that the effectiveness of these treatments will vary depending on the severity of the indentation or hyperpigmentation, as well as individual factors such as skin type and overall health. It's important to discuss all treatment options with a qualified plastic surgeon before making a decision. Thank you for your interesting questions. I hope i have answered your questions regarding how to fix indentations left from liposuction and how to fix skin hyperpigmentation after liposuction.

Sincerely, Dr. Katzen

Garrett Jones, DO · Answer

Hyperpigmentation and indentations from liposuction scars can be treated using a combination of medical and cosmetic approaches. Here are a few potential options:
1.) Topical Treatments for Hyperpigmentation:
a.) Hydroquinone: This is a commonly used topical agent for lightening dark spots and hyperpigmentation.
b.) Vitamin C: Applying a vitamin C serum can help brighten the skin and reduce the appearance of dark spots.
c.) Retinoids: These can promote cell turnover, which might help with pigmentation issues over time.
2.) Chemical Peels: Chemical peels involve applying a solution to the skin, which causes the outer layer to peel off, revealing smoother and more even-toned skin underneath. They can be effective for treating hyperpigmentation.
3.) Microdermabrasion and Dermabrasion: These procedures involve removing the outer layer of skin to encourage new skin growth and improve the appearance of scars and hyperpigmentation.
4.) Laser Treatments: Fractional laser treatments and intense pulsed light (IPL) therapy can target areas of hyperpigmentation and promote collagen production to improve the texture of the skin.
5.) Fillers or Fat Transfer: Dermal fillers or fat transfer procedures can help address indentations by adding volume to the affected areas. Consult a skilled practitioner to determine the most suitable option for your specific situation.
6.) Microneedling: Microneedling involves creating controlled micro-injuries in the skin, which stimulates collagen production and can improve the appearance of scars and texture irregularities.
7.) Scar Massage and Silicone Sheets: Massaging the scar tissue and using silicone sheets may help improve the texture and appearance of scars over time.
8.) Consultation with a Dermatologist or Plastic Surgeon: It's important to consult with a medical professional who specializes in skin care or cosmetic procedures. They can assess your specific situation and recommend a personalized treatment plan.

Camille Cash, MD · Answer

For contour irregularities you can consider fat grafting to the area.  Hyperpigmented areas may benefit from lasers or you can consider scar revision.  Speak with your surgeon to learn more about the options.

Mats Hagstrom, MD (license on probation) · Answer

Scar issues usually come down to two varieties. Either they are hypertrophic or hyperpigmented or both. It’s important to recognize if the problem is only regarding pigment or if scar hypertrophy is part of the problem.
Scar hypertrophy means the scar is thick and often hard.
Hypertrophy is the best treated with silicone tape used for many months.
Hyper pigmentation does not respond well to silicone sheeting or silicone tape from my experience. The best thing to do is to avoid sun exposure and give it a full 18 months before making a final assessment. They typically continue to fade slowly for a long period of time. This can take 18 months and then some individuals improvements happen even after that. If the hyperpigmentation persists, then start by talking to your provider for consult with dermatologist, I do a lot of laser work and ask if they have treatments that can lighten the scar.
The indentation at the incision it happens for two reasons. One is that every time the cannula is inserted into the same opening. A small amount of fat is taken from the same place over and over again. Usually Liposuction is done in a fan pattern. If providers exit the incision too many times, then too much fat gets removed from that single area at the incision site. Provider should be careful to minimize the number of times the cannula is put in and out of the incision because that area can get a little over treated. The second reason for getting an indentation in this area is the development of contractile scar tissue. Sometimes the issue is a combination of both fat removal and spa tissue contraction.
Depending on how much this bothers you, it may be possible to improve it to some degree, but it is not straightforward or always simple.
If the problem is related to fat, having been removed, and it’s generally a volume issue and grafting some fat or potentially using Fillers can improve the contour.
Providers can inject a small amount of Celine solution or numbing solution to see if the contour improves by adding volume before committing to doing a procedure. This simple technique can help differentiate if the problem has a scar tissu contractile component. if it does, then discard tissue needs to be released with a procedure called Subsicion in conjunction with volume augmentation. It’s a similar treatment to have cellulite is managed.
Follow up with your provider reschedule second opinion in person consultations with other providers on how far you want to go with.
The majority of patients seeking cosmetic surgery, such as Liposuction will have some minor imperfections, and patients should generally not expect perfect textbook outcomes as a reality for most patients. In general, most patients can find at least some minor imperfection with the outcome of an aesthetic surgical procedure. To make an accurate assessment on the outcome of a plastic surgery procedure patients are generally always show proper before and after pictures. 
Try focusing on the improvement the procedure did give you as opposed to the small area of imperfection.
Most treatments in medicine having some side effects.
Best,
Mats Hagstrom, MD

What can I do to correct hyperpigmentation and Indentations from liposuction scars? 11 months post op (photos)

Answers (5)

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