6 months on & abdomen still looks bruised & very little change in colouration from a few months ago (Photos)

Hello, in my opinion there appears to be post-inflammatory hyperpigmentation, which can be a tough problem in some patients. Essentially the inflammatory response to surgery has increased the amount of melanin in the overlying skin. Skin type and genetics play a large role in this phenomenon, which can sometimes improve very slowly on its own (6-12 months and sometimes longer after the procedure) and sometimes may benefit from evaluation by a dermatologist or a plastic surgeon comfortable with skin lightening treatments such as creams (hydroquinone), chemical peels, or various lasers.

This may be slowly resolving bruising or hyperpigmentation response to the procedure. Mostly likely it's bruising but bruising is typically resolved at this point. A "flat hard wall" as you said, in conjunction with the overlying skin changes, may indicate that there was some bleeding in that area after the surgery. If there is old blood in that area, then it may take a while for it to totally absorb. I recommend that you continue to consult with your surgeon and if you haven't already, consider endermologie and or lymphatic massage of that zone to help break up the firmness.

Dear Gregarious107285,
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

You may have had a small hematoma early on that is slowly absorbing. Hopefully the pigment from the broken red blood cells will not stay and leavy a permanent discoloration. Massage might still be helpful.

Thank you for sharing your photos and questions. You may be experiencing hyperpigmentation of the suctioned area. This generally improves with time but it can be a slow process. Sometimes we can use laser treatments to help speed the process along.

What you are experiencing is neither common, nor uncommon to liposuction. It is hyperpigmentation caused by the hemosiderin in the blood staining the skin. It fades over time in most patients, but in some, some residual darkening is permanent (usually in black or Hispanic patients more commonly). In lighter skin clientele, using laser will alleviate much of the pigment. Laser is not indicated in many dark skinned patients. The use of tretinoin cream (Retin-A) will sometimes lessen the pigmentation.
Best wishes.
Dr. Taranow

You have what is most likely a Hemosiderin deposits staining your fat tissues and skin.
Liposuction as a procedure has evolved and improved over the decades. The biggest breakthrough happened in the early 1990s when Dr. Jeffrey Klein did pioneering research on the use of a numbing solution called tumescent solution. His formula which is still used by most surgeons today is basic intravenous fluid (dilute salt water) mixed with lidocaine and epinephrine. It’s the addition of epinephrine that revolutionized Liposuction. That drug causes vasoconstriction with temporary shutting down of the blood supply through the fat while the surgeon does liposuction. The lack of blood flow through the tissues also allows the lidocaine to keep the patient number longer and also dramatically increases the safe amount of lidocaine that can be used. dr. Klein calculated safe levels of the solution that could be used by measuring lidocaine levels in the blood of patients after surgery.
Before his research it was believed that the maximum dose of lidocaine that was safe to use was 6.5 mg per kilogram. Dr. Klein’s research indicated that when used in the tumescent solution combining lidocaine and epinephrine 35 mg per kilogram could be used. there have been later studies showing even higher doses are safe including 50 mg per kilogram and 70 mg per kilogram of lidocaine.
With Scientific evidence showing that 800% more lidocaine could be used than previously thought possible liposuction became a procedure that could be performed without general anesthesia.
Using sufficient amounts of tumescent solution keeps the patient comfortable both during and after the procedure and also drastically reduces blood loss.
When done as an awake procedure surgeons have to meticulously and thoroughly numb all areas being treated including areas outside the periphery of the treated zone.
If the tissues are not thoroughly saturated with tumescent solution the patient will not tolerate the procedure. for that reason doctors who do liposuction as an awake procedure will always spend a significant amount of time and effort carefully injecting tumescent solution through all the tissue layers in a very thorough manner. When general anesthesia is used surgeons still inject tumescent solution because it decreases postoperative pain and reduces blood loss substantially. Before surgeons were using tumescent solution (1980’s) patients would lose large amounts of blood and often need blood transfusions after liposuction. In order for the drugs in tumescent solution to be fully effective requires a bit of time.
Lidocaine begins numbing almost immediately but epinephrine takes 15 to 20 minutes before full vasoconstrictive can be seen. The effects of this drug is actually easily visualized as the skin begins to blanch and turn pale white from the reduction in blood flow from the constricted blood vessels.
Operating room time is expensive and surgeons are often not willing to sit and wait 20 minutes for the epinephrine to be in full effect.
Surgeons using general anesthesia typically also don’t focus nearly as much time and effort in making sure all the tissues are saturated with tumescent solution.
The anesthesiologist has the patient asleep and is usually responsible for making sure the patient is comfortable when they wake up from surgery so the need isn’t there. The potential lack of attention to detail in being as thorough as possible in the first step of doing modern liposuction is very real.
The surgeon is focused on the procedure at hand which is removing fat. operating room time is expensive sometimes around $1000 per hour. In an attempt to get on with the procedure they usually spend a few minutes injecting tumescent solution to get it out of the way so they can begin the real work.
Those of us who do the procedure with the patients awake will spend 20-40 minutes(depending on areas treated) simply getting patients injected with tumescent solution. The time taken is in part to keep the patient comfortable and in part to do it thoroughly so we can do the procedure without the patient having pain and minimize bleeding.
The difference in a blood loss between the two ways of doing liposuction can be quite profound.
Awake liposuction procedures usually has very little blood loss.
Patients will get bruised but usually most of it is cleared up by about a week or 10 days. Sometimes patients may have a small lasting area of bruising that lasts three weeks but that’s rare.
I’m guessing in your case you were probably black and blue for six weeks or even months. perhaps the bruising even travel down to your thighs or your gonads.
I’m guessing your procedure caused substantial bleeding most likely because injection of tumescent solution was done insufficiently or not enough time was given for epinephrine to be in full effect. The resulting hematoma or blood in your tissues required your immune system to work overtime to slowly dissolve all of the red blood cells full of hemoglobin.
Hemoglobin is the molecule that gives blood its intense deep red color. in the body hemoglobin is broken down and eventually becomes bile. Bile is produced by your liver and stored in your gallbladder and is used in the absorption of digested fats. Hemoglobin and bile are molecularly pretty different molecules so the body has to modify hemoglobin through a series of steps in the conversion process. it is the intermediary molecules in the transformation of hemoglobin to bile that causes the intense pigment changes we see in the manifestation of physical bruising. Each of the molecules in the multistep transition of hemoglobin becoming bile has a different color. Red blood cell haemoglobin molecules are broken down into two subunits, heme (the part containing iron) and globin. The heme breaks down into iron and biliverdin, a green pigment. Biliverdin is then transformed to bilirubin, an orange pigment. When people say someone is black and blue they are referring to a green pigment, and orange pigment combined with dark blood. The term “black and blue” is actually incorrect since none of their pigments have a blue color to them.
It’s been many years since I studied biochemistry and I’ll spare you the details of how the iron molecule is processed and instead will just say that some of it becomes something called hemosiderin which in a sense it’s like having an internal iron tattoo.
Hemosiderin deposits or hemosiderin tissue staining is most common in individuals who have venous stasis disease when red blood cells slowly leak out of capillaries and overtime the hemosiderin formed by the iron inside the hemoglobin in each red blood cell starts staining the lower parts of the legs of the individual affected.
Anytime there’s a large collection of blood in a finite area or repeated bleeding overtime patients are at risk for developing hemosiderin stains.
In chronic conditions like venous stasis disease the staining and discoloration gets worse with age.
What is the result of a one time injury or accumulation of blood it typically gradually improves with time.
The timeframe of the body breaking down hemosiderin can be very slow.
The process can take years and sometimes be permanent or semi permanent.
That said almost everybody sees gradual improvements given enough time.
The easiest answer to your question is that you’re still bruised.
It simply isn’t the same kind of bruising you saw during the first month after surgery it is the manifestation or the long-term sequelae of having had a lot of blood in your tissues.
Ask for a copy of your operative report and try to read it. Patients have full rights to their medical records by simply requesting them at least in the United States and I would think in most of the western world.
All surgeons typically include a statement in the beginning of the report that describes how much blood was lost during the procedure. it may be abbreviated by EBL(estimated blood loss).
For liposuction surgeons never know how much blood they lose and usually just make up a number.
It’s not wrong to do that because it’s impossible to measure blood loss accurately from Liposuction.
See if there’s any notation in the operative report or simply ask the surgeon if you had a lot of bleeding during surgery.
Sometimes plastic surgeons take pictures of the canisters full of fat after the procedure as documentation. Ask your surgeon if by any chance he or she took pictures of the canisters of fat. If they did ask to see the pictures.
Fat removed from Liposuction should be light yellow or at most a golden orange color. If it’s dark red it means it’s full of blood.
I don’t have any particular answers for your question or recommendations on how to improve your situation but I believe your outcome is a direct reflection of how the surgery was performed unless you have some underlying blood clot or bleeding disorder.
I believe your surgeon could’ve done a better job at infiltration of tumescent solution and doing that would’ve saved you what you’re now going through.
There are no adjuvant treatments to speed the process or improve the aesthetic outcome.
The process is slow and takes time. I recommend you take pictures every few months and document them and look for signs of progress.
If you see your surgeon again you have my permission to tell them that they should be more vigilant with the use of tumescent solution and always give up epinephrine enough time to be in full affect before starting surgery.
Hopefully you saw some improvements from the Liposuction.
The firmness you feel is most likely a combination of the fascia of your abdominal wall combined with scar tissue from months of inflammation from healing and breaking down large amounts of blood.
The firmness will also likely improve over time. Make a note of how firm you feel your abdomen is compared to other areas and check for progress every few months just like taking pictures and looking for progress.
In this response I am making a number of assessments and you should consider everything I said as general statements. they may or may not apply to you.
It’s not possible to make accurate assessment based on limited information and the information presented is quite limiting.
Your surgeon is the most informed person since they did the procedure and that is the person you need to speak to about what’s happening.
Plastic surgeons are a Notorious Bunch for dismissing patient’s concerns and coming up with lame excuses.
Many seem to handicapped or incapable of acknowledging they did something less than perfect or have something to learn.
The surgery selection process and training seems to self select for certain personalities. In the end most plastic surgeons are caring individuals who want to help patients look and feel better about themselves.
I hope your results continue to improve.
I hope my response was helpful for you.
Best,
Mats Hagstrom MD