Abscesses or fat necrosis & do they need to be drained? (Photos)

Question

Had fat transfer to outer thighs, developed an infection at site of transfer after 4 days. Sent to hospital, given IV antibiotics and discharged with oral abtibiotics. Blood cultures normal, showed mild infection. Mild fever. Diagnosed as cellulitis. Infection has reduced but am left with large golf-ball lumps under the skin. Are these abscesses or fat necrosis? Do they need to be drained?

Daniel Barrett, MD · Answer

Dear Arcanely,
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

Karl William Schwarz, MD · Answer

Fat necrosis is common after fat transfer and can appear anywhere we transfer fat--it is not as common in the face because the blood supply to the face is so rich but I see it after transferring fat to the gluteal area and the hips and legs in some of my BBL patients. I find that they go to the ER and get diagnosed with an infection and get them drained but in my practice I let them run their course and I feel I end up with better results than if they are drained and treated like a regular abscess. If you watch the video below on BBL complications and fat necrosis it will explain it better.

Williams Bukret, MD · Answer

Abscesses or infected fat necrosis have to be drained by puncture-aspiration or surgically in addition to antibiotic treatment. Diagnosis of abscess can be confirmed clinically, with ultrasound and puncture. Communicate with your surgeon immediately if you didn't, to address this complication opportunely.

Darryl J. Blinski, MD · Answer

Sorry for your severe postoperative complications of fat grafting to the thigh areas. I must compliment the excellent posted photos. I assume you had surgery not in your city? But traveled away for the surgery? You need t be under the care of a private practice boarded Plastic Surgeon. In my practice I see SOOO many of your all coming from clinics or out of country surgeries with all types of these complications. In your case I would recommend IV antibiotics for 5 days, with daily ozone therapy. Best to virtual with...

Douglas Taranow, DO, FACOS · Answer

While your photos are very alarming, your history is incomplete.  We need to know more information like how long post-op you are now, how the circled areas of redness are doing (resolving, or remaining).  If not an abscess, there is no need for draining.  IF the lumps remain for some time after the redness resolves, then steroid injections or surgical removal may be indicated.  Many times surgeons will wait a full year to see if the lumps resolve on their own (I prefer to add steroid injections to help them along, but ONLY if there are no signs of infection).
Best wishes.
Dr. Taranow

Arian Mowlavi, MD, FACS (license on probation) · Answer

What you need to do is to wait for the redness to subside(the cellulitis); if you have an abscess it won't get better and you will need to have urgent incision line incision (called I and D) to drain if you have an abscess. Once your cellulites resolves (redness gone), you will need to be evaluated to see if you have any dead fat/necrotic fat iin the area which will show up as a soft lump; if present, this can either be liposuctioned out if minimal to moderate or require an excision if larger, but this is not urgent and you can give it at least three months to see how it evolves.

Mats Hagstrom, MD (license on probation) · Answer

Surgical infections when they develop typically need incision and drainage or at a minimum confirmation that there’s not an infected fluid collection.
This means radiographic evaluation by ultrasound, CT scan or MRI.
Alternatively A needle aspiration can be used to see if there’s a puss collection.
Postoperative infections are typically not cellulitis and almost always need to be treated surgically.
The surgeon who did your procedure should be managing your infection actively including examining you on a daily basis and taking you to surgery if indicated.
Best,
Mats Hagstrom MD

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