What are the signs of fat necrosis and how is it treated?

   Fat necrosis, whether in the buttock or elsewhere, usually involves the feeling of a hardened discrete mass that is the calcified dying or dead fat.  Treatment may include massage, tincture of time, as most of these go away with time.  Occasionally, these areas may have to be excised.  There are probably multiple reasons for this to occur, some of which are not entirely preventable.  I think I did around 250 or so Brazilian buttlifts last year and I did not have an issue with fat necrosis reported to me by patients or identified on physical exam.  Kenneth Hughes, MD Los Angeles, CA

Fat necrosis usually presents as a firm nodule in the area of fat grafting.  It can be painful at times.  The big danger is infection..you would then see redness and increased pain.  Treatment is usually massage for non- infected areas and surgery plus antibiotics for infected areas.

Fat necrosis most often presents as a discrete area of firmness with or without pain. In the absence of pain, the mainstay of treatment is time, as the firmness frequently improves with time. Massage may also be beneficial. If the area is painful, consideration can be given to surgical excision. If the excision leaves a contour irregularity, further surgery may be necessary to correct it.