Why do some ab etching results heal to look flat and 2D?

Question

I've been looking into doing 360 abdominal lipo + j-plasma w a lipo specialist in Bangkok. However, I realised that while all his results look amazing immediately post-op, some heal to look flat. Can't post pictures but imagine someone painting the outline of ab muscles on a flat tummy w brown eyeshadow - it looks fake. I looked into other docs in BKK and they're the same. Is this an issue w the doctor or an isssue w the patient's recover care? How can it be avoided?

Randal Haworth, MD, FACS · Answer

The outcome of liposuction can vary from patient to patient, and the final result depends on several factors, including the skill and technique of the surgeon, the patient's individual anatomy and healing process, and post-operative care. It's difficult to assess the specific issue without seeing the photos or having more detailed information.

That being said, there are a few potential reasons why some individuals may end up with a flat or "fake" appearance after abdominal liposuction:

-Insufficient fat removal: If too little fat is removed during the liposuction procedure, it can result in a less dramatic change in body contour. This can lead to a flat or less defined appearance.

-Poor skin elasticity: The elasticity of the skin plays a significant role in how it retracts after fat removal. If a patient has poor skin elasticity, the skin may not tighten properly after liposuction, resulting in a less sculpted appearance.

-Inadequate post-operative care: Proper post-operative care is crucial for optimal results. This includes wearing compression garments as prescribed, following the surgeon's instructions for activity and exercise, and maintaining a healthy lifestyle. Neglecting post-operative care can potentially impact the final outcome.

To avoid potential issues and achieve the best possible outcome, it is important to choose a skilled and experienced plastic surgeon who specializes in liposuction. They should have a thorough understanding of body contouring techniques and be able to assess your individual needs and expectations. Additionally, following all pre- and post-operative instructions provided by your surgeon can help optimize your results and minimize potential complications.

It's also worth considering seeking multiple opinions and consulting with different surgeons to ensure you find a provider who has a consistent track record of achieving the results you desire. Reviewing before and after photos of previous patients, if available, can help you assess the quality of the surgeon's work.

I hope this helps,
best of luck !

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding why some ab etching results heal to look flat and 2D. Thank you for your history. Most results of VASER ab etching do not heal in 2D.  Most results of VASER ab etching heal amazingly well in 3D.  During VASER ab etching, the anterior abdominal wall fat is melted from around the rectus abdominis muscle. Also, during VASER ab etching, the skin above the rectus muscle is heated by the VASER.  The heated skin then shrink-wraps on top of the underlying rectus.  These two key maneuvers allow for the 3D results of ab etching.  Please look carefully at VASER ab etching photos. Most VASER ab etching photos will reveal a four-pack or a six-pack result. However, photos are really only 2D.  Therefore, I suggest you watch VASER ab etching videos, which may present more of a 3D effect than 2D "look" of photos.  Therefore, I would look at more videos on VASER high-def ab etching.  If you still cannot see 3D results, perhaps ask your chosen plastic surgeon to provide actual patients for you to examine and see for yourself the amazing work that can be achieved with VASER high-def ab etching. I hope I have answered your question regarding why some have ab etching results that look flat and 2D.  Good luck!

Emmanuel Mallol Cotes, MD · Answer

Thanks so much for your inquire,

Removing too much fat can lead to a flattened appearance instead of a natural, muscular look. Also, Poor skin elasticity can prevent the skin from adhering closely to the newly contoured muscles, leading to a flatter appearance.

Some other factors might be: 
Inadequate post-operative activity or improper healing can affect the outcome.
Not wearing compression garments as recommended can affect how the skin reattaches to the underlying tissue, impacting the final results.

Ensure that your surgeon has specific experience and a proven track record in abdominal etching and discuss your goals and the surgeon’s approach in detail.

Sincerely, 
Dr. Emmanuel Mallol

Ahmad N. Saad, MD, FACS · Answer

When HD liposculpture is properly done, results are 3D. And should only get better with time.
Check out the link below:

Emmanuel De La Cruz, MD · Answer

The aesthetic outcome of abdominal etching can vary from person to person, and several factors contribute to how the results manifest, including the appearance of flat or 2D contours. Here are some key considerations:

Individual Anatomy:

Natural Variations: The natural anatomy of each individual, including the underlying musculature, body fat distribution, and skin characteristics, can influence how well-defined the results appear.
Pre-existing Conditions: Factors such as the thickness of the subcutaneous fat layer and the quality of skin elasticity play a role in the final outcome.
Surgeon's Technique:

Precision in Fat Removal: The surgeon's technique in selectively removing fat to enhance muscle definition is crucial. Precision in fat removal and attention to detail contribute to achieving more sculpted and natural-looking contours.
Artistic Skill: Achieving aesthetically pleasing results requires a surgeon with a keen understanding of the underlying anatomy and a sense of artistry in contouring.
Post-Operative Care:

Compression Garments: Wearing compression garments as recommended by the surgeon helps shape the treated area and can contribute to the desired contour.
Follow-Up Care: Adhering to post-operative care instructions, including activity restrictions and attending follow-up appointments, is important for optimal healing.
Healing Process:

Swelling and Bruising: Swelling and bruising are common after surgery. The extent and duration of swelling can impact how contours appear during the initial healing phase.
Resolution of Swelling: As swelling resolves over time, the contours become more defined. It may take several weeks to months for the majority of swelling to subside.
Realistic Expectations:

Individual Goals: It's important for individuals to have realistic expectations about the achievable outcomes of abdominal etching. While the procedure enhances muscle definition, factors such as skin thickness and overall body composition influence the final appearance.
Muscle Tone and Exercise:

Role of Exercise: Engaging in regular abdominal exercises can contribute to muscle tone and further enhance the appearance of the abdominal muscles.
Post-Operative Exercise: Surgeons may provide guidelines on when and how to resume exercise after abdominal etching to optimize results.
Revision Procedures:

Consideration of Revisions: In some cases, individuals may choose to undergo revision procedures to further refine results or address any asymmetry. Revision surgery, if needed, is typically considered after complete healing.
If someone is dissatisfied with the results or has concerns about the appearance of flat or 2D contours after abdominal etching, it's crucial to communicate openly with their surgeon. Revision options, if appropriate, can be discussed during follow-up consultations to address specific concerns and achieve the desired outcome.

Raja Mohan, MD · Answer

It honestly depends on the surgeon and their recommendations post-operatively. I recommend seeing a board certified plastic surgeon.

Daniel P. Markmann, MD · Answer

Without seeing that doctors pictures, it's tough to know exactly what you are referring to.  I have been performing Ab Etching surgery for about 19 years now.  I have never seen any of my patients abs flatten after surgery.  Of course there is some swelling that will go away.   Maybe he is doing fat grafting to the abs.   Some of the transferred fat always goes away.   But, Can say for sure since I can see his patients pics.

Sean Satey, MD, FACS · Answer

Great question. There are multiple factors at play here. First, some surgeons inject fat into the muscle belly to enlarge and enhance the overall look of the muscle belly. While this may look great immediately post-operatively, a lot of the fat will die - which is why this is a practice pattern I don't utilize. Second, it depends on the baseline musculature of the patient. A strongly muscle will have more defined inscriptions, which will result in larger, prominent muscle definition. This is why I have some of my patients help define the muscles prior to surgery with an aggressive exercise regimen 30 days prior to surgery. Third, the degree of fat left behind preferentially over the muscle belly. If all of the fat of the abdomen is taken down evenly, minimal definition will result. True etching occurs with gutting of the fat layer directly over the inscriptions and the linea alba/semilunaris lines. Hope this helps clarify.

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