Liposuction Difficulties for Fibrous People?

Question

I have heard about difficulties with Liposuction for people who are very "fibrous," including more pain and the inability to get at enough fat to show a significant improvement.   Are all athletic people (who work out a lot) fibrous?  Is there a way to tell beforehand?  Thank you.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding the challenges associated with performing liposuction on individuals with fibrous tissues.

It is true that people with fibrous tissues can experience more difficulties during liposuction. Fibrous tissue, which is denser and more collagen-rich, can make the fat harder to remove and potentially lead to more pain and bruising during and after the procedure. This type of tissue is often found in individuals who are very athletic or have engaged in significant levels of physical activity, as their bodies adapt to stress by strengthening not only the muscles but also the connective tissues.

However, not all athletic people have highly fibrous tissues, and the degree of fibrousness can vary greatly from person to person. Factors such as genetics, age, and specific types of exercise can all influence how fibrous an individual's tissue is.

Determining Fibrous Tissue:

Physical Examination: A skilled plastic surgeon can often determine the fibrous nature of your tissue through a physical examination. They may be able to assess the firmness and quality of the tissue which can give them an indication of how fibrous it might be.

Imaging Tests: In some cases, imaging techniques like ultrasound or MRI might be used to get a better understanding of the tissue composition, although this is less common for this specific purpose.

Approaches to Liposuction in Fibrous Tissue:

Technique Adjustment: Surgeons might adjust their techniques or use specific tools designed to handle fibrous fat more effectively. Devices like power-assisted liposuction (PAL) or ultrasound-assisted liposuction (UAL) can be particularly useful as they provide additional power and energy to break up tough fibrous fat.

Expectation Management: It’s important for patients with fibrous tissue to have realistic expectations. While improvements are definitely possible, the extent of fat removal might not be as significant as in non-fibrous patients.

Preoperative Preparation: In some cases, preparing the tissue before surgery with certain treatments might help reduce its density, although this approach is not standard and should be discussed with your surgeon.

If you are considering liposuction and suspect you might have fibrous tissues, the best course of action is to consult with a board-certified plastic surgeon who has experience working with similar cases. They can provide you with a more tailored assessment and discuss the most effective strategies for achieving your desired results.

I hope this information helps clarify some of the complexities involved in liposuction for fibrous individuals and assists you in making informed decisions about your body contouring options.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Matthew Schulman, MD · Answer

I agree that it is difficult to predict who is "fibrous." I find the upper back and breasts (especially in men) generally fibrous. Also, people that have had prior liposuction tend to be more fibrous. The are many advances in liposuction that will help in treating fibrous area; these include power-assisted liposuction, ultrasonic liposuction, and laser-assisted liposuction. An experience surgeon should be able to examine you and be able to tell ahead of time if you are fibrous. He or she can then chose the most appropriate method of liposuction.

James Knoetgen, III, MD · Answer

Liposuction can be more challenging for individuals with fibrous tissue due to the denser and tougher nature of this type of tissue. Here are some specific difficulties and considerations for liposuction in fibrous areas:
Challenges:
1.	Tougher Tissue:
o	Fibrous tissue is denser and more resistant than fat tissue, making it harder for the cannula (the instrument used in liposuction) to move through and suction the fat effectively.
2.	Increased Risk of Irregularities:
o	Because the fibrous tissue can cause the cannula to move less smoothly, there is a higher risk of creating uneven fat removal, leading to potential skin irregularities or indentations.
3.	Longer Procedure Time:
o	The increased resistance can make the procedure more time-consuming, as the plastic surgeon needs to work more carefully to ensure even fat removal.
4.	More Swelling and Bruising:
o	Fibrous areas are more prone to trauma, which can result in increased swelling, bruising, and a longer recovery period.
Considerations and Techniques:
1.	Advanced Techniques:
o	Plastic surgeons may use techniques such as tumescent liposuction, which involves injecting a solution that helps to break up the fibrous tissue and makes fat removal easier.
o	Ultrasound-assisted liposuction (UAL) or laser-assisted liposuction (LAL) can also be beneficial. These methods use energy to liquefy the fat before removal, making it easier to treat fibrous areas.
2.	Experienced Surgeon:
o	Choosing a plastic surgeon with significant experience in performing liposuction on fibrous areas is crucial. Their expertise can help mitigate some of the challenges associated with these procedures.
3.	Pre- and Post-Operative Care:
o	Proper pre-operative planning and post-operative care can enhance outcomes. This might include wearing compression garments, undergoing lymphatic drainage massages, and following the plastic surgeon’s specific instructions closely.
4.	Realistic Expectations:
o	It’s essential to have realistic expectations about the outcomes and potential need for touch-up procedures. Discussing these expectations with the plastic surgeon before the operation can help align your goals with achievable results.
Common Fibrous Areas:
Certain body areas tend to be more fibrous and may present more challenges during liposuction, including:
•	Male chest (for gynecomastia treatment)
•	Upper back
•	Flanks or love handles
•	Areas previously treated with liposuction or scar tissue
While liposuction on fibrous areas can be more challenging, advancements in techniques and the skill of the plastic surgeon can significantly impact the success of the procedure. If you are considering liposuction and have concerns about fibrous tissue, it’s important to discuss these with your plastic surgeon, who can offer tailored guidance and appropriate techniques to address your specific needs.

Brian K. Brzowski, MD, FACS · Answer

It is not impossible to remove fibrous fat, just harder. This extra effort almost always leads to extra swelling and bruising which delays the time before you will see your changes.  There might be a little increase in postoperative discomfort as a result of the extra effort.
I've never been able to reliably predict who will have more fibrous tissue. There's no definite relationship between active patients and more sedentary ones when it comes to the composition of the fatty layer.  
There are anatomic areas, however, that are consistently more fibrous: the male breast, the upper back, and the fat around the belly button.  
An experienced plastic surgeon will be able to use the tools necessary to achieve a good result. You have many excellent ones to chose from in your area.
Good Luck!

George J. Beraka, MD (retired) · Answer

Hi.

	"Fibrous" is not a true medical concept. In some people and in some areas, the fat is a little less soft but, with good technique, this does not affect the result.

	The fat deposits of athletic people are not more fibrous.

	In people that have had previous liposuction, the procedure is more difficult, but that is because of internal scarring.

Liposuction Difficulties for Fibrous People?

Answers (5)

Answer: Fibrous fat is harder to remove

Answer: Fibrous fat is harder to remove

Answer: Liposuction works if you have localized fat deposits.

Answer: Liposuction works if you have localized fat deposits.

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Everything you need to know about Liposuction

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Liposuction Difficulties for Fibrous People?

Answers (5)

Answer: Fibrous fat is harder to remove

Answer: Fibrous fat is harder to remove

Answer: Liposuction works if you have localized fat deposits.

Answer: Liposuction works if you have localized fat deposits.

Browse related questions

Recommended reading

Everything you need to know about Liposuction

Our mission is to create a world where every investment in modern beauty is Worth It.