Not Enough Fat Removed After Liposuction?

Question

I had an abdominal Liposuction on June 12th, 2009 to correct a muffin top that resulted from a myomectomy to remove uterine fibroids last year. My stomach ballooned out over a c-section type scar, and I wanted to flatten that area. The day after my Lipo surgery, I took my garmet off to shower and saw almost no change, not to mention that right above the scar where I wanted my stomach to be flattened the most still buldges out. Now, its very hard and sore. Does this mean that not enough fat was taken out?

John Philip Connors III, MD · Answer

As I understand your question, you are less than a week after surgery; and therefore still in the "Swelling" phase. I make sure patients understand that the first week after surgery is fraught with swelling and bruising. The second week starts the resolution phase at which point swelling and bruisng START to subside....swelling, depending on the volume of the total treatment area, can persist for 6 weeks and up to 6 months.  DO NOT step on a scale during the first month as you will typically see a weight gain.
Therefore, it is rather early to expect significant results. I would discuss the above phases with your surgeon and I am sure he/she, as an experienced cosmetic surgeon would agree and help educate you and prepare you along the path to recovery.  Good Luck!

Kenneth D. Steinsapir, MD · Answer

Dear Morena
You have waited a full year since your liposuction.  This is plenty of time to allow this area to heal.  Clearly you have an issue.  Without a personal examination, it is difficult to know precisely what the issue is.  
Gynecologic surgeons (not all fortunately) are apparently trained to lift and sweep up the abdominal fat prior to making the low transverse abdominal incision.  This effectively traps a wad of fat above the incision once it has been sutured back together.  This seems to be an appalling and all too common technique.  
Liposuction can be very effective in flattening these undesriable collections of fat.  This is completely analgous to the so-call "mommy pooch" after a c-section.  Many of these respond great to liposuction.  However, remember that liposuction is an art form and some surgeons loose interest with liposuction because it does not fit their big cutter model of the world.  
Normally one would expect that an area undergoing liposuction would become very firm after surgery, but this area would soften and return to its normal pre-surgical texture several months after surgery.  That yours did not suggests that something else is going on.  It may be related to how your abdominal wall was repaired following the myomectomy.  
I would strongly recommend that you find a board certified plastic surgeon with a strong in body work.
Dr. Steinsapir

Otto Joseph Placik, MD · Answer

I agree entirely with Dr. Shaefer.
You most likely would benefit from a scar revision.
Sometimes the problem is not the fat but a tight adherent scar similar to a tight belt that causes bulges.
The scar has an absence of fat making the area immediately above it seem more prominent. By undergoing scar revision, a layered repair of the fat, SFS, and skin will likely yield a superior result.
Of course there are other potential reasons that could explain your findings but given the limited information above, this is my educated guess.

David Shafer, MD, FACS · Answer

You have two issues. The first is that you just had liposuction. It can take several weeks to months for the swelling to resolve. Second, if you have c-section scar, the tissues may be contracted in that area which causes the tissues above the incision to balloon over the scar. This can only be helped by revision the scar or, possibly a miniabdominoplasty. If you post pictures, we may be able to give you more specific advice.

Steven Wallach, MD · Answer

The area that you are concerned about often needs excision to remove the redundant tissue that overhangs the old scar. Liposuction can help, but like in your case it did not give you the desired result. However, the firmness will soften with time as the swelling subsides.

Sirish Maddali, MD · Answer

Since you have just had liposuction, you should give it time (3-6 months) for all the swelling to improve. After that, you can reassess the situation and decide on a plan. If the scar is still stuck down, then a consultation with a good plastic surgeon can help you decide on the right course. Given your description, a surgical procedure to revise the scar would be helpful. It may even be combined with liposuction, but that really depends on your examination. Good luck.

Peter E. Johnson, MD · Answer

A low transverse incision such as a c-section scar can heal very well as my colleagues in OB have shown. Unfortunately some will develop a tethering of the skin to the deeper tissues forming a bulge or fold above and over the c-section scar. The tethering produces the impression of excess fat over the scar, like the muffin top you describe. It is unlikely that liposuction alone will correct the altered contour of the lower abdomen, or fill the depression along the scar line. You should wait of course now that the liposuction has been done, however you will probably benefit from a release and repair of the incision, layering the repair.Best of luck,peterejohnsonmd

M. Ryan Khosravi, MD, FACS · Answer

If it is about one year after your surgery. You waited enough that was good, but you need a visit by a plastic surgeon for evaluation of your complaints.

Marcus L. Peterson, MD · Answer

Liposuction on the abdomen is deceptive because of all all the different layers that make up the appearance.  Liposuction only addresses one of the layers and even if the liposuction was done perfectly it can be hidden by the defects in the other layers.
The other layers of the abdomen are the skin and the muscle wall.  If the skin is a little loose or becomes looser after the liposuction then you will not see a lot of results from the liposuction.  The same is true if the muscle wall is lax.  The tissue above a scar will tend to swell and needs to have compression to prevent accumulation of fluid that may lead to permanent stiffness and bulging.
The best thing to do is have a plastic surgeon look at it and see why you have the appearance that you have.
Best Wishes
Dr. Peterson

Carl W. "Rick" Lentz III, MD (retired) · Answer

It is hard to be sure what your condition is presently. In that light I would encourage you to find a different Board Certified Plastic Surgeon and have a complete reanalysis. You may just need further liposuction. You may just need a scar revision or you may need liposuction and a full abdominal tummy tuck. Be sure you feel comfortable with the new surgeon and their recommendations.

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