Still Have Muffin Top After Laser Lipo - Too Conservative?

At one month, you are still having edema and swelling.  I would wait for two months to go by before any thorough evaluation.  If you had 3.5 lbs of fat removed, that would translate into well over a liter of fat.  We would need to see a photo to do an evaluation of the fat distribution.  Perhaps more could be removed, but the risk of uneven skin texture goes up and the risk of flaccid skin also goes up.  More can be removed in the future, but wait a year to decide that.

When multiple sites are done with liposuction, the limiting factor is the amount of local anesthetic needed. The more fat to be removed, whether per zone or because of multiple areas, the amount of local anesthetic used is greater, but there is a maximum safe amount of local anesthetic that can be delivered safely.  If adding another body site of fat accumulation to be treated with liposuction would require more than a safe amount of local anesthetic, then the surgeon can't treat that area in addition to the other areas all at the same time.  Smart Lipo involves the use of laser energy that heats up the tissues.  Local anesthetic is important to limit the risk of a burn. If a patient is having the procedure under sedation then the surgeon may lessen the tumescent local anesthetic per area as the patient will not feel it, but then smart lipo should not be done if this increases the risk of tissue heating beyond the safe level. When the patient is awake, enough tumescent anesthetic needs to be given for patient comfort per area, so adding that third or fourth area to be done the same day may not be possible. There are multiple variables from patient to patient and anyone having questions about a procedure they have had should discuss it with their surgeon whom they trusted to do the procedure.

I counsel patients whether I perform traditional tumescent liposculpture or laser liposuction, that final results should not be evaluated for 2-3 months.  Following either procedure, the tissues make actually become more swollen at 2-4 weeks, At about a month, tissues treated with laser often become indurated--firm to touch--as a result of skin contraction.  Hang in there, and re-evaluate 3 months after surgery.  It is always better for the surgeon to be more conservative rather than more aggressive.  Three and a half pounds is quite a bit of fat for a single procedure, and seems appropriate for the areas treated.  A future touch-up session is always a possiblity.