How bad will necrosis this get before it gets better? (photo)

I had surgery 3 1/2 weeks ago. I had a infection but that is currently getting better. I am now questioning how bad the Necrosis will get? Does it look like I will lose more dead skin. Also when black scab falls of will that be raw skin? Still draining not sure how long that will last. Thanks

Doctor Answers 6

Depends on management

I am sorry you suffered this rare but devastating complication. This
usually occurs in smokers (even second-hand smoke or one nicotine gum,
etc.), in patients who have liposuction in areas of the blood supply to
the abdominal skin, too-tight closure, or in the random 1-2% where
everything is still done properly but inadequate circulation leads to
dead fat and/or skin. You have both, as evidenced by the black dead skin
in your photos. BTW, infection can also lead to circulation impairment
and necrosis--or necrosis (warm, wet, and dead) can lead to
infection--sort of chicken or egg, but related.

Until healing is complete (and that means the dead tissue will need to self-separate over
weeks, or surgical debridement can accelerate the removal of the dead
fat and skin), you will have drainage and a portal for infection.
Debridement is the way to go faster and with less risk, but that is
minor surgery. Letting things heal over time requires constant wound
care, vigilance about infection, and prolonged dressings, odor, and

Surgical debridement requires more surgery and scarring,
but you will have more scarring anyway--tissues died that were expected
to survive and heal. Judicious additional surgery now can minimize the
extra scarring and perhaps even get you back to your life more rapidly.
Talk to your surgeon, and no smoking if that is an issue with you or
those around you. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 238 reviews

Necrosis after abdominoplasty

You have skin necrosis after abdominoplasty.  It is in the central lower part of the abdomen which is the most common location.  Factors which contribute to skin necrosis after abdominoplasty are smoking, too much skin undermining, tension on the skin flaps, aggressive liposuction causing too much trauma to the skin, early application of an abdominal binder.  The skin is struggling for circulation right now and will demarcate itself of what is viable, marginally viable vs. dead skin.  If this is seen early such as immediately after surgery, hyperbaric oxygen treatment can help reduce the zone of injury.  Once you have dead tissue you should not keep the tissue dry as seen in your photo.  Exposed dry tissue deepens the injury and more tissue will die.  I recommend application of Silvadene cream two times a day with washing with water to keep tissues moist.  Periodic debridement of necrotic tissue will hasten healing.  The wound will then contract when granulation tissue develops. After the wound closes which takes about a month or two with the use of Silvadene the tissues will start the process of softening. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 78 reviews


the black will fall off and as long as there is no infection the wound will heal in 2-3 months. after a year a scar revision can be done. after the black falls off the wound will look bigger than it does now. be patient

Jonathan Saunders, MD
Newark Plastic Surgeon
4.7 out of 5 stars 59 reviews

Tissue necrosis after surgery

Thanks for the question.  At 3 1/2 weeks post-surgery, any potential tissue loss has probably been well demarcated and will not extend beyond the areas of eschar (black).  Those areas of black tissue will require debridement before the areas can heal.  The sooner the black tissue is removed the faster the healing process will be.  I would recommend following up with your surgeon to get that process started.

Necrosis following tummy tuck

Thank you for your question.I am sorry to hear that you are having this issue.  Unfortunately this can happen during tummy tuck procedures.  By 3 1/2 weeks the areas involved should be well demarcated as it appears on the photo.  The scab will fall off and there will be healthy tissue underneath as the body repairs itself.  The scab however will unfortunately have drainage and an odor to it for some time yet.  The best thing to do in these situations is to be patient, follow your plastic surgeons advice.  A touch up can be performed later if necessary.Best Dr. L

Andre Levesque, MD
Austin Plastic Surgeon
5.0 out of 5 stars 1 review


It appears that you lost of bit of tissue following an abdominoplasty.  It appears to be well demarcated.  I do not suspect that it will get any worse based on the limited information provided.  When the scab falls off two things will happen - you will see viable tissue beneath, or the scab will fall off by contraction and heal.  Time will tell.  In the meantime, follow the advice of your plastic surgeon.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.