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

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 hassle.

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

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

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. 

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.

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