Fat remains in abdomen 1 year post-op. Is this a poor abdominal liposuction outcome? (photos)

Question

I had liposuction on my waist and abdomen 6 months ago. I have been patient and waited for final results. I have not gained weight since the surgery. I did not have much fat above my navel, so all the lipo was on the area below it. I feel a lot of fat remains. I can grab a handful of it. It appears that any fat removed was from the lateral lower abdomen and immediately above my c section scar. The center is still the same. Is this a bad result or am I expecting too much?

Gerald Minniti, MD, FACS · Answer

Most of what you're pulling on is skin. Many of your photos show not only skin laxity in the umbilical and supra-pubic areas of your abdomen, but also abdominal wall protuberance, indicative of muscular separation. The scar in your supra-pubic area reveals you had one or more pregnancies. I don't know whether you went to a board certified plastic surgeon, or to a dermatologist, but if the former, you should have been properly counseled about these issues. If the later, well, it's to be expected there would be no conversation. In plastic surgery, we like to use this saying: 'If all you have is a hammer, everything looks like a nail'. What this is getting to is that the average dermatologist isn't going to bring up these confounding issues of muscle and skin laxity/excess, and promote the only thing they can do, which is liposuction, typically with some 'skin tightening' modality like J plasma, Bodytite, Vaser, excetera. The reality is this: even without a formal exam, I can tell you that result of a revision liposuction (regardless what someone may call it, e.g. high def, etc.), will be clouded by muscle wall protuberance or worse, skin irregularities/waves. That's why you should be suspect of dermatologists who promote these skin tightening devices. It is true they can tighten skin, but on the order of millimeters. In the one photo you show, you have inches of excess skin. At the very least, you are a candidate for a 'mini tummy tuck', which does not involve the repositioning of skin from around your belly button. But for a true transformation of your abdomen to possibly better than pre-baby appearance, a full tuck would be required (and no, contrary to what many plastic surgeons might tell you, the degree of functional skin excess is NOT a determinant for candidacy for a full tuck). When properly performed, a full tuck will leave you with a very, very low scar that would be difficult to see, even when naked. I hope this response opens up your mind to possibilities for a true transformation.

Jason Emer, MD · Answer

Pending a formal evaluation, you may be a good candidate for a Revision Liposuction. You need a formal evaluation by an expert in body shaping and contouring to determine what is best.

The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heats the skin with radiofrequency devices such as Renuvion (J-Plasma), InMode BodyTite, and ThermiRF to heat the undersurface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HI-DEF VASER Liposuction and can only be done by a well-trained body contouring specialist. At the same time, fat should be harvested and purified, with PRP and stem cells added, and then injected into muscles, indentations and cellulite to get body shaping and contouring. For a Brazilian butt lift (BBL), we inject the fat into the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with a combination of QWO or Cellfina, subcision, and/or fillers such as Bellafill, Renuva synthetic fat, or Sculptra. If skin is very loose before surgery, then it will need to be removed: tummy tuck/abdominoplasty for lower abdominal skin; breast lift for excess breast skin; and/or a brachioplasty for loose arm skin. Overall, you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting. See an expert. Best, Dr. Emer.

Camille Cash, MD · Answer

An in person evaluation would be helpful to determine if your results could be improved with further liposuction and potentially adding J Plasma for skin tightening or if it would be better to consider a tummy tuck.  I've included a video on deciding between the two that I hope you find helpful.

Mats Hagstrom, MD (license on probation) · Answer

I’m dictating this, so I’ll apologize in advance for grammatical errors.
To make a quality assessment regarding the outcome of any plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Liposuction results are generally based on two variables.
The first variable is the patient candidacy for the procedure and the second variable is the skill and experience of the provider.
 to assess someone’s candidacy for liposuction. It’s important to differentiate all the tissue variables that can contribute to what the abdomen looks like.
There are generally four tissue variables that determine what the abdomen looks like.
These are.
1) abdominal skin laxity due to previous pregnancy.
2) excess subcutaneous fat.
3) muscle separation from previous pregnancies.
4) excess visceral or intra-abdominal fat.
My best guess is that you were concerned about pregnancy related changes and we’re hoping that Liposuction would reverse. The changes of previous pregnancy is.
I could be wrong, but that is my best guess.
Pregnancies do not change fat distribution.
Pregnancy related changes are related to skin laxity and muscle separation.
 skin laxity is the number one reason patience fail to get quality liposuction results.
Even mild skin laxity reduces candidacy substantially.
To assess the thickness of your subcutaneous fat layer I do not recommend grabbing or pinching your skin.
Doing so simply accumulates the skin laxity, and makes the fat feel much thicker than it actually is.
The most accurate way to assess the thickness of subcutaneous fat is to put the skin under gentle tension, then gently press your finger until you feel the underlying muscle wall.
You don’t need to push hard at all.
 I’m guessing the the thickness of your subcutaneous fat around your mid abdomen is about half an inch.
See what your abdomen looks like by pulling on your skin and putting the skin under tension.
making an assessment regarding the outcome should also preferably include the amount of fat removed with the procedure.
We really can’t give any opinion about the outcome of your procedure without having comparison photographs.
It’s possible your provider was conservative and the amount of that they removed.
 the results certainly don’t look bad, but we can’t compare without knowing what you looked like before.
Consider reposting with proper before and after pictures.
Delivering consistent, Liposuction is more than most people realize.
The number of plastic surgeons of truly mastered lip section is pretty small.
 being certified in plastic surgery with years of experience, and an overall good reputation does not mean somebody has mastered any single procedure.
Most plastic surgeons think they’re better at Liposuction than they actually are.
Like I said the number of providers who truly master this procedure and can deliver predictable quality outcomes it’s actually pretty small.
From what I see Liposuction skills very dramatically among plastic surgeons.
There isn’t all that much patience can do regarding their own candidacy.
Understanding your own candidacy, for Liposuction can greatly improve patient satisfaction.
Somebody who is an excellent candidate, for Liposuction has the potential of having excellent results.
They can also have poor results if the procedure is done by someone who lacks sufficient skill and experience.
 a patient who is a poor candidate for Liposuction that does not have the potential of getting outcomes regardless of who does the procedure.
Understanding your candidacy for this procedure is not easy or straightforward.
The number of plastic surgeons who can accurately assess patients candidacy and then Deliver highly predictable outcomes, consistent with multiple before, and after pictures of previous patients who had similar body characteristics is actually quite rare. 
A substantial number of people including plastic surgeons think of Liposuction as a fairly simplistic procedure.
In reality, it is a very difficult operation to master to the point of assessing patients candidate disease and consistently delivering expected results.
To get a quality second opinion consultation, I suggest scheduling those as in person second opinion, consultations with plastic surgeons in your community who seem to have a strong background in lip section of work.
Come prepared with you a complete set of proper before and after pictures and a copy of your operative report.
 These are all available from your current provider.
If your procedure was not done in an aggressive enough manner, then there may be a room for improvement with a secondary procedure.
If sufficient amount of fat was removed, and the outcome is now primarily related to mild skin, laxity and possible muscle separation. Then further, Liposuction probably isn’t going to do all that much.
Generally speaking secondary Liposuction delivers on a small fraction of what’s possible with The Primary procedure. There are a lot of variables to take in the consideration.
Best,
Mats Hagstrom, MD

Fat remains in abdomen 1 year post-op. Is this a poor abdominal liposuction outcome? (photos)

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