It is possible to graft fat in the small, severely indented portions? (Photos)

Question

Likelihood of Looking Better? Aggressive lipo done Aug. 2020 by novice surgeon, and indentations created from ill fitted garment as well as from oversuction. Novice surgeon used cannula to break up scar tissue as attempt to correct irregularities while over suctioning near hip in 2021. It is possible to graft fat in the small yet severely indented portions? Please help, my self esteem is really down.

Daniel Barrett, MD · Answer

Dear Warmhearted363759,
I would have to examine you but it appears that this is a contour irregularity after liposuction. This happens often when areas the undergo liposuction are not feathered appropriately.
The good news is that it can be fixed and I have done so with good results before. While there is always a chance for contour irregularities with liposuction, someone who takes their time and uses the appropriate sized cannulas should give you a superb result.I have all my patients wear compression garments and I use multiple sized cannulas to feather out the result.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Arian Mowlavi, MD, FACS (license on probation) · Answer

Abdominal contourin revision will requrie a modified abdominal skin resection followed by a combination of fat grafting and liposuction. Please consider a consultation with a high definition liposuction revision specialist to get mroe feedback on why this is the definitive treatment for you.

Mats Hagstrom, MD (license on probation) · Answer

I continue to warn people about the importance of properly vetting plastic surgeons before having body contouring procedures.

Delivering consistent high-quality Liposuction results is more difficult than people believe in the variation in outcome is drastic as you know firsthand.

Unfortunately Liposuction is a permanent and more or less irreversible procedure.

The ability to create improvements is based on if the initial treatment was done aggressively or not.  overly aggressive treatments that are also uneven of my farther the most difficult to correct.

Attempted ways of correcting these type of outcomes come down to revision Liposuction, grafting fat or converting the procedure to a skin tightening procedure like a full tummy tuck.

None of these options are good  options for you.

The reason grafting fat will not fix the problem is because the areas were you need volume restored is now completely devoid of tissue to support any grafted tissue.  in order for a fat graft to survive there Hass to be tissue to support the graft.  it’s simply grafting fat then the fat will survive where you don’t need to survive and it will survive least we need it the most.

Sometimes it’s possible to selectively put very small amounts of fat in each thin area and slowly build up the volume and repeat this process every six months until there is sufficient amount of host tissue to successfully graft enough volume of fat to attempt to even out the fat layer.

In the end all of the scar tissue still limit what can be obtained and most people are not willing to go through the number of revision sessions required to start seeing improvements.

If you opt for going this route then understand that the least visible improvement comes after the first round of fat transfer since we’re starting with virtually no host tissue in the most indented areas.

For that reason the improvements will be very subtle during the first few rounds and start showing improvements after 4 to 6 rounds of fat transfer done over 2 to 3 years.  consider that revision work is many times more difficult than primary work it speaks for itself that you need to be in the hands of someone who has truly mastered liposuction in fat transfer work.

There’s a high likelihood these type of providers will not want to take on your case because patients are often left disappointed and blame other frustration on the surgeon who operated on them last.

The amount of time it takes during consultation combined with patients who often have PTSD like apprehension of having further procedures is often not compensated for.  It’s easy for plastic surgeons to spend our after hour discussing these type of outcomes and what can and cannot be done with numerous follow up phone calls and emails and in the end most patients end not scheduling surgery.

For that reason taking on revision work based on other providers poor performance is fairly undesirable and deserves to be financially appropriately rewarded.

There’s no possible way this can be improved with any significance with a single procedure.

Not all talented surgeons charge exorbitant prices but those who have mastered their field are unlikely to give discounts and considering that someone may need that many procedures patients often throw in the towel because of a lack of faith, lack of  financial resources or simply unwillingness to have any unnecessary surgical procedures ever again.

Any provider who tells you that this can be easily corrected should not be trusted. Anybody who suggests using energy devices to break up scar tissue especially VASER is also to be avoided.

In fact most providers should probably be avoided for this type of work.

To find someone suitable to help you will require interviewing a lot of plastic surgeons.

Depending on how motivated you are to move forward the first step is to find the right provider to work with and stay with that provider.

To do that I recommend exclusively having in person consultations.

The reason for the in person consultation is not only for the surgeon to get an accurate assessment of your situation but more so for you to properly vet the surgeon, their skill and their experience.

During consultations patients should ask providers to show their entire collection a before and after pictures for the procedure you’re interested in.

It’s unlikely you’ll find providers who have large collections of impressive Revision Work with long term follow up.

Fat transfer results look very impressive early on but earlier results do not represent final results when it comes to this procedure.  when looking at before and after pictures of fat transfer work confirm that all after pictures were taken at least three months from the date of surgery.

This means the background is not in the operating room or in the recovery area and there are no surgical markings left on the patient.

Hopefully providers will be upfront and honest about this.

In your case it is really having someone with fat grafting experience that is most important.

Hopefully they’ve done a lot of similar work of correcting poor results from other providers but if they don’t then asked to see their entire collection of complex fat transfer results they were challenging.

In the end you’ll have to use your sense of trust and rely on pictures that were shown as well as reading reviews on various physician review websites.

When it comes to reviews I recommend avoiding providers for the any significant number of justified negative reviews. The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.

Likewise if you have not done so already I recommend you share with the public what your experience was like with your procedure in the hands of that provider.

Reviews should be written honestly and professionally.

I’m sure you would have appreciated someone else having gone through the same experience sharing their story having warned you that maybe that was not the best provider for you for this procedure.

I think that’s about all I had to say about this post.

I use ward recognition so forgive the grammatical errors and rambling nature.

Best,

Mats Hagstrom MD

It is possible to graft fat in the small, severely indented portions? (Photos)

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It is possible to graft fat in the small, severely indented portions? (Photos)

Answers (3)

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