Lumps 6 months after liposuction - what are my treatment options in case ultrasound doesn’t help? (photo)

Question

I got liposuction over 6 months ago, I now am left with an extremely lumpy result. The lumps are not hard and feel like soft pockets. I started ultrasound therapy with the aspen machine with a different surgeon, but I was wondering what other options I have in case the ultrasound doesn’t help. Picture attached

Zoran Potparic, MD · Answer

Irregularities after liposuction are seen routinely. They last several months and disappear for the most part; in the case that there is residual asymmetry and lumps, revision liposuction may be needed.  We do not recommend doing anything aggressive sooner than 1 year after surgery, longer the better. Continue massage. Good luck.

Semih Yildiz, MD, FEBOPRAS · Answer

Your photo appears to show uneven, lumpy contour in the lower abdomen/waist area. Soft pockets after liposuction can come from several different issues, including residual swelling, uneven residual fat, localized fluid such as a seroma, scar tissue or fibrosis, or skin laxity. At 6 months, some healing can still continue, but a noticeable contour irregularity may not fully correct with ultrasound alone. Ultrasound or massage may help soften swelling or fibrosis in selected cases, but it cannot remove residual fat or replace missing volume.

The next step is an in-person exam with a board-certified plastic surgeon, ideally with comparison to your pre-op photos and diagnostic ultrasound if a fluid pocket is suspected. Depending on the cause, options may include more time, compression and massage, aspiration if there is a seroma, careful revision liposuction for true residual fat pockets, fat grafting for dents or over-resected areas, or a skin-tightening/excision procedure if loose skin is the main problem. Many surgeons wait closer to 9-12 months before elective revision unless there is a treatable fluid collection or worsening symptoms. Increasing redness, warmth, pain, drainage, fever, or rapidly enlarging swelling should be checked promptly.

Gianfranco Frojo, MD · Answer

This is a complicated issue and difficult to fully evaluate with the photo listed. Sometimes there can be excessive liposuction in the superficial fat plane instead of staying in the deep plane where the fat should be removed from. This can create contour irregularities or persistent edema (or both) that are quite challenging to fix). I would wait at least 1 year before becoming overly concerned that this may not improve as it truly takes 1 full y ear to heal from a surgical procedure. I would continue with compression, attempt lymphatic massage and also see a board certified or board eligible plastic surgeon with experience in aesthetic surgery.

Daniel Barrett, MD · Answer

Dear Diligent212547,
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

Nilay Shah, MD · Answer

Hi! There is always a chance of contour irregularities with liposuction. However, some may disappear over a period of time. If you do not notice any improvement then you may have to undergo a revision liposuction but ideal time would be one year post op. Would suggest that you go for an in person consultation for better assessment to an experienced surgeon for a second opinion.

Douglas Taranow, DO, FACOS · Answer

It is not unusual to have lumpiness post liposuction.  Usually, this lumpiness will resolve over 6 months or improve up to a year.  Your condition looks more like a combination of your fat, skin as well as some over-suctioning.  I limit the amount of fat I take (leaving a layer behind just under the anterior abdominal skin) in patients who are older, have had children or with certain skin laxity issues.  It is exceedingly difficult to fix your issues with Aspen, repeat liposuctioning or ultrasound.  Sometimes I use feathering (liposuction without the canula hooked up to suction) to break up the scar tissue and the larger fat collections.  This may require combined fat transfer in areas of deeper dimpling.
Best wishes.
Dr. Taranow

Darryl J. Blinski, MD · Answer

Sorry for the "lumpy" post liposuction results as seen in your photo. Was a Vaser lipo done?, because this type of result is very common following Vaser Lipo. I offer 3 treatment/surgery options: #1. re operation using S.A.F.E. lipo tecihniques to release internal lipo fibrosis with postop aggressive massages and compression.Fee $6,000+.  #2. injection sessions using hyper diluted Radeisse/Sculptra combination, usually 3 sessions about 1 month apart. Fee based on # of syringes/vials of these products needed, usuall $3,000 per session. #3. A combination of doing both options. Best to virtual consult with...

Mats Hagstrom, MD (license on probation) · Answer

Your results are a direct reflection of the lack of skill and experience of your surgeon.
The procedure wasn’t done incorrectly and this left you with an uneven fat distribution.
The uneven fat distribution was created with surgery and only surgery can change your fat distribution.
Delivering consistent quality liposuction results is more difficult than most people believe in this includes plastic surgeons. Simply being board-certified in plastic surgery with a good overall reputation is insufficient to confirm a provider has mastered this this difficult procedure.
Correcting poorly done Liposuction is very difficult and often is not possible. Ultrasound is not going to address the primary problem which is that your surgeon left you with an uneven fat distribution.
Revision surgery is many times more difficult than primary Liposuction so the importance of finding the most experienced and talented provider is absolutely paramount. there are no nonsurgical treatments that can correct this or will help in any way.
You’re wasting time and money with any attempted nonsurgical treatment option.
The only treatment is revision liposuction with or without fat transfer and the potential result is a limited improvement.
Recognize that attempts of revising are making the outcome improved can also easily make things worse if the surgeon is not talented or appropriately experienced.
When interviewing for plastic surgeons it’s important to properly vet providers to ensure that they have the proper skill and experience.
Defined the most talented provider I suggest patients have multiple and the person consultations. During consultations ask each provider to show their entire collection of before and after pictures. simply seeing a sampling of pictures which most likely represent the best results of the providers career is insufficient to confirm that the provider has the skills to deliver consistent quality results.
This is why patients need to ask providers to open up their portfolio and show has many before and after pictures as possible. An experience provider should have no difficulty showing you at least 50 sets of before and after pictures.
Ask providers to show as many pictures as possible of patients with similar body characteristics to your own.
These recommendations are a bit more pertinent to Primary Liposuction for those who have not had the procedure and order what you should ideally done before choosing your provider.
The process of finding experienced talented providers nonetheless it’s the same whether it’s revision surgery or primary with the exception that revision surgery is many times more difficult than primary Liposuction and providers will most likely not have as many before and after pictures.
Hoping that your fat distribution is going to rearrange itself nonsurgically is wishful thinking and as much as I wish I could give you optimism and tell you there’s a perfect treatment I’m sorry to tell you that that is not the case.
My practice has been awarded exclusively to doing only liposuction and fat transfer procedures for over a decade and I’ve been a board-certified plastic surgeon for 25 years. I’ve done over 8000 liposuction procedures.
Your result is simply the outcome from someone who lacked skills and experience.
Only partial improvements can be had in the best case scenario and this will most likely require more than one procedure.
Like I mentioned earlier revision work is more difficult than primary Liposuction so you need to interview a lot of plastic surgeons to find the most talented provider in your community.
I also recommend patient read all reviews on various physician review websites avoiding providers for 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.
Some providers may also reject taking on your case because revision work often is difficult and extremely time consuming.
Good luck,
Mats Hagstrom MD

Lumps 6 months after liposuction - what are my treatment options in case ultrasound doesn’t help? (photo)

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