What can I do to improve induration bumps/streaks after liposuction and J-Plasma? (Photo)

Question

I had a liposuction on my stomach 8 months ago. And I was tightened with J-plasma. I still have these knotty hardenings, especially under my chest, on my upper abdomen, when I tense my muscles you can see them very clearly. My doctor says it will go away but it has been over 8 months now and it has not changed. Do you know what I can do to improve the appearance, or does it really go away by itself at some point? A heartfelt thank you.

Daniel Barrett, MD · Answer

Dear annabebe2021,
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

Alan Gonzalez, MD, FACS · Answer

Hello @annabebe2021 Thank you for your question. The surgical procedure of liposuction, may or may not be associated with technology. Many times the characteristics of these lumps under the skin or retractions are secondary to a conventional fat extraction technique. We handle fat from the use of laser technology, which is light, or vaser, which is internal ultrasound associated with microair (PAL- Power ssisted liposuction) the first two devices allow us to vase or Laser produce lipolysis (is to pass the fat of a solid state to a liquid state so that there are no irregularities under the skin) and the microaire or the PAL allows us to make the extraction of the melted liquid without so much trauma.It is important to be able to evaluate the case a little more to determine if only with a new lipolysis from the combination of technology can be improved. If it is only a lipolysis of the body contour, we will be able to improve the appearance by 50% towards 70% of the result you currently have; because fibrosis behaves as a scar inside the tissue and it is very difficult to be able to remove it completely.

Jason Emer, MD · Answer

this likely is because you needed a tummy tuck or they went to aggressive and didnt do aftercare procedures like RF and muscular toning.  Please see an expert for consult other photos need to be seen.  Best, Dr. Emer.

Carlos Gonzalez Legarda, MD · Answer

Hello Annabebe2021. Of course we are limited to a picture instead a personal evaluation, but I see in your picture you had sagging or skin excess on your tummy before your surgery, then your surgeon perform a great liposuction and later used the J plasma to improve the skin contraction. Then what you see now is exactly the skin contraction J plasma usually does.  I mean skin contraction implies new subcutaneous scar tissue, and is that new scar tissue done by your own body the bumps you see.  According that concept (but remember you need a personal consultation for a better evaluation) my suggested treatment are: recombinant collagenase enzymes. If the product is available at your country, then you can discuss with your doctor if he/she can do that.  
Other side, you are not asking but it is good for other people to know how to prevent those bumps: Local massages, a good girdle , and it is preferable  surgeries cutting skin like the tummy tuck over the J plasma when patient has skin excess.

Mats Hagstrom, MD (license on probation) · Answer

Your results were final at about three months and have most likely not changed very much since then.
At eight months they are certainly final and your results are not going to change by waiting longer. Your doctor is not being truthful and it’s simply hoping that you get tired of coming back.

In some ways it’s pointless to go back because that doctor does not have the confidence to do Liposuction properly so he or she should not be doing a revision anyway.

You may want to negotiate for a partial or full refund though.

Liposuction results are permanent and more or less irreversible.

Correct and poorly done Liposuction is extremely difficult. This is especially true when the treatment was done in an aggressive manner.

Treatment options typically come down to revision Liposuction, fat transfer and for some patients converting the procedure to a skin tightening procedure like a full tummy tuck.

None of the options are particularly great.

Typically the best results, from doing selective revision Liposuction with fat transfer focusing on small individual prominent areas of disfigurement.

Partial improvements is all patients can hope for. To get ideal results especially when fat transfer is the option of choice patients typically require several rounds of revision surgery.

Revision surgery is many times more difficult than primary Liposuction and do you know from first-hand experience that Liposuction is far more difficult to do well on a regular basis than people believe.

It’s hard enough to take a smooth even contour and remove fat and still leave a smoothie even contour. Taking an uneven contour of fat and making it even is many times more difficult.

There are no nonsurgical treatment options that will help your situation. The primary underlying problem is that too much fat was removed and it was done so in an uneven manner.  You now have scar tissue, insufficient amounts of body fat that is also significantly uneven.

At this point you need to try to find the most experienced plastic surgeon in your community who has more liposuction and fat transfer experience than anyone else.

This will require multiple in person consultations.

The following is a list of general recommendations for those seeking cosmetic surgery. These are all very applicable for revision work as well.

Be careful of anyone who claims that they can easily fix this.

By the way, I sold my J plasma device about a year after purchasing it because it caused nothing but problems for my patients.

1. I recommend patients avoid traveling long distances for elective surgical procedures. There are of course instances where there is a lack of local talent and traveling to some degree is inevitable. If traveling for the procedure patients should be ready to travel to have the consultation, post operative appointments and follow up should there be issues or complications.
Patients sometimes do not appreciate the importance of in person consultations, that complications do happen or the number of people who have issues with their results or need revisions.

2. Schedule multiple consultations with different providers in your area who seem to have a good reputation for the procedure you’re interested in. Starting with at least five consultations seems like a reasonable number to me.

3. Whenever possible schedule in person consultations.  
4. During in person consultations ask each plastic surgeon to show all of their before and after pictures for the procedure you’re interested in.

The goal is not to see the best results of their career but to get an idea of what average results look like and get some type of confirmation of how many of these procedures that provider has performed.

Ask to see results that were not as good as the doctor would’ve hoped for and talk about the differences in outcomes.

Honest and experienced providers should have no problems presenting this type of information.

A highly experienced plastic surgeon should have hundreds of before and after pictures for the procedure you’re interested in. At a minimum at least 20+.

5. Read all the reviews on various physician review websites paying close attention and avoiding providers with any significant number of justified negative reviews.  Providers with an abundance of reviews often have aggressive marketing campaigns.

The plastic surgeons I respect most all have the single variable of not having justified negative reviews on their online profiles. 
In my opinion justified negative reviews are far more telling than an abundance of positive reviews.

6. Avoid scheduling for surgery or making a deposit on the day of the consultation.  Give yourself some time to think about the decision and make sure you finished all scheduled consultations before committing to having surgery that will permanently and irreversibly change your body.

When in doubt slow down and schedule more consultations.

Choosing the right plastic surgeon is the single most important variable to having a positive experience.

7. Don’t go chasing after technology or names of certain equipment. Instead focus all your efforts on finding the most experienced and talented board-certified plastic surgeon.

Best,

Mats HagstromMD

Jonathan Cook, MD - Account Suspended · Answer

What you are seeing and feeling are "contour irregularities," which result from uneven aspiration of fat during liposuction. Contour irregularities cause divots, depressions, and a wavy appearance of the skin. There could also be a component of "internal scarring," which is caused by surgical trauma or the application of internal energy during liposuction. Internal scarring causes tethered skin, palpable nodules, tightness, or positional changes in the appearance of your skin. One final possibility is that you may have areas of "fat necrosis," which happens when injured fat cells create scarred nodules after surgery. An in-person examination will help to differentiate between these possibilities. 
Contour irregularities can be corrected through secondary liposuction, with possible fat grafting. If the nodules are indeed "fat necrosis," they may go away on their own, or they may respond to one of a few approaches, including daily massage, subcision, or careful steroid injection. Fat necrosis is also treatable with liposuction and possible fat grafting. As always, you should weigh the pros and cons of additional treatment and determine for yourself how much further treatment is right for you.

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