Is this fat necrosis? What can I do to fix my problem? (photos)

Question

Hello I had a bbl fat transfer In 2019 I think I sat on my early I’m not quite sure what I did but my butt is uneven fat observed, discoloration, flatness in the middle, and I believe I have fat nicrosis because I have 3 hard lumps in my butt what do you suggest I do? The appearance off my buttocks is really ugly and I don’t feel comfortable with showing off my butt in public, beaches or pool etc.

Ryan A. Stanton, MD · Answer

Although some before photos would be very helpful, it does appears as though you have had significant fat necrosis and thus likely fatty necrotic cysts (“hard lumps”) as well. As for the cysts, they can be removed by simple excision. As far as restoring volume, perkiness, and projection to your buttock - You are in good company with many others who had high hopes for BBL but instead received disappointing results (lumpiness, unevenness, lack of projection in the central and/or lower buttock, etc.). It is not as much the quality of the doctor but rather the quality of the procedure that is a large part of the problem.  Thus, going back for round 2 BBL most often produces the same disappointing results but at another financial loss.   Buttock implants indeed provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the buttock and often smoothing out lumpiness.  Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in buttock implants so be sure to consult with one that is reputable and experienced. Unfortunately you may have to travel long and far away from home to find this particular surgeon. Glad to help.

Kenneth Hughes, MD · Answer

Hello, thank you for your question. Dead fat, unlike living fat, cannot be removed by liposuction, or removal of fat through a cannula by pressure extraction. The dead fat hardened by calcium must be removed in total through an incision in the skin, much like a cyst or a tumor is removed. If the removal is extensive, reconstruction with additional fat grafting may be necessary as well. Thus, the issue of fat necrosis requires an expert skill set to create the optimal result. The goal is both optimal removal of the dead fat while sparing any living adjacent tissue to minimize the overall defect and allow for the best possible reconstruction. A board certified PS should be able to perform both the fat necrosis removal and about three months later perform the BBL.

Daniel Barrett, MD · Answer

Dear Intellectual1527,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Douglas Taranow, DO, FACOS · Answer

I'm very sorry you experienced these issues.  The firm areas may be treated with steroid injections or in extreme cases, surgical excision.
The discoloration may be permanent as it has been well over a year.  The flat areas most likely have multiple scar bands holding the skin down.  Releasing these bands will allow the skin to become more round, but may also allow too much fat to collect in the 'loose skin".  This may cause a lump to form which is a whole other issue to treat.  Unfortunately, there is no easy cure for your issue.  Another BBL procedure should reduce some of the flatness you are concerned with.
Dr. T

Mats Hagstrom, MD (license on probation) · Answer

In order for us to make a better assessment you need to post proper before and after pictures.

If you don’t have before pictures ask your surgeon to forward the ones they took before your procedure.

Knowing what your body look like before the procedure allows us to assess how the procedure was performed more accurately.

Fat transfer can only be treated by direct open excision.  The indication for removing fat necrosis is based on how much it bothers the patient in comparison to how much they’re willing to put up with the consequences of removing the dead fat.

If you had a flat spot before the procedure then it may be challenging to improve it with a second BBL.

The discoloration maybe due to hemosiderin deposit if the procedure was done with bloody fat or without proper tumescent  solution.

Typically hemosiderin stand tissues follow areas that were highly bruised for a long time after the procedure.

Unfortunately the results and out, or a direct reflection of how the procedure was done and that is a reflection of the surgeon you chose.

Your plastic surgeon is ultimately responsible for the outcome of your procedure and you intern are responsible for choosing that provider.

I’m guessing there may be a lack of faith at this time and a second opinion is probably appropriate.

To get accurate thorough detailed assessments including treatment plants you should commit to having in person consultations.

When preparing for a second opinion consultation you shouldn’t have ready your first procedure operative report and before and after pictures taken by your first provider. These are part of your medical records and available to you if you call that doctor or clinic and request all of your medical records including the operative report and all pictures taken.

It will be important for the next surgeon to have this information.

Secondary procedures are far more difficult than primary procedures. It may be difficult to restore your buttocks to what you look like before or together as substantially improved results. Some improvements are probably possible.

I cannot emphasize enough the importance of choosing the most talented and experienced board-certified plastic surgeons for this and all cosmetic surgical procedures.

Best,

Mats Hagstrom MD

Is this fat necrosis? What can I do to fix my problem? (photos)

Answers (5)

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