What are my options with an old hematoma? (Photo)

Question

I'm looking to have this pad of flesh under my left butt cheek removed . It was the result of a hematoma from a bicycle accident where I impacted it on the ground at high speed about 12 years ago. It never went away and it's starting to slouch and cause a banana fold. What is this? If it is scar tissue, can I use a laser to remove it? What are the risks of blood clots with various procedures?

Randal Haworth, MD, FACS · Answer

Hello !

Based on the information you provided, it sounds like you may have a soft tissue mass or lump on your left buttock that developed after your bicycle accident. It is possible that this mass is scar tissue or fibrous tissue that formed as a result of the hematoma, but it is difficult to say without a proper medical evaluation.

If you are looking to have this mass removed, it is important to consult with a board-certified plastic surgeon or a qualified healthcare professional who can assess the area and recommend the most appropriate treatment option. In some cases, surgical excision may be necessary to remove the mass, particularly if it is large or causing functional issues such as the banana fold you mentioned.

Laser therapy may not be the best option for removing scar tissue or a soft tissue mass. Laser therapy is typically used for treating surface-level skin issues such as wrinkles, scars, or hyperpigmentation, and may not be effective for deeper tissue issues.

As for the risks of blood clots with various procedures, any surgery or invasive procedure carries a certain level of risk. Blood clots can develop during or after surgery, particularly in individuals who are predisposed to clotting disorders or who have a history of blood clots. Your surgeon or healthcare provider will evaluate your medical history and risk factors to determine the best course of action to minimize the risk of blood clots during and after the procedure. It is important to discuss any concerns or questions you have about the risks and benefits of the procedure with your surgeon or healthcare provider.

I hope this helps,
best of luck !

Thomas Wright, MD · Answer

The area of the hip/buttocks going down to the lateral thigh is a tricky area to fix.   I recommend researching and finding a surgeon who has a lot of experience with liposuction in that area. I have a good deal of experience treating issues like you, but I always caution the treatment can sometimes worsen the banana roll.  The risk of blood clots is very low with liposuction especially when tumescent anesthesia is used. Wishing you the best of health.

J. Timothy Katzen, MD, FACS · Answer

Hi foreverYolo,

Thank you for your question regarding your options for addressing an old hematoma following a bike accident 12 years ago. I appreciate the history and the picture you provided. Over the years, your initial hematoma has likely transformed into scar tissue, primarily composed of collagen. To eliminate this scar tissue, a surgical intervention will be necessary.

There are two primary approaches to address buttock scar tissue: closed surgery and open surgery.

For a closed surgical approach, I recommend the VASER liposuction technique. With this method, the VASER is employed to dissolve scar tissue. In my assessment, the VASER is probably the optimal minimally invasive method to eradicate your aged buttock scar.

Alternatively, the open surgical method would necessitate a more substantial incision, either positioned atop the buttock or directly over the scar tissue. Using this technique, the internal scar can be excised directly.

Should you be concerned about any indentation that might arise post-buttock scar removal, buttock fat grafting can be considered to fill in the indented area. Typically, fat grafting to the buttocks, following scar removal, is scheduled a minimum of four months post-surgery. Please note that while fat grafting to the buttock isn't obligatory, it might be desirable to address any depressions resulting from the scar removal.

Thank you for inquiring about potential solutions for an old buttock hematoma. I wish you the best in your decision-making process.

Arif Eroglu, MD · Answer

Hello; depends on impact that; there was bleeding. This, may have caused a hematoma. However, the hematoma; does not remain for 12 years. Accumulated blood after hematoma; it is either removed from tissues or gets organized. During the healing period, that occurs while it is removed from tissues; connective tissue is formed; due to the collagen formation. In this process, calcification may also develop or the area, around the blood clot hardens; creates mass; the center may contain jelly-shaped blood material. To start with, I recommend for an ultrasound. Trauma-related, organized; if hematoma is present; it is not possible to erase this; with laser or extraction. By cutting from the mass; must be removed surgically.

Mats Hagstrom, MD (license on probation) · Answer

That area is difficult to assess and treat, especially with Liposuction. They are young is prone to having a Contouring The Irregularities, and bulging in an upright standing position. When you’re standing upright, the skin on the back of the thigh is pushed into the buttocks causing skin redundancy, often forming a bulge on many people. Your previous injury may or may not be contributing to the contour. Skin contributes more to contour problems in this area than fat distribution, and Liposuction is often not nearly as effective as people think. 
It’s very important to have a very clear understanding of what the problem is. Try leaning forward, which will put the skin under some tension and see if the contour improves. If it does, then, Liposuction is unlikely to make a big difference.
The key to understanding body contour issues is to understand what the underlying problem is. Even mild skin laxity can cause significant contour issues, and if the problem is not directly related to subcutaneous fat distribution in Liposuction is not the correct treatment.
The banana roll should generally not be treated. Expect to get different opinions from different providers. The area is much more difficult to treat than most people think.
I suggest being more selective than you think necessary, and be careful of providers to think this is an easy spot to fix
Best,
Mats Hagstrom, MD

What are my options with an old hematoma? (Photo)

Answers (5)

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