If by "dense" you are referring to "fibrotic' or "fibrous" fat, then the answer would be "yes, very fibrotic or very fibrous fat can affect body contouring". Some patient's will not give up their fat easily, and by that I mean the fibrotic tissue constantly clogs the liposuction cannula, the fibrous strands clog up the fat injection cannula, fat will not easily or smoothly contour, etc. I see this type of thing regularly in patients who have marginal elasticity due to preponderance of stretch marks or marginal overall skin quality pre operatively. Although this type of individual's fibrous fat makes contouring quite a challenge, and much more work on part of the surgeon, at the end of the day the contouring should not be comprised. It just takes a lot more work to get there. Now if a patient has had previous liposuction to the areas being treated , especially Ultrasonic Assist (UAL) or Laser, contouring definitely can be compromised in a meaningful way a second time . The resultant scarring which inevitably occurs with prior liposuction of any type, even CoolSculpting treatments will create significant dense fibrotic changes of the tissues making smooth contouring an impossibility. A surgeon never can tell just how much previous liposuction (or CoolSculpting) might interfere with a quality outcome. I have been pleasantly surprised in many "re-do", or secondary, or revision liposuction cases (any of these terms apply to treating a previously treated area) how nicely the contour turned out, and how much fat I could remove, but then again, I have had patients with such dense scarring that I bent the infiltration cannula attempting to pass through this densely fibrotic tissue, very little fat could be removed and some areas I could see contour irregularities as some fat was removed in one area, but no fat could be removed in an adjacent area due to dense scar tissue. Other very real risks of performing secondary , or "re-do" liposuction , especially in the abdomen is that the tissue is so incredibly difficult to pass a cannula, that a forceful attempt to do so can result in the dense scar tissue deflecting the cannula off the area and re directing the cannula to a place it was never intended to go, meaning a perforated bowel, etc. If this isn't enough of a concern, the scarring can also induce compromise in blood flow to the skin which can result in skin loss post operatively. When performing BBL with this type of fat, (which has been harvested from heavily scarred tissue from prior liposuction), the survival of transferred fat may not be as good as harvesting fat from a "virgin" area. As a practice philosophy, I rarely perform secondary liposuction any longer, except for select individuals with acceptable medical reasons as to why they put on additional fat after their initial liposuction procedure, and then only if they did not have laser or UAL previously, in that these modalities create "cement" type of scarring, meaning the scarring is so dense that a cannula may not safely pass through the tissue. Liposuction is meant to be a body contouring procedure, and not a weight control method, or an excuse for continued poor eating habits after the first round of liposuction.
