What should I do for fibrosis? Too much lipo? (photos)

Question

I've had smart lipo in 2011 then in 2017 I received lipo but I had dents that looked like cellulite. I found out months later it called fibrosis. I went in 2019 to get a bbl and for him to fix my fibrosis and make it " go away " it made it worst . What should I do ? I've done about 50 massages and compression garments.

Trevor M. Born, MD · Answer

Dear DG727Thank you for your questions and photos!  I am sorry that you are unhappy with the results - liposuction irregularities are challenging .  Depending on how fat fat is remaining in the area- SAFELIPO is probably the best option - and very technically challenging .With Warm RegardsTrevor M Born MD

Jason Emer, MD · Answer

this type of fibrosis or irregularity needs a proper evaluation sometimes it requires a tummy tuck to cut all the scar tissue, re lift the tissue, fat graft and then reposition the skin. sometimes revision lipo with ultrasound and internal RF can help.  often there is improvement when done by a revision expert, but perfection is tough. 
You need a formal evaluation by an expert in body shaping and contouring to determine what is best.  Traditional liposuction awake and smart liposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radio-frequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well . trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a Brazilian butt lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting.  Dr. Emer.

Daniel Barrett, MD · Answer

Dear DGZ27,
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

Kenneth Hughes, MD · Answer

It is always the PS and not the method that produces the results.  I perform a great number of liposuctions revisions and they are difficult, but I think improvement is realistic in your case.  While you cannot obtain complete perfection, I have used BodyTite successfully to improve the results.  I would need to see you in person to determine if BodyTite would be a treatment option for you.

Connie Hiers, MD, FACS · Answer

Just based on your photos, you appear to have had too much fat removed in certain areas. Fat transfers can be done, or you can get improvement with Sculptra injections done as a series of injections. For patient who had little or no fat to transfer, I have gotten fairly good results with Sculptra. Please choose a surgeon who has had experience in fat transfers and Sculptra injections in scarred areas. Garments and massage probably will not be helpful.

Arian Mowlavi, MD, FACS (license on probation) · Answer

The definitive correction for liposuction deformities requires the advanced technology of ultrasound assisted VASER liposuction. As an official trainer of VASER liposuction, I encounter suboptimal liposuction outcome referrals weekly. VASER liposuction has been the only modality that has consistently corrected liposuction caused deformities. VASER liposuction ensures a smooth contour regardless of severity of contour irregularities by virtue of being able to remove any and all remaining fat comprehensively and uniformly. Finally, when skin redundancy irregularities are observed, Renuvion technology can be simultaneously applied to tighten your skin to optimize your overall contour outcome. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing. 
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Mats Hagstrom, MD (license on probation) · Answer

Fibrosis is a Laymans term the plastic surgeons usually don’t use all that often.It is often used to describe hardening of tissues that can happen from things like radiation therapy.What happens after liposuction it’s not so much a condition of fibrosis but instead someone having been over treated leaving virtually no fat and instead leaving scar tissue. everyone who has liposuction gets scar tissue. Those who develop and out, often called fibrosis do not necessarily have more scar tissue but instead no longer have soft fat to support the scar tissue or to “hide it”.Instead they are left with an uneven fat distribution, scar tissue between their skin and muscle creating the appearance and texture you have.It’s not uncommon for surgeons with good Intentions of making this better to infect make it worse when doing revision liposuction since the primary problem was that too much liposuction was done in the first place.Treatment options are not particularly helpful. They are revision liposuction, Fat transfer or removing the skin by converting the procedure to a tummy tuck.In your case I don’t think any of these options are particularly good. Even in the best hands the amount of improvement at this point it’s going to be fairly minimal.Anyone who goes in to simply do more liposuction or “ Break up the scar tissue“ using power devices like VSER Will mostly make it worse just like your last surgeon did.Fat transfer doesn’t work because there’s no longer enough healthy host tissue to support the graft Leading to fat graft failure.For those who have been botched on their lower abdomen and have enough skin laxity to be a good candidate for a full tummy tuck this is sometimes a good option but you don’t seem to fit that category.Unfortunately you went to plastic surgeons who were not sufficiently skilled at liposuction.I continue to stress the point of patients being highly selective when it comes to choosing plastic surgeons for liposuction and fat transfer procedures.taking a smoothie even contour and leaving it smooth is hard enough. Taking an uneven contour and making it smooth is difficult to the point of being almost impossible.I wish I had a more upbeat and optimistic view as well as some realistic treatment options but in your case I’m afraid for their surgery put you at significant risk for making it worse and is unlikely to make a substantial improvement.Consider sharing your experience with others so that future patients can make educated decisions and choose their surgeons accordingly.With the supersaturation of manipulated positive reviews by self promoting practices we need honest opinions from patients who had real experiences. I’m sure looking back you would’ve appreciated learning what other patients had gone through from these providers and being able to have made a more educated decision in regards to provider selection.Best, Mats Hagstrom MD

Richard M. Levin, MD (retired) · Answer

Liposuction involves removing fat..carefully.. no matter what type or modality to remove the fat including "SafeLipo" , Vaser, Body Tite, etc. Too much fat has been removed unevenly in your abdomen whether surgical error or misuse of the available technology but all of this is operator dependent. Solution is problematic for you,  but I would offer to consider a careful evaluation and realistic discussion of possible avenues of improvement that may improve but not totally solve your problems.

David E. Berman, MD (retired) · Answer

I just saw a patient on friday with the same problem as you have. There is too much of a good thing. when doing any type of liposuction (I have done almost 1,000 Smartlipo cases). You want to reduce the fat. However, it is very important that you leave enough fat so that you do not get the problem which you have. This is due to removing almost all of the subcutaneous fat. To look both good and natural, you need to have a thin layer of fat, in the subcutaneous tissue so that the skin does NOT stick to the muscle. It is better to leave too much fat, than to liposuction too much away. Although it is suggested to either do fat grafting (which is possible but likely you don't have much fat to use), it can be hard to place this fat, when the skin is stuck to the muscle. Even a tummy tuck where you will lift up all of the skin and then replace it back down, will have a very challenging time, fixing this, since it will not remedy the problem, which is a lack of fat in the subcutaneous area. This is certainly more likely to happen when you go to a non-plastic surgeon, but I have seen it happen even with plastic surgeons. david berman mdps i think garments are over rated for their effect on your final result. they are somewhat helpful, but i think sometimes people treat them as though they will have a profound effect on the final result, which i do not believe to be the case for most patients.

What should I do for fibrosis? Too much lipo? (photos)

Answers (9)

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