Stomach is bumpy and irregular after tummy tuck revision - what can I do? (photos)

Question

I had a full tummy tuck October 2021. The next day it was discovered I had developed a golf ball sized hematoma. My drains were removed 7 days later then I had the area aspirated daily for 30 days. It then showed I had a pseudobursa. I had a full revision May 2022 with drains and all. I could tell a few days after the revision that scar tissue still remained. The Dr. then placed Kenalog 10 and 5FU to try and dissolve the scar tissue. My stomach looks so bumpy and irregular. What can I do?

Daniel Barrett, MD · Answer

Dear Breannab525,
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

Mats Hagstrom, MD (license on probation) · Answer

Your pictures show someone who had aggressive poorly done Liposuction as part of the procedure.
The contour irregularities are not because of scar tissue but rather an uneven fat distribution due to liposuction done by someone who lacks sufficient skillet experience in that procedure.
It sounds like your dreams were moved prematurely after the first procedure.
If patients develop a significant fluid buildup that requires draining on a daily basis which is the correct treatment I sometimes recommend patient consider asking for a referral to an interventional radiologist who can place a new drain externally. this is some thing surgeons don’t have the ability to do but an interventional radiologist can. 
If you think you have a fluid collection with a chronic seroma then consider getting an ultrasound to confirm if there are any fluid collections.
Treatment options to improve on poorly done liposuction are Limited.
Liposuction is a permanent and irreversible operation.
Treatment options for Poorly done Liposuction results generally come down to attempt at creating an even fat distribution with either revision Liposuction(removing more fat) fat transfer(an attempt to add fat) or a combination of both.
Your pictures did not indicate anything was done well from the tummy tuck but rather liposuction which I’m guessing was done at the same time.
Did your surgeon discuss doing abdominal liposuction in conjunction with the tummy tuck?
If so did you ask the plastic surgeon to review Liposuction before and after pictures during the consultation to get a good understanding of what that would look like?
Injections of steroids or five fluorouracil will not correct a chronic seroma. once encapsulated it can only be managed by direct surgical excision with the placement of a drain.
Your situation is complicated. To get an accurate assessment and better understanding of what happened and potential treatment options for improvement I suggest getting in person second opinion consultations.
For second opinion consultations patient should come prepared bringing with them all before and after pictures. If you’ve had more than one operation then you should bring before and after pictures of each of the procedures.
You should also bring a copy of the operative report for each of the procedures.
These are all part of your medical record and available to you if you request from your surgeons office.
Delivering consistent quality liposuction results is more difficult than most people believe.
Your results appear substandard.
That said, the number of plastic surgeons who can deliver exceptional results without any skin contour irregularity on a consistent basis it’s a relatively small.
Doing liposuction well on a consistent basis is far more difficult than most people believe and this includes a substantial number of plastic surgeons.
Revision work is many times more difficult than primary Liposuction.
For that reason you need to be extremely selective in finding only the very most talented providers for both Liposuction and potentially fat transfer if you want to try to improve on your outcome.
I recommend all patients start the process by having multiple in person consultations with plastic surgeons who seem to have skill and experience in the procedure you are interested in. in this case it would be Liposuction revision.
Make a list of what seems like experienced providers with overall good reputation.
Read through reviews and all various physician review websites. it’s very helpful if you can find positive reviews specifically for the procedure you’re interested in and obviously avoid providers with any significant number of justified negative reviews especially if they were related to Liposuction.
During each consultation bring pictures of your own body for reference. Ask each provider to open up their portfolio and show you their entire collection of before and after pictures. this works better for primary procedures because providers will have far more examples before and after pictures of primary procedures then they will have revision work.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped for. For reference and experience surgeon should have no difficulty showing you at least 50 set a before and after pictures of commonly performed procedures like a tummy tuck or abdominal liposuction. highly experienced providers will have hundreds or potentially thousands of before and after pictures of these common procedures. They will however not have nearly as many pictures of revision work.
All plastic surgeons will have a variety of outcomes and it’s fair game for patients to ask to see a variety of outcomes.
Bing showed a collection of preselected pictures which most likely represent the best results of the providers career is totally insufficient to get a clear understanding of what average results look like or how many of these procedures they have actually performed.
A surprising number of board-certified plastic surgeons with overall good reputation and years of experience actually don’t know how to do liposuction well.
Unfortunately too many plastic surgeons see Liposuction as a grunt procedure that lacks significant learning curve and the results represent their attitude.
The truth is delivering consistent quality liposuction results including making accurate assessment and the ability to deliver results consistent what was shown on before and after pictures on a regular basis far more difficult than most people believe.
The number of providers who can do this well and consistently it’s a relatively small.
Generally speaking the best plastic surgeons and doing revision work are most likely going to be the same ones who are the best at doing the primary procedures.
Fat transfer is particularly challenging when treating badly done Liposuction. in order for grafted fat to survive there has to be a sufficient amount of host tissue to support the grafted fat in order for it to survive. in areas where you need fat added the most are the same areas that are the most devoid of host tissue. This means only a very small amount of fat it’s likely to survive in the areas what do you need most fat added. for that reason quality revision work often requires multiple procedures.
Each single area of disfigurement is identified as either needing fat added or fat removed in order to create a more even fat distribution. The surgeon then very carefully removes small amounts of fat in the thicker areas and grafts fat in the thinner areas. A single procedure should be able to create modest improvements to get better improvements will require multiple rounds of you doing careful and calculated work.
This type of work is technically difficult and requires a substantial amount of skill and experience. outcomes can easily be made far worse in an attempt of doing revision work in which case improving the results simply become more and more difficult.
The single variable that determines the potential of salvaging a liposuction outcome is related to how aggressive the first treatment was done.
Highly aggressive liposuction treatments are very difficult to improve on and sometimes it simply isn’t possible to make improvements.
To give you any more advice or information will require an in-depth in person consultation.
It would be very important to know if you agreed on having Liposuction as part of the procedure?
You may be in a position to get a refund or a partial refund of the money you spent on your procedure.
This would be more likely if you did not consent for having liposuction and Liposuction was performed without consent.
Operating without consent is considered a fairly serious medical violation. whether that is the case here or not may or may not be the case.
The surgeon who did your previous work it’s probably not the correct provider to do any further revision work. if you want to try to improve on your current out, you will have to find someone far more talented at the These procedures.
This may require having multiple in person consultations.
I recommend patients avoid virtual consultations whenever possible and I highly recommend people avoid traveling long distances for elective surgical procedures.
Make careful notes during each consultation especially about the quantity and quality of before and after pictures.
Look for providers who seem to enjoy doing Liposuction and his practice includes a high percentage of liposuction and fat transfer cases.
There is no one single procedure they can restore your abdomen.
Small gradual improvements can be made through theories and procedures they can at least make things somewhat better.
I cannot emphasize enough the importance of provider selection and the importance of properly vetting plastic surgeons through having multiple in person consultations before committing to permanent and irreversible operations.
Patients need to insist on providers opening up their portfolio a before and after pictures and showing sufficient numbers including variety of outcomes of previous patient who had similar body characteristics for you to have a very good understanding of an average results look like in the hands of each provider.
It will not be easy to improve on your current outcome but there is generally some potential improvement possible.
There are no non-surgical options that can help your current situation.
What you need is to find the most talented and experienced provider willing to work with you.
Best,
Mats Hagstrom MD

Stomach is bumpy and irregular after tummy tuck revision - what can I do? (photos)

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Stomach is bumpy and irregular after tummy tuck revision - what can I do? (photos)

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