Considering revision lipo - Dep, crooked depression going down the middle of my stomach (photo)

Question

I had a combination of Vaser Lipo360, SAFE lipo, and power assisted lipo more than one year ago. What can I do to fill in the deep, crooked depression going down the middle of my stomach?

Daniel Barrett, MD · Answer

Dear Itsaandy,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

George Marosan, MD · Answer

Thank you for your question and photos. Despite all the tools used by your surgeon, he/she is a poor technician with poor understanding of the underlying anatomy. It is the surgeon making the decision, the VASER, PAL are tools to achieve Hi Def Lipo in the trained hands. This is a difficult problem to correct. You will need corrective surgery with VASER lipo, fat transfer to the over suctioned areas and safe lipo to redistribute the fat and give you an acceptable abdomen. Might need more than one surgery. See a board certified plastic surgeon experienced in advanced body sculpting techniques. This is not a touchup surgery! I personally would not recommend returning to your original surgeon, even if the surgery is offered at no charge. Obviously, this is your decision. good luck.

Gerald Minniti, MD, FACS · Answer

Despite getting state of the art techniques, your surgeon left you with irregularities not usually seen on patients from highly experienced surgeons. Depending on how much fat is left on your abdomen, you will need more SAFElipo, and possibly fat grafting to smooth the irregularities above your belly button. No more Vaser!

Steven H. Wiener, MD · Answer

Thank you for your question and photos.  It appears that your liposuction resulted in uneven fat removal or over-resection of fat in areas leaving a significant dent.  After one year, this is unlikely to improve. Treatment with fat harvest and transfer to this area will improve the contour.  This may require more than one session.

Jennifer Reichel, MD · Answer

Your fat was NOT removed in a smooth, even process! This should not happen with an experienced surgeon. Please EVERYONE, make sure you have vetted your surgeon - regardless of whether their background is dermatologic surgery (derm surgery) or plastic surgery!!!!

The best option for you is to have a touch-up lipo done (you could try Kybella, but it would take a lot of treatments and still might not work). 
The surgeon can mark-off the areas that are indented and work with small cannulas on the raised areas. I would then turn off the suction and just run the cannula through all of the tissue to remove adhesions.
I do agree it is very helpful to stand the patient up at the end of the procedure and smooth any visible irregularities. It is also helpful to have the patient do a partial sit-up. This cannot be done if you are under general anesthesia.

David Hansen, MD · Answer

Lipo under general doesn't allow you to stand the patients up during lipo and fine tune the results.  Never get lipo  under  general if you really want great results.  You can get this fixed easily with the micro canulas and local and morpheus with quantum.

Guray Yesiladali, MD, FEBOPRAS · Answer

Thank you for sharing your photo&mdash;this does help clarify your concern. The central, uneven depression you’re noticing is a relatively common complication after aggressive or multi-modality liposuction procedures, especially when deep and superficial layers are both treated.
This kind of contour irregularity may be caused by:
Over-resection of fat in a narrow, central area
Adhesion or scarring between skin and underlying fascia
Uneven fat removal, leading to visible asymmetry and “grooving”
To improve this, your most effective options may include:
Fat grafting (lipofilling):Autologous fat transfer remains the gold standard to restore smoothness and volume. This technique can carefully fill in depressed areas and soften irregular transitions.
Subcision or internal release:If the depression is tethered by scar tissue, releasing those fibrotic bands surgically (often combined with fat grafting) can improve the contour.
External treatments (limited effect):Devices like radiofrequency or microneedling can improve superficial texture, but are unlikely to fully correct deep volume loss or structural depression.
Since more than a year has passed, a revision is now safely possible. A consultation with a board-certified plastic surgeon experienced in revision body contouring would give you the clearest path forward.
I hope this helps guide your options toward a smoother, more balanced result.
&mdash; Güray Yeşiladalı, MD

Cengizhan Ekizceli, MD · Answer

Thank you for your question and photo.A contour depression like this after liposuction may be improved with options such as fat grafting or structural filler to smooth the area. Revision liposuction alone is unlikely to help. A consultation with a surgeon experienced in revision body contouring would help determine the best plan for you.

Christopher T. Chia, MD · Answer

Regardless of the energy component associated with liposuction, the basic reason for a deep and crooked depression or "dent" following suction removal of fat is that there was too much fat removed from one area compared to that of the surrounding areas. There is less support of the overlying skin compared to the fat and skin right next to it causing it to collapse downward or invert resulting in a visible dent which is accentuated in certain light and shadows. Since a year has passed without improvement, it is not due to swelling or other reasons that resolve on their own and, unfortunately, requires another procedure or procedures to correct the aesthetic deformity. That would include tumescing or putting fluid into the subcutaneous fat space under the skin just as was done with liposuction, releasing any scar tissue with a cannula off suction (we don't want to remove any more fat from the area of the dent which would make it worse) and finally putting in volume or material to fill the depression smoothly to re-support the skin. The best filler is your own fat harvested from a different area you want to reduce in size and process the fat for injection into the defect. Depending on how much fat survives after several months, another procedure or more may be required to gain the desired amount of smoothness. In our practice, this often can be done under local anesthesia (awake) which reduces risk of general anesthesia and the number of days to recover and may be financially advantageous since extra staff especially anesthesiologists are not required. Consult a qualified plastic surgeon and good luck to you.

Mats Hagstrom, MD (license on probation) · Answer

I’m not a fan of high definition, Liposuction, a.k.a. etching. It tends to not look natural and ones done. The outcome is irreversible.Because almost 100% of the fat is removed in the definition lines getting this to change his difficult because there’s no fat to work with.Grafting fat will fail because there’s no tissue to graft into.Recognizing that any attempt at improving, the outcome can make things worse.Best,Mats Hagstrom MD

Considering revision lipo - Dep, crooked depression going down the middle of my stomach (photo)

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