6 months post surgery on my hand it looks misshapen. What can I do at this point? (photos)

Question

I had hand surgery where a doctor created a flap from my mid wrist to my lower wrist due to fat atrophy caused by too many cortisone shots. I was told it would look a little indented, but it seems the doctor took too much fat and my hand looks completely mis-shapen. I can not go back to this doctor any longer because I honestly do not trust him. Any advice on what can be done here would be appreciated. This is 6 months after surgery at this point.

Michael Kulick, MD, DDS · Answer

Without seeing how you looked initially, it is hard to imagine what really happened surgically. Why did you receive so many cortisone shots into your forearm? I do a lot of hand surgery, provided many steroid injections and have not seen atrophy that required a flap or fat injection.  I have also injected fat into the hands with good success. 
What you need is a consultation. 
Good luck. 
Dr. K

Mats Hagstrom, MD (license on probation) · Answer

if your doctor lifted a flap with a thin layer of fat then there would be a chance of losing the flap because of a loss of blood supply.  Doing the entire procedure with an overall failure leading to exposed tendons would be disastrous.  This was not a cosmetic procedure I'm guessing.  Fat atrophy can look pretty bad but it is often functional and it does still have coverage over structures like bone and tendons.  This point there's no way to go back to your fat atrophy without the flap.  At this point the flap could be defatted either by liposuction or with open surgery.  That will restore the contour very nicely. It looks like a very well done procedure.  If you want an accurate assessment then I would suggest an in person consultation. If you still don't trust your hand surgeon then find another one.  Try to understand this from the surgeons perspective. Failure of the procedure because of a slightly better short term Aesthetic outcome is perhaps not a very smart move.  Even if the patients willing to take that chance the doctor may not. For good reasons and that is a fair way of approaching patient care.  Perhaps you asked about this before but fat transfer to skin missing fat from fat atrophy secondary to steroid injections works poorly so your doctors choice of procedure was  correct.  Best, Mats Hagstrom MD

6 months post surgery on my hand it looks misshapen. What can I do at this point? (photos)

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6 months post surgery on my hand it looks misshapen. What can I do at this point? (photos)

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