1 year after vaser lipo, main concern is dimples present in surgery site. Which procedure can help minimize this? (photos)

Question

A little over a year ago I had vaser lip with renuvion skin tightening. I have 3 large dimples that were present immediately after surgery. Interested in revision - have done a few consults with differing opinions. One surgeon said fat injections, not enough loose skin to do a tummy tuck. Second surgeon said, tummy tuck is the only way to fix. Opinions/Insights Please. Goal: I want to be able to wear a bikini without anyone noticing that I have had "bad lipo" or "lipo".

Daniel Barrett, MD · Answer

Dear lia.akiko,
I would have to examine you but it appears that this is a contour irregularity after liposuction. This happens often when areas the undergo liposuction are not feathered appropriately.
The good news is that it can be fixed and I have done so with good results before. 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

Connie Hiers, MD, FACS · Answer

An examination is needed to be certain, but you appear to have a few areas of dents and a little excess fat. The residual fat could be taken and transferred to the dents. I would suggest this first over the tummy tuck.  Be sure to go to a surgeon who does lots of fat transfers.

Darryl J. Blinski, MD · Answer

Great posted photos. Your complication of uneven Vaser Lipo very common using this heat generating lipo technique. The correction would be to try injecting multiple sessions of fat grafts or Sculptra 
/Radeisse combo or both. Fees en toto $20,000. Or maybe expert surgeon re lipo with small bore cannula might smooth out with hyperfix taping and many massages. That fee $8,000. Best to virtual consult with...

Mats Hagstrom, MD (license on probation) · Answer

Your results are direct reflection of how the procedure was performed. Your provider lacks sufficient skill to deliver consistent quality liposuction results.
Delivering consistent quality liposuction results is more difficult than most people believe and this definitely includes plastic surgeons.
A substantial number if not most plastic surgeons think they are far better at Liposuction than they actually are. renuvion does not create any significant skin tightening and if anything causes increased pain and complications. I say that from first-hand experience using the device for over a year.
The ability to improve poor liposuction results depends on the number of variables. The first variable is probably based on if the patient was a good candidate for Liposuction in the first place. to make an assessment on the outcome of a procedure we really need to see proper before and after pictures. If you don’t have before and after pictures and ask your surgeon to forward the ones they took. whenever seeking a second opinion always show your before and after pictures. You should also get a copy of your operative report which would be good for any future surgeon to see it before doing any other abdominal procedure. Your opera report and before and after pictures are part of your medical record which are available to you upon request.
The most difficult cases to correct our when Liposuction was done in an overly aggressive manner leaving very little fat left to work with.
While you do have some debits and irregularities you also have large parts of your abdomen that were under treated.
Fixing under treated liposuction results is far easier than trying to correct over treated areas.
You should definitely be able to get a nice improvement from revision liposuction with potentially grafting small amounts of fat in the areas where too much fat was removed.
Getting the central Perry umbilical area send out so it’s consistent with the rest of your abdomen is one area that can easily be improved.
Revision procedures or secondary liposuction are far more difficult than primary procedures.
I’ve already shared with you that delivering consistent quality liposuction results it’s not some thing all plastic surgeons are capable of doing and the importance of choosing as efficiently skilled and experience provider cannot be overstated.
Considering that secondary liposuction is more difficult than primary liposuction the importance of choosing a sufficiently skilled provider is even more important.
To find the best provider I suggest patients schedule multiple in person consultations. During each consultation ask each provider to open up their portfolio and show their entire collection of before and after pictures. Being shown a handful 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 much experience each provider actually has.
Bring pictures of your own torso with you for a reference and comparison and ask the provider to show as many pictures as possible of patients with similar body characteristics to your own.
For reference in my opinion an experience provider should have no difficulty showing you at least 50 set so before and after pictures of commonly performed procedures such as abdominal liposuction.
Ask the provider to show you examples of excellent outcomes, average outcomes and less than outcomes.
Make sure they are only selecting patients who have similar body characteristics to around in regards to skin laxity, potential pregnancy related changes, BMI, overall body shape and amount of body fat.
All the plastic surgeons have a variety of outcomes including results they’re not proud of. It’s fair game for patients to ask to see a variety of outcomes and to get access to as many before and after pictures as possible.
Count exactly how many before and after pictures each provider shows you there in a consultation.
 Before consulting review lots of before and after pictures online and come up with a rating or a grading system to rate or a greater results of previous patients who had similar body characteristics to your own.
Use the same rating system to read the before and after pictures of each provider during in person consultations.
It is absolutely critical you get providers to open up their portfolio and show you lots of pictures. If they don’t have sufficient quantities of before and after pictures or unwilling to open their portfolio and show you more than simply cross that provider off your list.
Other things to consider are the total amount of time spent during the consultation and how thoroughly the provider discussed all aspects of the procedure including preparation, recovery, risks and benefits, alternative procedures, medical history, examination, review a before and after pictures etc.
Top-notch plastic surgeons tend to be detail oriented and this should be true for both in the operating room and outside of the operating room.
Finally I recommend reading all reviews on various physician review websites avoiding providers with any significant number of justified negative reviews. The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
There’s no right or wrong number of consultations to have to find the right provider. I suggest most patients start with at least five consultations and schedule more if you have any doubts about having found a truly stellar plastic surgeon who has mastered body contouring with Liposuction.
In your case you may also benefit from fat transfer.
If a surgeon recommends both Liposuction and fat transfer then you’ll also need to assess their skill in fat transfer.
It’s going to be difficult for plastic surgeons to show you the number of before and after pictures I’ve previously described when it comes to Revision Work or a secondary liposuction procedures.
We simply don’t do nearly as many revision jobs as primary Liposuction.
Generally speaking providers who have mastered primary Liposuction are probably the correct ones to go to for secondary work as well.
Considering how difficult it is to do secondary procedures I would suggest you put a significant effort into finding the most talented provider in your community.
Avoid virtual consultations and avoid traveling long distances for elective surgical procedures unless you are able to have in person consultation and in person follow up visits.
When in doubt continue having consultations until you found a provider who has the skill and experience to give you a quality outcome.
Recognize that you are the one hiring the plastic surgeon and you have a full right to ask to see supporting information to confirm what average results look like and how many of these procedures each surgeon has performed.
Don’t let the process intimidate you and recognize that you are the one in charge of the consultation since you were the one paying for the procedure.
Think of a consultation as a hiring interview where you are hiring a surgeon.
If you take a passive approach the plastic surgeon will take advantage of it and only show you images and information that are flattering in their favor.
This is why it’s so important to get providers to open up their portfolio and show you as many pictures as possible.
Are most patients know when they found the right provider. It tends to be obvious.
Providers with sufficient scaling experience should present a collection of before and after pictures that reads like a telephone book.
When in doubt slow down and schedule more consultations.
Poorly done Liposuction can leave people disfigured and revision work can make things far worse rather than better if the correct provider is not chosen.
Based on your pictures I don’t think you need a tummy tuck. providers who are recommending that procedure are probably ones who don’t like or are not particularly good at doing Liposuction.
Recommending a tummy tuck once someone is a good candidate for liposuction it’s a sure tail sign that someone hasn’t mastered liposuction.
Good luck,
Mats Hagstrom MD

Jose Segura, MD, PhD - Account Suspended · Answer

Good morning, the details that it presents may be due to fibrosis or thinning of the skin in the areas where the holes can be seen; alternatives would be revision laser liposuction to improve the skin and remove fibrosis and tighten. And combine with an endoscopic abdominoplasty since the abdominal muscles are seen in the open photo. That would be the suggestion for your case. With the reservation that nothing can be done for the amount of scarring under the skin and not cause more damage. That is why a review of you is important. Greetings.

1 year after vaser lipo, main concern is dimples present in surgery site. Which procedure can help minimize this? (photos)

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