Sclerosing a Seroma Post Tummy Tuck with Lipo?

Seromas post abdominoplasty are a known complication.  The use of a sclerosing agent is sometimes necessary and this can lead to hard, indented areas on the skin above the sclerosed area. 

 

The drainage plus schlerosing agent allows the cavity to scar shut.  In my practice, I allow 8 to 10 days to elapse before I begin ultrasound (this is the same therapeutic ultrasound that the physical therapist uses to get rid of sore muscles).  Ultrasound converts sound waves into heat, which brings blood supply to the area, which allows the body to more rapidly absorb the extra scar tissue causing the dents.  It also decreases swelling and evens out the tissue on your abdominal wall. 

 

Ultrasound should be done 3 times per week for about 3 weeks.  This should cure about 90% of post sclerosing dents and divets.  In the unusual situation, a little extra ultrasound will cure the other 10%. 

 

 

 

 

It is likely that the fluid that was infiltrated into the seroma was doxycycline which is commonly used agent used to help in cases of recurrent or problematic seromas. I am sure that there other sclerosing agents, but none with which I am familiar. Regardless, the hard and indented areas are likely areas of scarring below the skin. Without an exam, it would be difficult to be certain, but the issues will likely improve significantly over time with aggressive massage of the hardened tissues. I would suspect that it will take 3-6 months for the tissues to soften and normalize. 

Seroma is a difficult problem to resolve. The best way is to prevent it. When it occurs, one tries to sclerose it frequently with an antibiotic of the tetracycline family. This whole process is going to involve significant inflammation and scarring deep in the tissue and be manifested by hardness and skin irregularity. Fortunately, with a lot of time and patience most of it will resove itself, if not completely but I would say 80% so later if a touch up is needed it will be small and simple.