Options for improving fibrosis after ab etching? (Photos)

Question

I had an ab etching procedure over a year ago and was left with asymmetrical hard knot-like tissue around my navel—what are my options for improving this? Radio frequency, kybella injections, Carboxytherapy, ultrasound, steroid injections?

J. Timothy Katzen, MD, FACS · Answer

Hi, Ea7199 in Tucson. Thank you for your question regarding your options for improving fibrosis after ab etching.  Thank you for your history and pictures.  Let's first analyze your post-op ab etching pictures. You have excellent results. There is a clear delineation of the linea alba and semilunaris lines. There is a clear definition of the transverse inscriptions outlining the muscle bellies of the rectus abdominis muscles. The scarring and hard-knot you describe around the umbilicus are common after VASER HI DEF ab etching.  Most plastic surgeons specializing in VASER HI DEF ab etching would suggest repeating the VASER to this area of scar tissue.  The VASER is an excellent tool to melt scar tissue from previous VASER liposuction  Also, during the VASER procedure, the scar tissue can be broken up and removed.  Regarding specific treatments, you mentioned radio frequency, kybella injections, carboxytherapy, ultrasound, and steroid injections.  Let's look at these individually.  Most plastic surgeons would agree that radio frequency is probably not strong enough to break down this post-op VASER scarring. In regards to kybella injections, kybella dissolves fat, not scar. 
 So kybella is not going to work. Regarding carboxytherapy, most plastic surgeons would not suggest it.  Again, like radiofrequency, carboxytherapy is not strong enough to break down this type of fibrotic scar.  You mentioned ultrasound.  Ultrasound from outside your skin is not used to break down scars.  However, ultrasound from the inside as a VASER would be the best treatment.  You suggested steroid injections.  Steroid injection may help to break down the scar tissue, especially if you do not want to undergo surgery again.  The difficulty with steroid injections is that the results are not predictable and may take several injections and many months to correct.  
VASER HI-DEF abdominal sculpting or etching is a technically difficult procedure.  Your plastic surgeon must know his abdominal wall anatomy. When seeking revision VASER HI-DEF abdominal etching, please seek an experienced, board-certified plastic surgeon with significant experience performing the VASER HI-DEF procedure.  Not all plastic surgeons own a VASER machine, and most plastic surgeons do not perform the VASER HI-DEF procedure. Do your research.  Ensure your selected plastic surgeon has performed at least 100 VASERHI-DEF  abdominal etching surgeries and has the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, VASER HI-DEF  plastic surgeon in your neighborhood, consider traveling. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS ( Plastic Surgeon, President of  the American Society of Bariatric Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Jason Emer, MD · Answer

REAL SELF 2024
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fibrosis
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B121 Revision / Irregularities / Lumps / Fibrosis / Indentations after Liposuction 
C121

Pending a formal evaluation, you may be a good candidate for a Revision Liposuction. You need a formal evaluation by an expert in body shaping and contouring to determine what is best.

The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heats the skin with radiofrequency devices such as Renuvion (J-Plasma), InMode BodyTite, and ThermiRF to heat the undersurface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HI-DEF VASER Liposuction and can only be done by a well-trained body contouring specialist. At the same time, fat should be harvested and purified, with PRP and stem cells added, and then injected into muscles, indentations and cellulite to get body shaping and contouring. For a Brazilian butt lift (BBL), we inject the fat into the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with a combination of QWO or Cellfina, subcision, and/or fillers such as Bellafill, Renuva synthetic fat, or Sculptra. If skin is very loose before surgery, then it will need to be removed: tummy tuck/abdominoplasty for lower abdominal skin; breast lift for excess breast skin; and/or a brachioplasty for loose arm skin. Overall, you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting. See an expert. Best, Dr. Emer.

Pending a formal evaluation, you may be a good candidate for a Revision Liposuction. You need a formal evaluation by an expert in body shaping and contouring to determine what is best.

The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heats the skin with radiofrequency devices such as Renuvion (J-Plasma), InMode BodyTite, and ThermiRF to heat the undersurface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HI-DEF VASER Liposuction and can only be done by a well-trained body contouring specialist. At the same time, fat should be harvested and purified, with PRP and stem cells added, and then injected into muscles, indentations and cellulite to get body shaping and contouring. For a Brazilian butt lift (BBL), we inject the fat into the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with a combination of QWO or Cellfina, subcision, and/or fillers such as Bellafill, Renuva synthetic fat, or Sculptra. If skin is very loose before surgery, then it will need to be removed: tummy tuck/abdominoplasty for lower abdominal skin; breast lift for excess breast skin; and/or a brachioplasty for loose arm skin. Overall, you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting. See an expert. Best, Dr. Emer.
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Stanley Okoro, MD · Answer

Thanks for your question and the photo you provided! Without knowing the rest of your vitals, past medical history, and examining you in person it is difficult to answer with complete certainty. I do see the slight fullness under your belly button on your side profile. Since this is likely scar tissue at 1 year post op, I would try to shrink it with RadioFrequency. You may first try Morpheus 8 which can be non-surgical and then possibly BodyTite. Make sure you consult with a board certified plastic surgeon. Good Luck!

Ajaya Kashyap, MD · Answer

Thank-you for your question. The photographs do not show the fibrosis very well . However, the best option for fibrosis may be to have a steroid injection followed with massages to see if it can be helpful even at this stage. The other option is injection of a very small amount of fat cells. Please discuss your concerns with your Plastic surgeon who can help you. All the best!

Sean Satey, MD, FACS · Answer

Great question. I'd start with a combination of steroid injection (kenalog-40) every 4 weeks for 3 sessions, and intermix ultrasound directly over the area. If it doesn't improve, I'd proceed a focal revision under twilight sedation. I caution you to seek an experienced provider that specializes in revision procedures. In my practice, nearly 60% of our cases is revision work from other surgeons. Best, Dr Satey, Beverly Hills, Ca.

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