Fat necrosis, delayed healing, still warm & swollen 9 weeks post arm lift. (Photo)

Question

I have a large, rock hard fat necrosis above elbow in L arm. Surgeon believes my compression garment was too tight. I also have open, but healing, spots along incision. Doc says he'll do a revision once inflammation subsides since skin will probably be stretched out. I'm so disappointed. Does that sound reasonable that fat necrosis can be caused by compression garment? It was really tight on L arm especially. Doc said he removed more from L arm. R arm is also still numb and swollen but less so.

John J. O'Brien, MD · Answer

Hello, and thank you for your questions and her photos. I am sorry that you're having problems following your procedure. It looks like you have some swelling and several open areas, and I believe many of these issues  will improve with time. You may also have a low-grade infection or cellulitis I would recommend that you continue to follow up with your treating surgeon. I would recommend that she will allow the tissues approximately 9-12 months to improve and consider revisional surgery at that time. Best of luck with your continued recovery.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding fat necrosis delayed healing and possible arm infection nine weeks after an arm lift or brachioplasty. You mentioned that your plastic surgeon said that you had fat necrosis above your left arm. Fat necrosis during an arm lift can be caused by many things including compression, loss of blood supply, infection, and tension within the wound. It is all together possible that the compression garment may have caused the fat necrosis. Even though the cause is important, the treatment is far more important. In your specific case, I would avoid the compression garment until the redness has subsided. Also, I would avoid the compression garment till all the incisions have healed. Since it is red and swollen, I would suggest you take antibiotics. I would suggest weekly follow-ups with your plastic surgeon. I would wait till all the incisions are healed before even considering revision. You mentioned that it is very tight on the left arm. This is completely reasonable considering the pictures you sent and the surgery you have undergone.  You also mentioned numbness and swelling in the right arm; this is also within normal limits. I would suggest you continue to follow up with your plastic surgeon on a weekly basis. This fat necrosis will resolve. The fat necrosis will soften, liquefy, and seal. There should be no evidence of permanent hardness in your brachioplasty. Thank you for your questions regarding post-operative healing after a brachioplasty or arm lift. If you have any further questions regarding the arm lift or post-operative healing after a brachioplasty, please contact my office. When considering an arm lift or brachioplasty, please seek an experienced, board-certified plastic surgeon who has performed hundreds of brachioplasties in their career. Travel out of state if you must. 
  
Sincerely, 
  
Dr. Katzen

Sam Speron, MD, FACS · Answer

It seems that you're unhappy with your results of your arm lift. I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of arm lifts and liposuction. Good luck with your future correction!I hope my answer helps and if it does, please take a moment to up vote this answer on the “respond” button on the top right.  Have a great day.

Yannis Alexandrides, MD, FACS · Answer

Fat necrosis can occur for a variety of reasons, including wearing a garment that is too tight. At this stage I would follow the plan that your surgeon has made for you.

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