Uneven skin - how do I fix it? Is it loose skin or fat? (Photo)

Question

Is it loose skin or is it fat? How do I fix it? I had a seroma after lipo and now my skin is uneven. I’ve had doctors recommend a tummy tuck to more lipo to j plasma. Nobody has the same answer for me. I feel like all the fat is gone but I’m not 100% sure. There is no fat left anywhere else. I’ve also previously had 3 c sections.

Giuseppe Fiore, MD · Answer

Hi,
Sorry to hear about that
Thanks for your question and pictures. 
It is important to make a face to face medical/surgical assessment where the surgeon will assess the skin irregularities/ indentations , asymmetry, skin elasticity and fat distribution. 
In you case it is crucial to make a bespoke treatment plan that requires several steps from less invasive to more invasive (abdominoplasty). 
I would suggest to start with a less invasive procedure : in some cases a revision with Vaser (no liposuction) and Bodytite or Renuvion with or without fat graft in some localized area can reduce the skin irregularity and smooth the areas of previous liposuction and contract the skin. After this procedure you would need to follow a bespoke aftercare plan that involves some non invasive treatments such as MLD/external ultrasound/monopolar radiofrequency/ Morpheus 8/shockwave therapy, massage roller to smooth the skin and achieve further skin contraction. 
You would need to wait 6-8  months to assess the results. If after this period you are still not happy and the results are not satisfactory then in my opinion the ONLY option to be considered is abdominoplasty ( Tummy tuck) to remove the excess of skin. 
I would advice to make an appointment with a with a surgeon expert in body contouring and skin tightening procedures for a medical/surgical assessment in order to make a bespoke surgical or medical treatment. 
Hope this help,
Dr Fiore

George Marosan, MD · Answer

Thank you for your question and photo. Based on this photo only, it is difficult to assess how much looseness you have. There are also some irregularities from your previous surgery and it seems like you have muscle separation and or an umbilical hernia, too. An in person examination is required to determine which surgical approach will give you the best long lasting results.
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Navjot Singh, MD, FACG · Answer

Thank you for sharing your picture. I would strongly recommend talking to your current surgeon about a revision. If you had a seroma, you could have scar tissue making the area uneven. It could be skin laxity. It's hard to tell from the pictures.

Connie Hiers, MD, FACS · Answer

The Renuvion might give you enough tightening to smooth most of your abdomen, but the tummy tuck will remove all the excess skin. However, I would suggest going with the Renuvion to avoid the long scar.

Mats Hagstrom, MD (license on probation) · Answer

It looks like you had poorly done very aggressive liposuction
To make an assessment on the outcome of a procedure we always need to see proper before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the ones they took.
Collecting poorly done Liposuction is very difficult, and sometimes not possible. Your outcome is the result of having most of your fat removed, and what fat is left was left in an uneven distribution
I question if you were a good liposuction candidates in the first place, because you also have moderate skin laxity.
Delivering consistent quality, Liposuction results is more difficult than most people believe. The number of plastic surgeons for truly excellent at this procedure is relatively few.
Liposuction is a permanent and irreversible operation. If done poorly, it is extremely difficult to improve on the outcomes. In reality most plastic surgeons are not particularly good at Liposuction though there are, of course many who are excellent. Most plastic surgeons think they’re better at Liposuction and they actually are.
Liposuction results have more variation in outcome based on provider selection than any other plastic surgery procedure.
For this reason I recommend patient be very selective when it comes to choosing providers for Liposuction. I recommend patient have at least five in person consultations before choosing a provider. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of Liposuction results. As providers, especially to show your previous patient who had similar body characteristics to your own. 
Being shown a handful of preselected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider. It’s also very important to understand the candidacy for the procedure as a major impact on what the procedure can, or cannot accomplish. For this reason, patience should bring pictures of their own body with them for reference during consultations. Make sure providers only show you before and after pictures of previous patients who had similar body characteristics to your own.
For reference an experienced provider should have no difficulty showing you at least 50 sets of before, and after pictures of commonly performed procedures like Liposuction. In reality, highly experienced surgeons will have hundreds or even thousands of before, and after pictures of commonly performed procedures.
I recognize that this may not be useful since you’ve already had Liposuction.
Liposuction revision work is many times more deal, then primary Liposuction. The best providers for revision work are generally the same providers who are the best at doing primary liposuction. Revision work generally comes down to removing more fat, adding fat with fat grafting or converting the procedure to a skin tightening operation like a tummy tuck. None of these options are going to be great or restore your body to preprocedure or give you the results you had hoped.
What’s your procedure done using an energy based device such as VASER?
At this point, I would be very selective and cautious moving forward with any procedure to try to correct your. It’s not possible to restore, forgive you and natural fat distribution, because almost all your fat has been removed. What was left was left in an uneven distribution. It’s possible that the only option is to convert this to a full tummy tuck. That type of decision cannot be made or recommended with a post on the website.Recognize that having a tummy tuck does not address having an uneven fat distribution. It will, however, treat your abdominal skin laxity. Aggressive Liposuction will leave scar tissue this can sometimes inhibit what can be achieved with a tummy tuck procedure.
What happened to? You is very unfortunate. I suggest you consider writing, honest, appropriate and professional reviews about your experience so other patients can learn about your experience.
I’m sure you would’ve appreciated Previous patients who had similar experience, having shared what they went through before you chose your provider.
Unfortunately, there is no easy solution.
I would steer far away from JPlasma, a.k.a. Renuvion. The procedure is most likely going to make things worse and put you at risk for having complications. Revision liposuction, or removing more fat, with a goal of creating a more even contour may or may not be appropriate. For individuals who have a good skin elasticities usually some improvements can be had as long as the provider doing the revision work is sufficiently talented.
Your situation is complex, and there is no easy solution. The most important variable is finding the most talented and experienced provider who has enough insight to realize the inherent limitations of most of the procedure options you have been given. 
In the end from my perspective, based on limited information, without having the luxury of an examination, most likely your best options are going to be accepting the outcome for what it is, or converting this to a full tummy tuck.
What happened to you is unfortunate. What is also unfortunate is how often this happens. 
Unfortunately, too many patients are under the belief that Liposuction is a fairly simple procedure that should be done easily by anybody who is board-certified in plastic surgery especially those who’ve been in practice for a few years with overall good reputation. Unfortunately, being bored, certified in plastic surgery is not sufficient to confirm that somebody has mastered Liposuction.
Doing this procedure well on a consistent basis, including the ability to make an accurate assessment, regarding who is or is not a good candidate, for the procedure is far more difficult than most people believe. 
Best,
Mats Hagstrom, MD

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