I Had Smart Lipo on my Upper and Lower Abs Twice. The Fat Came Back in That Same Area. What Went Wrong?

I want flat abs and smart lipo was done twice on me within a two year period. Once the swelling went done the fat was still on my abs. I worked and and eat pretty healthy during and after the procedure. so what went wrong?

Doctor Answers 5

Smart Lipo

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Fat is distributed in different plains. The fat may not have been removed in the deeper plain.


New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Persistent abdominal fat after Smartlipo

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There are several factors that can explain your feeling that “the fat is still there.”  First, Smartlipo may not be the ideal procedure for your needs; your underlying muscle positioning and overlying skin tone play significant roles in the outcome of a Smartlipo procedure.  If you have protrusion of your rectus abdominus muscle or some skin laxity, your overall contour may not end up as sculpted as you desire, even with proper nutrition and exercise.
Second: If skin laxity and muscle positioning do not explain your predicament, it may be necessary to investigate some underlying metabolic imbalances.  For example, low thyroid hormone levels from hypothyroidism or elevated sex hormone levels in PCOS may stimulate enlargement of residual fat cells after Smartlipo. 
I recommend a follow-up with your physician to assess your abdomen with your pre-procedure photos, and consider some blood tests to rule out an underlying metabolic imbalance.   Good luck!

Daniel Levy, MD
Bellevue Dermatologic Surgeon
4.8 out of 5 stars 44 reviews


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Diet and exercise are critical after lipo. Not all of the fat cells are gone. Also, you may need skin removal as in a tummy tuck. check with your doctor and look at your pictures. Your expectations may have been too high

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

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Hello, Having liposuction twice doesn't guaranteed that the fat will not return. With out pictures it's hard to say whether you need a possible tummy tuck. You need too make sure you tell your surgeon what it is you're really expecting.

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

Fat coming back to the abdomen after smart lipo

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It is unfortunate that you are unsatisfied with your results from smart lipo. It is hard to comment exactly why without seeing your photos. One thought is that you may have loose skin or loose rectus abdominus muscles that may account for the less than favorable results. You may want to consider a tummy tuck, a mini tummy tuck or a combination of lipo and tummy tuck called lipoabdominoplasty. Good luck!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.