How to smooth stomach unevenness 1+ year after lipo 360? (photo)

Question

I received lipo 360 in October 2021. Even after following instructions I have unevenness that makes me self conscious. Is there something I can do, or another procedure, that would smooth my stomach? The skin is not loose.

Gianfranco Frojo, MD · Answer

This is rather common after liposuction if there was over aggressive liposuction performed, any high energy based devices such as VASER, or just poor technique. I would recommend revisionary liposuction to mainly help use any remaining fat to smooth out the contour of those areas.

Dallas Buchanan, MD · Answer

Thank you for your questions and concerns. The most common complaint after liposuction is contour deformity. In your photos, you appear to be pretty fit and it is patients who are thinner to start with that have a higher risk of contour deformity. I am guessing, that in an effort to give you a great result, your surgeon pushed the envelope a bit and suctioned into the superficial layers of fat, creating this appearance. These types of cases are incredibly hard to fix and often cannot be completely corrected. Usually requires revision liposuction with fat grafting and is often more expensive and labor intensive than the original operation.
Good luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Daniel Barrett, MD · Answer

Dear Thoughtful586830,
I would have to examine you but it appears that this is a contour irregularity after liposuction. This happens often when areas the undergo liposuction are not feathered appropriately.
The good news is that it can be fixed and I have done so with good results before. While there is always a chance for contour irregularities with liposuction, someone who takes their time and uses the appropriate sized cannulas should give you a superb result.I have all my patients wear compression garments and I use multiple sized cannulas to feather out the result.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Bruce K. Smith, MD · Answer

While the irregularities should continue to improve with additional time, (and certainly external treatments like external ultrasound, and lymphatic drainage massage procedures would assist in the natural softening and remodeling process), a secondary procedure to equalize and release some of the scar tissue that is causing the irregularities, may be necessary. This type of procedure is an absolute "finesse" type procedure with a very small canula, not to remove fat but to equalize and smooth the fat and release scar attachments. An external compression sponge, (like Reston) with a properly fitted compression garment or binder, would help minimize recurrence of the irregularities.

Camille Cash, MD · Answer

An in person evaluation is always best, but typically a tummy tuck will help to improve contours after liposuction.  There may be other alternatives such as fat grafting, but a consultation is needed to determine if you're a candidate.

Kenneth R. Francis, MD, FACS · Answer

Dear Thoughtful,

One of the risks of liposuction surgery is contour irregularities, i.e. lumps and bumps.   Sometimes they are the result of an inattentive liposuction procedure, sometimes they are the result of the somewhat unpredictable nature of the healing process that is different in each one of us.  Sometimes they are permanent, sometimes they improve with time, exercise and massaging.  Scar tissue will continue to remodel and readjust itself for sometimes years.  So there is a small chance that your unevenness will improve some on its own.  An attempt at redistributing whatever leftover fat there is in your abdomen with a separation and redistribution liposuction procedure (no fat removal) might help some, but would be dependent on the presence of some fat, would not be guaranteed, and would carry a risk of making things worse.  Be wary of non invasive procedures that will promise you the world.  Good luck!

Darryl J. Blinski, MD · Answer

The one posted photo shows the complication of energy based liposuction in many cases/FIBROSIS. Very few options to correct are available. I use a combination of surgery doing SAFE lipo for fibrosis release with drain, aggressive postop massages and compression. After 2 months injection of hyper diluted Radeisse into any dents or irregularities. Fee from $8,00-$20,000. 
Best yo virtual consult with…

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality liposuction results is more difficult than most people believe. liposuction results are permanent and irreversible. Once surgery is completed if it was not done well patients are more or less stuck with their results. it is extremely difficult to improve and poorly done Liposuction.
It’s hard enough to take an even fat distribution, do liposuction and leave the fat distribution thin but consistent and even. To start with an uneven about this tribulation and make it even his many many times more difficult. Since in your own case your provider was not able to maintain an even fat distribution through the procedure the chance of someone with that level of skill would most likely simply make things worse in an attempt of doing a revision. 
Liposuction is unfortunately seen as a simplistic procedure by both the public and providers.
In reality mastering this procedure to the point of being able to consistently deliver excellent results that are predictable based on an accurate assessment and consistent with before and after pictures shown during a consultation is not easy.
The number of providers who can do liposuction well on a consistent basis it’s relatively small.
Bing board-certified in plastic surgery with an overall good reputation and years of experience does not mean that somebody knows how to do liposuction well.
Liposuction results have more variation and outcome based on who does the procedure than any other plastic surgery operation I’ve ever seen.
Results can vary from stunning body transformations to disfigurement.
The choice of provider for anybody interested in liposuction is absolutely critical.
Patients do not seem to appreciate the technical skills necessary and years of experience to master this procedure when choosing providers.
Some improvements may be possible but before even considering revision surgery you have the first and foremost find a provider who has sufficient skill and confirm they have mastered this operation.
The process of finding the right provider for a revision to work is essentially the same as finding the right provider for primary Liposuction. there are however a few exceptions. to improve liposuction results surgeons will generally recommend revision Liposuction, fat transfer or in some cases converting the procedure to a skin tightening operation like a full tummy tuck.
In cases were fat transfer is a better option he’ll need to find providers who have school and experience with that procedure going through the same vetting process but including fat transfer.
To find the best provider I recommend patients start by having multiple in person consultations with local board-certified plastic surgeons in their community who seem to do a lot of liposuction.
You can look at providers website and simply find the ones that have the greatest quality and quantity of before and after pictures of Liposuction results on their websites.
During in person consultations ask each provider to open up their portfolio and show you their entire collection of before and after pictures. providers may be apprehensive in doing this but I suggest you push each provider to show you as many pictures as they are willing to.
Being shown a handful of preselected sample pictures which most likely represent the best results of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
It’s helpful if you bring pictures of your own body printed to the consultation and use those as a reference.
Ask providers to only show you before and after pictures of the previous patients who have similar body characteristics to your own.
For primary Liposuction and experience provider should have no difficulty showing you at least 50 sensor before and after pictures commonly performed procedures like abdominal liposuction.
Highly experienced surgeons will in fact have hundreds or even thousands of before and after pictures of commonly performed procedures if they have sufficient skill and experience
For revision surgery you should not expect providers to have nearly as many before and after pictures.
Generally the best providers for doing good revision work are going to be the same providers who do quality primary liposuction. as mentioned earlier the single exception is for individuals who would benefit from having fat grafting done in which case you need to vet providers for fat grafting outcomes.
Take careful notes during each consultation regarding dewan entity and quality of before and after pictures. familiarize yourself with what quality results should look like by looking at lots of before and after pictures before consultations. When reviewing pictures make sure you only choose examples of patients who had similar body characteristics to your own in the before pictures.
Candidacy for Liposuction varies massively and candidacy it has a big impact on what’s possible with the procedure.
Based on your description and picture included you were a good candidate for Liposuction.
Create a rating system for quality outcomes and grade or rate each provider‘s collection of before and after pictures based on both quantity and quality.
Continue having consultations until you feel very comfortable you found the best provider in your community.
I do not recommend patients do virtual consultations especially in a complex situation like your own.
I also recommend patients avoid traveling long distances for elective surgical procedures if at all possible.
Recognize that revision Liposuction is many times more difficult than primary Liposuction and in the hands of an inexperienced provider your outcome and can easily be made worse and attempt of improving your outcome. providers who believe they can easily improve your outcomes should be a red flag. Likewise providers who believe that certain technological devices especially power devices like VASER, J plasma, Renuvion or body tight will somehow magically improve your results should also probably be considered with caution.
Revision surgery can usually create some improvements but restoring your abdomen to pre-procedure or the type of results you had initially hope for is probably not possible.
Sometimes improving outcomes may require more than one procedure.
There is no correct number of consultations patients need to find the right provider. I generally recommend patient start with a minimum of five in person consultations before considering choosing that surgeon. unless you feel very confident that you found somebody pass the skill and experience necessary it’s generally better to slow down and schedule more consultations then to move forward for procedures that are permanent and irreversible.
Some providers may also be apprehensive of taking on revision work because the amount of improvement may be subtle and this type of work it’s often very time intensive. patients are often gun shy and apprehensive of trusting providers and consultations can take many times longer for revision to work with lots of follow up questions leading to no income for the provider.
Providers certainly have the right to say no for elective surgical procedures but I think you’ll find that in the hands of a sufficiently talented and caring provider they will offer you help if they think they can do it.
When in doubt slow down and schedule more consultations.
Consider writing a review about your experience so other patients will ask them insight regarding what your experience was like. I’m sure you would’ve appreciated hearing other patients perspectives who had similar outcomes to your own.
Best,
Mats Hagstrom MD

How to smooth stomach unevenness 1+ year after lipo 360? (photo)

Answers (8)

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