Which liposuction is best for revision lipo and why? (Photo)

Question

Another question is how do I know that the doctor can deliver amazing revision liposuction results? I had vaser liposuction and full body liposuction with a bbl in Sept 2021. I came out with a small dip on my right flank and I would like to have a more even waistline/silhouette. I have quotes from several drs offering me tumescent, traditional, vaser, bodytite, airsculpt liposuction ect. I really can't figure out which one is best for me.

Gerald Minniti, MD, FACS · Answer

You, and the docs who have spent a lot of money on those fancy machines, have bought into the concept that a machine can make or break the results of liposuction, or in this case, revision liposuction. It simply is not the case. It's the training, skill, and finally, the experience of the surgeon that will produce the best results. Having said that, your surgeon did a very fine job on your belly despite that dip. He might be the person to fix you.

Darryl J. Blinski, MD · Answer

You ask an interesting question, and only one posted photo. The basic concept is it is not the technology of liposuction but the experience of the surgeon and knowing how to use whatever technology, whether traditional visor, smart, Lipo laser, Lipo power, assisted Lipo tickle, Lipo air scope Lipo will deliver results you desire. as for the why have you not had a a combination of Sculptra and Radiesse injected in hyper dilute state, approximately 4 to 8 syringe/vials ( fee $$15,000). This might have corrected the denting. Now you need areas of liposuction arms waist, abdomen thighs and thigh rafting to the dented area. Expect feed to be $10,000-$15,000. I would also use J plasma with the liposuction to get some skin tightening, and other areas. Please do virtual consultations regards

Mats Hagstrom, MD (license on probation) · Answer

In my opinion, the first step is and always should be to get a clear understanding of what the underlying problem is.
It looks like your primary procedure was done, fairly aggressively with an intent on delivering high definition results.
While I personally do not do high definition Liposuction, because of its permanence and potential undesirable side effects. It can deliver, impressive results.
Your procedure looks like it was done fairly well.
It’s important to different sheet contour, irregularity as being part of the underlying muscle structure, excess fat removal, or if insufficient fat, was removed in the surrounding area.
Depending on what the contour irregularity represents will determine The best approach to treating it, including a good understanding if treatment will be successful or not.
Vetting plastic surgeons is difficult and most patients don’t do a very good job at it.
My personal recommendation is to start the process by first, making a list of providers who do a lot of the procedure you’re interested in in your community.
I then recommend patience schedule multiple in person consultations with those providers.
I generally recommend avoiding virtual consultations whenever possible.
 During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics for the procedure you’re interested in.
For commonly performed procedures and experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures that provider has actually done.
For unusual procedures, which often includes revision work providers are not going to have that many examples.
The candidacy for correcting Liposuction contour irregularities is highly variable.
This means that some patients end up with contour irregularities that are very difficult or not possible to correct.
Others are more straightforward and simple to correct and some may require multiple procedures with patients only receiving marginal improvements with each treatment.
It depends on what the actual problem is.
Is it a lack of fat, too much fat or is it an underlying body shape issue?
Generally speaking, patients were good candidates for revision, where those who had less aggressive treatments during the first procedure, leaving as efficient layer of subcutaneous fat to work with for the revision.
The most difficult cases are replacing fat when virtually all the fat was removed during the first procedure.
 For these type of defects fat transfer is about the only option. In order for fat transfer to be a viable option there has to be efficient amounts of host tissue to support the grafted fat.
When too much fat has been removed during the first procedure, there is usually virtually no host, tissue and fat transfer results becomes dismal.
Your photograph is insufficient to get a clear understanding of the ideology of the problem.
We can see the contour regularity, but not make a clear assessment regarding exactly what tissue layer needs to be manipulated.
To make an assessment regarding the outcome of a plastic surgery surgery procedure we generally always need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took. 
For your situation, ask the surgeons to clearly define the problem in regards to why the defect is there and what tissue near layer needs to be corrected.
If the recommendation universally is fat, transfer the recognize that this may be only partially effective and may need multiple treatments in order to build up tissue to get the results you’re hoping for.
Generally speaking, the best doctors for revision work are the same doctors who do the best primary procedures.
Plastic surgeons are either good at Liposuction and fat transfer or they’re not.
Generally surgeons are responsible for their own outcomes, and for most situations, the surgeon, who did the procedure should be responsible for correcting the outcome.
When there’s clear evidence of lack of skill, the patient is probably better off seeking second opinions.
In your case, still overall, results is quite excellent, so I see no need to seek second opinion consultations for revision work.
The exception would be if your current provider has no skill in fat transfer and fat transfer is the best way to fix the problem.
In the end, plastic surgery outcomes are almost always determined by two variables.
The first is the patient’s candidacy for the procedure, and the second is the skill and experience of the provider.
When, in doubt, refer back to those two primary variables, which are at the heart of potential outcome and actual outcomes. Understanding your candidacy, having an accurate assessment, or a correct underlying diagnosis is the foundation of treatment selection.
Treatment success is based on understanding the candidacy and the ability to implement procedures correctly.
I think the contour issue was created on purpose as part of the high definition of treatment plan.
When that’s the case, almost all the fat has probably been removed.
Hi definition type Liposuction is in many ways, permanent and irreversible.
That is one of the primary reasons why I avoid this technique.
Emphasizing muscle intersections by removing all the fat at these juncture lines becomes irreversible.
It is one of the drawbacks and advantages of having high definition body contouring.
Considering the circumstances accepting the outcome as it is, should be on the table.
An accurate assessment will require an in person consultation.
Best,
Matt Hagstrom, MD

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