What should I look for when considering my options in finding the best doc for my lipo revision?

Question

Botched etching. 26 y/o 5’2 110lb. Lipo/bbl 1.5 years post op. My abdominal lipo was done with etching technique. It’s lopsided and one side is more sculpted than the other. My goal would be to have a smoother appearance and minimize the look for the harsh lines. I understand this a complex situation however what would give a better outcome? Fat grafting to the shallow areas or removal of fat in the fatty areas? Or both?

John Michael Thomassen, MD · Answer

A combination of fat grafting and liposuction would be recommended to even out this result.  I would shy away from energy based devices like laser liposuction or even radiofrequency and stick to power assisted devices to avoid further dermal scarring.

Andre P. Marshall, MD · Answer

Hi Outlaw18, Unfortunately your surgery did not go as you planned. Revision liposuction is always more complex due to contour irregularities and scar tissue. Fat grafting is likely not needed and is rather unpredictable in these situations. In your case completion lipo to help smooth out the shadows and valleys which were previously created would likely be recommended. We recommend you consult with a board certified plastic surgeon for further evaluation.

George Marosan, MD · Answer

Thank you for your question and photos. Even without posting preop photos, it is obvious that your surgeon has no idea or technical ability to carry out body sculpting based on your muscle and bony anatomy. To carve fat based on the surgeon’s poor “visualization” of the abdominal area, is the result of what you end up with. These are advanced techniques promised by many, but achieved by the few who are well trained in these techniques. Also, to “etch” the abdomen and not consider doing the flanks, hips and back, will give unnatural body shape and results. BTW, you also demonstrate significant loose skin when you bend over, thus you might’ve not been the best candidate for body sculpting just with liposuction only. I use the VASER Hi Def Lipo techniques to give the best outcome based on your underlying anatomy. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. You should also look at the surgeon’s photos, don’t just believe what they promise you verbally. Good luck.

Daniel Barrett, MD · Answer

Dear Outlaw18,
finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Make sure he/she is a board-certified plastic surgeon. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. There is a number of different sites where you can check for reviews (Realself, yelp, google, etc.).You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Omer Sagir, MD · Answer

Hello Dear,
Thank you for the photos and detailed information.
The extra fat on the belly can be extracted and then a smooth two pack surgery can be performed to give you the desired appearance that you wish to have. An even look on the both sides will enormously update the overall look on your abdominal region. So seems like you would need fat removal and body sculpting via two pack surgery to give the area a more beautiful definition.

Darryl J. Blinski, MD · Answer

Even with nicely posted photos ONLY virtual consults with...can determine if your thoughts are good. I think possible lower abdominal lipo with directed fat grafts is the better options.

Mats Hagstrom, MD (license on probation) · Answer

I think the promoters of high definition liposuction and etching are not doing the world a favor. in my opinion these techniques rarely look natural and most of the time end up being a substandard result if not full on disfiguring.
Removing the remainder of the fat evenly so that you have a uniform thin fat distribution is probably sufficient. The etched area virtually have no post tissue so the grafted fat will survive the least where you need the most. any fat that’s accidentally grafted just outside of the etched lines will have host tissue and survive making the problem worse.
Of all the bad liposuction results I’ve seen yours looks very promising in regards to restoring this to a normal looking abdomen. delivering consistent quality liposuction results is more difficult than most people believe it and this includes plastic surgeons. The truth is that most plastic surgeons really aren’t very good at Liposuction. The fact that they’ve done hundreds or thousands of cases doesn’t change that they don’t take the procedure seriously and never bothered being critical of their own results or trying to master the procedure.
Typically plastic surgeons will see liposuction results 3 to 6 months after the procedure and that is too much time to remember exactly what they did during surgery.
This makes the learning curve for Liposuction very very slow unless someone is doing cases on a daily basis. 
Some people learned well or have simply figured out how to do the procedure correctly while others continue to do body contouring similar to our four year old draws with crayons.
Revision Liposuction is many times more difficult than primary Liposuction so the need for talent speaks for itself.
The two single variables I found consistent with the plastic surgeons I admire the most are the following.
1) They have a collection of before and after pictures that are highly impressive and reads like a telephone book.
2) they tend to not have many highly upset patients and in general tend to have less justified negative reviews on various physician review websites.
To find the best provider I suggest first making a list of all the plastic surgeons in your community who seem to do a lot of Liposuction based on number of pictures on their website and overall reputation. look for providers who have a lot of reviews mentioning liposuction compared to other procedures.
Once you have a list of providers start scheduling in person consultations. I do not recommend anybody schedule virtual consultations whenever possible and this is especially true for a vision of work.
During consultations as each provider to show their entire collection I’ll be for and after pictures for the procedure you’re interested in. Being shown a handful of pre-selected 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. for abdominal liposuction an experience provider should have no difficulty showing you a minimum of at least 50 sets of before and after pictures. Look at all treated areas for any evidence of skin contour irregularities. Ask each provider to review areas treated in areas not treated and look carefully at transition zones between treated and untreated areas. ask the provider to show as many pictures as possible a patient with similar body characteristics to your own. you should also ask the providers to show you examples of excellent outcomes, average outcomes and less than outcomes. we all have them and a confident experienced talented provider should have no difficulty showing you a variety of outcomes.
I do recommend reading all reviews in the various physician review websites avoiding providers with any number of excessive justified negative reviews. The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
You may not find providers that have that many pictures of Revision Work Revision cases can be very difficult and vary tremendously in regards to which ones are salvageable and which ones are not.
When fat transfer is involved patients should be ready that it may take a few rounds of fat transfer to get the results right. personally I do all liposuction using local anesthesia with mild sedation. Small areas can be done using local anesthesia only.
Recognize that doing revision work can be a thankless job from the surgeons perspective. Patients usually have lots of questions and are apprehensive about having more surgery. They are generally less trusting and often require consultations and multiple follow up communication. in the end after spending hours explaining what can and cannot be achieved many patients end up not scheduling surgery. it helps if you recognize this when you approach plastic surgeons needing revision work. you may want to write an honest professional review about your experience with your provider so others will learn from your experience. I’m sure you would have appreciated reading other patients experience we’ve gone through similar experiences from that provider. 
Continue having consultations until you feel like you found the right provider for your needs.
Best,
Mats Hagstrom MD

What should I look for when considering my options in finding the best doc for my lipo revision?

Answers (7)

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