Skin necrosis after liposuction? I'm 5 weeks post LiPo and BA (photo)

Question

A few days after the surgery my nurse noticed some bruising at my sides. There were very visible dark marks on my skin (see pictures). Slowly one side began to become a bruise and then a scab and peeled off. The other side kept getting worse and became a deep wound. My surgeon says it was the compression garment pinching my skin. Its now a very deep wound so I'm hoping for advice on how to keep scarring to a min. As I'm sure there will be visible scar tissue

Vishnu Rumalla, MD · Answer

Thanks for your inquiry,  first the wounds need to completely heal.  Then ask your doctor about silicone sheeting and topical steroids, good luck.

Stephen T. Greenberg, MD, FACS · Answer

Hello and thanks for your question. From the photos it is hard to diagnose exactly what caused this to happen, but the up side is that you seem to be healing. With many advances in technology, there are many things that can be done to help improving scars (for example lasers, creams and scar revision procedures.) I recommend speaking with your surgeon to see what he/she suggests in terms of treating the scar. Hope this helps and hope you are doing better.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Yannis Alexandrides, MD, FACS · Answer

The proper management would include things like application of silicone gel and things like cortisone injection or laser treatment may be beneficial.In extreme cases, scar excision could be another option.

Rohit Jaiswal, MD · Answer

Thanks for the question and photos- sorry you are undergoing this complication! 
Necrosis after liposuction may be due to either overly aggressive/superficial liposuction (may be higher risk with VASER liposuction) or due to overly tight compression garments as your surgeon noted. The treatment is usually just local wound care until there is full healing. 
Deeper wounds, as you have seen, can take longer and require more care and follow up. Closely monitoring these types of wounds are essential to make sure they heal correctly and that additional complications are avoided. There is not much one can do in the meantime to keep scarring down- at this point the priority is usually just getting to a closed, healed wound. 
After a period of usually one year, scar revision may be performed. This can involve cutting out the scar which may be wide and flat, and then restructuring it so only a straight, thin line results. However, again, the priority is usually to get a healed wound first. Other modalities like laser treatments may also help in getting the best scar possible. 
Close follow up with your surgeon is important to making sure the wound is healing properly. 
Best wishes, 
Rohit Jaiswal, MD
Plastic Surgeon
Las Vegas, NV

Robert M. Tornambe, MD · Answer

Uni Vee.   So sorry you are having this complication. It appears that the wound has healed, and careful scar care, including massage of scar and application of scar cream is needed for the next several months. Ask your plastic surgeon to advise best options. Good luck.

Aldo Guerra, MD · Answer

I’m sorry about your skin necrosis from liposuction. This is not common, but it happens especially with laser or ultrasound techniques. See a specialist on your wound care.

David A. Sieber, MD, FACS · Answer

Thanks for the great question and I"m sorry this happened to you. What you have looks like a burn from the liposuction and not compression necrosis from your garment. Using local wound care recommended by your surgeon this should heal up with minimal scarring.Best,~Dr. Sieber

David Graham, MD · Answer

For now you just want the wounds to heal. Keep the areas clean and let them rinse in the shower. Apply antibiotic ointment or vaseline daily. Also, follow closely with your surgeon as some areas of tissue may need cut away. Once the wounds are healed you can then address scarring modalities like laser, silicone gels, etc.

Paul J. Leahy, MD · Answer

I'm really sorry to hear that happened to you. I wonder if you had any laser treatment during the liposuction component of your surgery (like Smartlipo)? That looks almost more like a burn, and I think you would have felt pain if it was the compression garment causing that. For now, I would keep that site as moisturized as possible and do scar massage. Hopefully, the pigment will return in time. Best wishes.