Can I get my fat necrosis removed and a complete BBL revision? Who is the best surgeon that can fix my issues? (Photo)

Question

I had a BBL and got botched. My Lipo was to be 360, but I have a fatty pocket above my naval and my flanks weren’t touched.I have fat necrosis in my buttocks. On my left, there is a big hard spot in the middle the size of a golf ball. On the right, there is a hard spot that is smaller. What is the technique to get my fat necrosis removed? Will I need a large incision and where? Will I be able to get fat put back as I actually like the size of my buttocks. Who can help and is the best?

Kenneth Hughes, MD · Answer

The necrosis can be removed; once it heals, fat can be harvested to reshape your buttocks and fill in the dents. Having the BBL done a second time is an option as long as you have enough fat to be transferred. The revision implies that there is less fat than the first time, and scar tissue will make the surgery much more difficult on the surgeon.

Zoran Potparic, MD · Answer

It is very hard to comment on your result without before surgery photos! Irregularities after liposuction are frequent and may be addressed when result is mature (1-1,5 years after initial surgery). Dimples, hard mass and other irregularities of the grafted sites are result of uneven fat graft resorption and survival. About 50% of fat injected in the time of surgery will survive after 8 and more months. The rest will undergo resorption, necrosis, scarring, formation of oil cysts, etc. All of this will reflect on postoperative appearance when result is mature (about 1 year after surgery). you have to understand that uneven resorption and healing of the dead tissue is out of control of your surgeon; it is inherited feature of fat and any other grafting (bone, skin, tendon, etc) and depends on the available blood supply in the grafted area ( recipient site). Survival of fat grafts equally depends of patient ability to accept and retain so large quantity of fat grafts (most patients want large butts) as surgeons technique and skill!  Once result of fat transfer is mature, it can be treated with combination of liposuction and new fat grafting of  irregular areas. Whether scarred areas (after fat necrosis) need to be removed or can be just shaped with liposuction and grafting will depend on individual presentation and judgement of the surgeon.
I would not considered your result botched but rather inherited complication of fat transfer seen in about 10% of patients undergoing BBL. Hope this helps.

Daniel Barrett, MD · Answer

Dear Cute6117,
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

Andrew Gear, MD · Answer

Fat necrosis is a very real complication after liposuction or fat grafting.  It’s a biologic process and can be very capricious. It doesn’t necessarily mean that you’ve been botched. Preoperative pictures would be helpful to know where you started. Once scarring sets into a grafted area like the buttocks, it can be tricky to completely remove without creating further aesthetic issues. See multiple surgeons who do procedure a lot and get more than one opinion.   The application of powered blending and infusion as developed by Dr. Simeon Wall may be part of your answer

Mats Hagstrom, MD (license on probation) · Answer

If you want us to address the outcome of a procedure you need to post before and after pictures. If you don’t have before pictures ask the surgeon to forward the ones they took before your procedure.

It looks like your abdomen, love handles and waste were relatively well treated. The term abdomen 360 does not necessarily include the back. I typically use the term “full torso“ which technically includes upper abdomen, lower abdomen, love handles, waist, back and under arm area to describe the full treatment of the torso.

Patients to have mild skin laxity often have some hang after belly button. You’ll see that this area probably improves significantly if you pull on the skin above your belly button making your skin tight.

Do you have some cellulite and is often is made worse from fat transfer. In a perfect world this is discussed during an in person consultation.

Areas of fat necrosis can be excised. The size of the incision depends on the size of that necrosis and how deep it is.

Well you may not be perfectly thrilled with your outcome it is a fairly good outcome, probably better than average and it is certainly not botched.

It’s up to each individual to review in detail before the surgery exactly what areas are going to be included and not included in the procedure.

The term abdomen 360 does not imply including the back though for some providers it does to some degree.

I do not recommend having fat transfer at the same time as excising fat necrosis. That necrosis should be excised first and then patients should be allowed to heal fully for a minimum of 3 to 6 months before having another procedure.

Follow up with your provider and discuss your concerns with him or her.

Best,

Mats Hagstrom MD

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