What treatments are recommended for this level of fibrosis? (photo)

Thank you for your question and photo. Based on this photo, you do not have fibrosis, you have poorly done liposuction. You have over suctioned areas and unnatural grooves. Since you have internal scarring from your liposuction, the VASER is a reasonable approach. If you would be my patient, that is what I would use. I do have extensive experience with the VASER (over 15 years) and in my body sculpting practice over 50% of my patients are redos from other surgeons' poor outcome. Not everyone who use the VASER can use it appropriately, as you can read on this forum and other sites. I wonder, why didn't your surgeon use the VASER initially? Maybe they don't fully understand what it is capable for?See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

A combination approach would give the most improvement. I recommend first trying body treatments such as RF like Venus Legacy/Exilis Ultra, Inmode Forma/Contoura with shock therapy Z-Wave/Cellutone/Evive to break apart scar tissue. A VASER HI DEF procedure can be done for more contouring and smoothing, if you're a candidate. I use VASER HI DEF with ThermiRF/J Plasma/Renuvion/InMode BodyTite and fat grafting to get the most fat removal, skin tightening, contour and definition. This combination will give you the most toned result. I recommend getting a formal evaluation with a hi definition physique expert. Best, Dr. Emer

Vaser liposuction is not the best alternative, and adds unpredictable heat into the equation, which is unnecessary. SAFElipo will break up fibrosisand smooth your previous results. 

Dear Chloenom,
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

This can be corrected using high definition VASER liposuction. The definitive correction for liposuction deformities requires the advanced technology of ultrasound assisted VASER liposuction. As an official trainer of VASER liposuction, I encounter suboptimal liposuction outcome referrals weekly. VASER liposuction has been the only modality that has consistently corrected liposuction caused deformities. VASER liposuction ensures a smooth contour regardless of severity of contour irregularities by virtue of being able to remove any and all remaining fat comprehensively and uniformly. Finally, when skin redundancy irregularities are observed, Renuvion technology can be simultaneously applied to tighten your skin to optimize your overall contour outcome. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing. 
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Fibrosis is a term generally used for describing excessive scar tissue formation or hardening of tissues from reactions to things like radiation. Your primary problem is uneven and excessively performed liposuction not scar tissue formation or fibrosis. Too much fat was removed and it was done so in an uneven fashion. There is no good treatment for your situation. Some correction of contour can be created with revision liposuction. Generally speaking it’s hard enough to maintain a smooth even contour doing liposuction. Starting with an uneven contour and making it even is many many times more difficult.The use of VASER adds an order of aggressiveness and adds uncertainty to the outcome. VAS ER is ultrasound assisted liposuction. During this procedure the actual liposuction is simply traditional liposuction with a ultrasound pre-treatment of the fat. The surgeon cannot feel or see the impact of the ultrasound treatment during this part of the procedure. They had to rely on experience and experience only in regards to the impact of the ultrasound treatments.Later when the fat is removed with traditional liposuction if the ultrasound pre treatment was done Excessively then significantly more fat will be removed quite quickly.This device has been available for Over 20 years. I have used it many times. To me VAS ER has zero advantage in correcting irregularities and can without question make things much much worse.I would venture to say that the worst botched cases I see seem to all have been done using this device. That’s not to say that a VAS ER is a bad piece of equipment. It is one that can give great outcomes but can also lead to devastating disfigurement as well. I do think it adds a level of uncertainty which is not something you want.In your case there are many things that were done wrong. One is to treat the lower abdomen only but at least you’re upper abdomen isn’t disfigured. Defect was removed and evenly. This is the primary and the biggest problem. Lastly too much fat was removed. Since too much fat having been removed is part of the current problem removing more fat is really a potential risk for making your situation worse.if the Fed can be removed in a complementary way to create a more even contour then the outcome can be improved even though in one way things are getting worse by taking out more fat but at the same time and more even contour is created.Making the fat layer thinner of your lower abdomen only will create more of a mismatch between your upper and lower abdomen. I’m guessing your upper abdomen was intact. Because of this in an ideal world the upper abdomen would be treated during the revision surgery to try to match the lower abdomen but without the irregularities and maintaining a smooth even contour.Because of this in an ideal world the upper abdomen would be treated during the revision surgery to try to match the lower abdomen but without the irregularities and maintaining a smooth even contour.My personal approach to this would be to mark off every small area that was it either under or over treated.then use a very conservative small cannula and carefully treat the areas that have slightly more fat than the adjacent over treated areas.marking these things off before surgery is the only roadmap the surgeon asked to go by during the procedure. Once numbing solution(tumescent solution) has been placed the true contour will be distorted and it’s difficult to tell what area needs to be corrected.There is no good alternative treatment.If you had skin laxity and muscle separations from previous pregnancies and converting this to a full tummy tuck would be a great option.That does not appear to be the case for you.My recommendation is to be very cautious moving forward with revision surgery. You need to find the one plastic surgeon in your community who has more liposuction experience than anybody else. Someone who is obsessively meticulous and cares more about patient outcomes than their vallet. Find that provider and you can have some improvements with minimal chance of things becoming worse.I’m sorry to be so bleak but I speak from experience.my practice is devoted exclusively to liposuction and fat transfer procedures.I tend to set expectations fairly low so in that sense take thisadvice for what it is.I would suggest not wasting any money and secondary treatments like lymphatic massage, radiofrequency treatmentsor any other nonsurgical options. I would avoid using energy devices like VASER, J plasma/Renuvion,bodytite etc.I’m sure other surgeons will have different opinions about this. Those who are big fans of the VASER see this as the holy Grail. Maybe that device is in their hands but I personally see mostly bad outcomes come from its use.I’m going to assume that you went back and spoke to your initial provider.it’s important for that person to know the type of outcomes they’re creating so that they can either stop doing liposuction or at least try to improve their technique so others don’t have to live with this. I suggest you set up numerous in person consultations with experienced board-certified plastic surgeon is in your area. You’re looking for that one person who loves doing liposuction and is really really good at it. A fair number of plastic surgeons don’t like doing liposuction.Best, Mats Hagstrom, MD