Lipo above belly button, below rib cage? Will this address fibrous areas or should I try other options?

Question

I had a tummy tuck 7 years ago. Originally surgeon did not lipo upper abdomen below rib cage. He said it's too fibrous. But now my stomach protrudes noticeably. Is there any procedures for fiberous areas? Coolsculpting, Ultrasound or Sonobello maybe?

Alan Gonzalez, MD, FACS · Answer

Hello @jkdnys, thank you for your question. To make an informed recommendation, more information is needed. A consultation is vital to establishing a surgical plan that meets your needs, meets your expectations, and takes into account what is realistically possible. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Martin Jugenburg, MD · Answer

Hello, thank you for your question. If the area was too fibrous, possible vaser can be added to help break down that fibrous tissue to reduce the risk of injury or perforation to the area.

Justin Yovino, MD, FACS · Answer

Your best outcome comes from thorough and complete liposuction of that area. I find that this area of the body is commonly neglected by a lot of surgeons. Visit with a plastic surgeon who is very savvy in liposuction. Feel free to set up a consultation with us.

Sean Arredondo, MD · Answer

One of the best adjuncts for liposuction in this setting is VASER. I feel like it helps break up the fibrotic areas to get that stubborn fat out! Other adjuncts such as cool sculpting or eon can help as well. They have no down time, sometimes require more than one treatment. Generally you will not have as dramatic results, but the noninvasive methods are great options for the right patient.

Daniel Barrett, MD · Answer

Dear jkdnys,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Zamir Paez, MD · Answer

Using the latest technology available such as the renuvion and retraction combined with Vaser and Microair make the results optimal, avoid flaccidity, decrease fibrosis and you will have the abdomen you desire. We would like to review your case, you can contact us in my profile and we will explain the process.

Camille Cash, MD · Answer

There are techniques that can be used to improve fibrous areas.  Typically liposuction of the abdomen is not done in conjunction with a tummy tuck due to concerns for blood supply to healing tissues.  I encourage you to visit with a board certified plastic surgeon near you for a consultation and evaluation of the area.

Douglas Taranow, DO, FACOS · Answer

EVERYONE gets fibrosis (scar tissue) anywhere that surgery was performed.  The questions is, is the upper abdominal curve due to external fat (subcutaneous), or visceral (internal) fat along with a convexity (outward curving) abdominal muscles.  A physical exam would answer these questions.
If there is adequate subcutaneous fat, then liposuction will help (even if there is fibrosis).  If visceral fat, then diet, exercise or revision abdominoplasty is in order.
Dr. Taranow

Richard R. Orr, MD · Answer

I did exclusively tumescent liposuction from 1991 to 1998. I found the upper abdomen to be too fibrous to have a good result with Tumescent. When I was trained on, and began using ultrasonic liposuction, (in its many different brand names!), I found the upper abdomen was no longer a problem. I would avoid CoolSculpt. Initially we would only liposuction the deeper fat and leave the top superficial layer of fat alone, much like a "pillow-top" on a mattress, to minimize ripples and contour problems. CoolSculpt only attacks that superficial layer and I have seen MUCH more of a problem with irregular contours and feeling lumps of scar under the skin from CoolSculpt. Ultrasonic, under many different names, and laser, again under many names, will effectively attack that tougher fibrous layer in the upper abdomen. Be sure to find a board-certified plastic surgeon who does lots of liposuction, and look at their before and after photos, and get referrals from other people, and you should be fine with your upper abdomen.

Mats Hagstrom, MD (license on probation) · Answer

Surgical treatment options should be based on having a clear understanding of what the underlying problem is.
In other words the first step is to make an accurate diagnosis or assessment.
For this we need at a minimum to see quality before and after pictures. If you don’t have proper before and after pictures and ask your surgeon to forward the ones they took.
A quality assessment especially after having had a surgical procedure really requires an in person consultation with examination.
The most common reason people have a bulging abdomen after a full tummy tuck is because of excess visceral or intra-abdominal fat.
I suggest you follow up with the surgeon who did your procedure or scheduled a few second opinion consultations with other local board-certified plastic surgeons in your community.
For a second opinion consultations patients should ideally come compared to bringing with them before and after pictures and a copy of your operative report. those should all be available to you if you contact your previous surgeons office.
Alternatively you can try re-posting with pictures if you want us to make an assessment and recommend treatment options.
Your description is not sufficient for us to make an assessment.
Best,
Mats Hagstrom MD

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