Neuralgia and scar tissue post-liposuction. Will a revision make it worse?

Question

I had lipo in my abdomen and flank areas about 7 years ago. I never got the flat results I was hoping for--I have some firm lumps that may be scar tissue as well as a dent where too much was removed. I've tried lymphatic drainage, warm sculpting, Sculptura injections. Nothing worked. I'm considering a revision BUT Ive also had persistent nerve pain (stinging, burning) since the surgery. Is post-lipo neuralgia common and will a revision make it worse?

Justin Yovino, MD, FACS · Answer

Sorry to hear about your situation. Revision liposuction is a more challenging procedure than the initial liposuction for many reasons. I find that although some irregularities due to excess fat adjacent to too little fat can be improved with additional liposuction they typically don’t go away completely. A dent can sometimes be addressed with targeted fat transfer using fat obtained from excess areas. If there are considerable irregularities, no significant fat available, and excess skin, then a tummy tuck may be the best option. As for the pain issues, more surgery, especially liposuction may result in worsening of the symptoms. With all that said, it’s best to have an in-person consultation to go over your anatomy and goals.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took. Without including pictures we can’t make an assessment. Revision surgery is definitely not going to improve nerve pain for the formation of scar tissue, and can make these conditions worse.
You may or may not be a good candidate for revision surgery. Without seeing images, we can’t really address your concerns, and I don’t think anyone will be capable of giving you useful information based on the limited information you provided.
Generally, speaking revision work is many times more difficult than primary Liposuction. Patient should consider Liposuction a Permanente irreversible body contouring procedure. When done poorly, it is challenging to improve on the outcome. The most important decision is choosing the right provider in the first place. I recognize that that is a bit late for you but for others reading this post, I want to encourage you to be more selective when it comes to choosing Liposuction providers then you think necessary. I recommend patients have multiple in person consultations before choosing a provider. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing the best results of a provider’s career is insufficient to get a clear understanding what average results look like in the hands of each provider. Recognize that doing consistent quality Liposuction far more difficult than most people realize. The number of plastic surgeons who have mastered the procedure are in a small minority. 
Improving poorly done Liposuction results is generally done with Revision and Liposuction, fat, transfer, or a combination of both. Sometimes improvement can be had by converting the procedure to a skin tightening operation like a tummy tuck for the abdomen or a neck lift for the chin and neck.
Considering that revision work is more complex and difficult than primary Liposuction importance of finding the right provider cannot be over emphasized.
For second opinion, consultations patients should come prepared. This includes getting copies of your before and after pictures and a copy of your operative report from your previous provider.
Best,
Mats Hagstrom, MD

Neuralgia and scar tissue post-liposuction. Will a revision make it worse?

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Neuralgia and scar tissue post-liposuction. Will a revision make it worse?

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