BBL 19 Mo PO W/ Dr Moises Salama - Miami, FL

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*Treatment results may vary

Hello Everyone. My name is A and I recently...

Hello Everyone. My name is A and I recently relocated to Boston, MA. In February 2012 I got the Brazilian Butt Lift with Dr Moises Salama in Miami, FL.

It was painful and recovery was very stressful. I won't rehash all of the details because I was cranky, moody, etc and don't want to think about it. I do know that I would and do plan to do it all over again, so it must not of been that bad.

I'm posting pre and post op pics. I guess I will document my journey in the caption of those photos.

I'm currently aspiring to be a Duran Dolly and am researching her through Real Self. I thank all of the Duran Dollies that have shared their experiences on Real Self. Its actually what made me go ahead and come back to share my experiences with Salama, Nomie and Ruben.

Cost Breakdown ~ $8700
Approx $6500 with Salama (I think)
- this included the operation, anesthesia, garment, lower leg compression, post op massages
Approx $200 for meds (might be high but I really don't remember)
Approx $1000 post lipo massage (They were $80-$100 each once I returned home. DO NOT FACTOR OUT THIS COST IF YOU WANT TO AVOID LUMPY LIPO. My lipo looks great compared to some friends because they didn't do post lipo massage eeeewwwww can't be me).
- $1000 Travel & Post Op Care (again I am just rounding.)

Got a call, will update more later.

- A


I should have just said I'm ready for round 2, still researching surgeons.

I may go back to Salama as he agreed to some minor revisions. I have to decide on it because this will be my last time.

Other than a round 2 BBL, I wish for Latisse, Boletero or Restylane in my eye trough and thats it for now.
Pics will come soon, I promise!

Marked up by Salama getting ready to go under 2/8/2012

I needed the lipo much more than buns. I really got the BBL because I could get both for same price as lipo compared to other quotes. I didn't want it to look like I got my buns done, just wanted some roundness!

Q & A: Why go to another surgeon?

Someone asked this question and I figured I'd answer it here because I will get the question a lot. Even before I share my story lol.

Q: "If you liked it and it still looks good why are you going for round two with Duran ? Sorry to ask but im actually trying to decide if I should go with salama or not."

No problem and thanks for asking. It takes an artist to give you the dream body you want and although Salama is an artist, I've fallen for the variation in art produced by Duran. She can do shelf booties and upside down hearts from what I can see. HUGE Butts & perfectly rounded and proportioned medium butts. I LOVE that she can do that because I'm not aspiring for a HUGE butt. Salama actually gave me a smaller garment to compress my butt so it wouldn't be too big. I don't regret it AT ALL.

I like that I will be able to share my butt AND hip goals with her. I also admire her hip to waist ratio A LOT! I'm a huge fan of curves, so of course her hands are a true blessing to me. I don't really have hips and she can give me some. Salama's projection is great, but I'm after curves and sculpting. At the time that I saw him, he didn't cater to the hips. I'm not sure if this has changed or not.

Salama has agreed to revisions so its actually better financially for me to go to him. He's closer too. Another bonus. Duran is on my mind though as I prefer to be sculpted than revised. In addition to being affordable, unlike many other surgeons, I see a lot of her before and afters, I see the results of other women years post op, and since I've been through this before, the post surgery brusing seen in many of her reviews and Instagram tells me a lot about her artistry. Its hard to explain. I guess once you go through it or really savvy up on the process, you can tell what the surgeon does differently and what they focus on in the lipo areas. So far I just love her work. I STILL don't want a huge ass (although I have a nice one haha), I just want that jaw dropping waist to hip ratio and a SMOOTH transition into the hips. I want it smooth like a slide, or as close to that as possible. I'm not a fan of sharpness from too much shelf without some hips to smooth out the curve. I don't look like that, but at some angles it gets really close!

I'm still deciding on what to do for round 2. I'd prefer to go back to Salama because lord knows travel with recovery is a pain (plus its better financially), but if I have to travel out of the country to Duran in order to achieve my wishes, I will! IF Salama assures he can deliver based on my wish pics, then I'm all his. I just have to figure this all out and honestly am not into the communication behind it. If I could have it my way I'd just walk in and be done, but I have to be sure I'm communicating what I want which I didn't the first time. Right now though I'm drooling over Duran's results and how caring and attentive she seems to be. I can tell from the variety of her work that she is delivering based on each client's preferences. EVERYONE can get a shelf (based on my research I see a lot of surgeons are good at this, Salama is a beast though), BUT everyone isn't getting them Duran Curves. The ones that are, are paying at least $12k in the USA. This tells me that the placement of fat injections (during bbl) is an art and either you have the aesthetic eye for those curves or you don't and Duran has it for a really good price.

Last thing, geographically, the DR is filled with curves. If you see perfect curves on a variety of body types growing up, you likely with have a better aesthetic eye for them. Just like knowing how to layer a woman's hair to define her facial features, these surgeons need to study various women and learn how to place that ass on her lower half to compliment and transition the top.

Its all a personal preference and not a diss of his work. I hope thats clear :-)
My goal is to make the best choice.

P.s. Some of us are addicted to surgery & treatments like tattoos. From HCG Injections, to laser lipo, to laser hair removal, to botox, I have tried or have it on my to do list to try them all. I've spent thousands at cosmetic medical spas. A part of me I guess is just never content. I have no loyalty to my hair or nail stylists either. If another stylist is producing better results, I'm going to try them out. Just a tad bit about me so that you know where my mind is. I really don't want to seem like I'm throwing shade at Salama or dissing his work, I'm just peculiar. :-)


I guess this was a couple days or so post op

I wore the diaper to prevent the drain cords from moving around because they hurt!

I wore the diaper to prevent the drain cords from moving around because they hurt!

Before & After

Before and after pic of my right side

Before, embarrassing

More Before & 2 weeks after

All of the before & afters so far are 2 weeks post op.

Revisions, Errors, Imperfections....

When I come back I will post pictures of things that need revisions (Salama agreed to them and all I'd need to pay for is travel expenses and anesthesia). I believe EnjoySelf also needed revisions and went for round2 with him to correct. Honestly, I've sort've lurked her review for a while to decide what I want to do. Salama does good work, but with the opportunity to fine tune it....makes me wonder what he produces, may look jaw dropping ;-)

I have some hemosiderin staining (i guess this is light blood clotting under the skin) on one of my inner thighs which was lipo'd also. I haven't been treating it because it fades over time and traditional scar creams lighten the area verses treating the scar, but still looks bad today. I'll post photos of it also.

My 2 cheeks unfortunately are not shaped the same. I'll post photos of that too. Its not obvious, but I'm very very very conscious of it and no matter how unobvious it needs correction. Its only not obvious until someone notices. Once its pointed out, its pointed out. Over the past year I asked my friends and they agree with me, but they don't notice it as much as I do. Maybe because I actually see myself naked every day when jeans, leggings and leather skirts aren't shaping me.

These non-perfect things are the risks we take, but I don't hold it against salama because he was understanding, caring and agrees to fix them. I'm an understanding person also and didn't hold it over his head that it isn't perfect although I wish it were -_- I've seen a lot of surgeons for all sorts of procedures on RealSelf tell their clients they'll have to pay for full procedure to fix. So this says a lot about Salama that he agrees to fix.

Due to the above, I HAVE to return to this procedure for revision so I'm figuring I may as well go all the way and do a round 2! Who knows, I may settle for revisions because I do look good, but again if I have to go through it again why not look BETTER and go ahead and get dream curves. I chose salama first because I knew he'd give me some ass with success for sure whereas the other curve doctors were not at the time. If only Duran was around marketing on RS at the time I'd have gone to her. Oh well. The size of my ass is out of the way, next on to perfecting these small errors and getting my waist to hip ratio on point!

My original review before I had a tantrum and had it removed (Privacy Related)

Here's a link to my original review of salama. Unfortunatley there are no pictures.

In a nutshell, I had a temper tantrum while recovering and have my account deleted. Some girl got my real name through one of the drivers that cater to EPS and she said my name on here. LAWD HAVE MERCY I WENT OFF! I think I was the first person on this site to go off like that LOL. Its funny now, but when someone strikes a nerve the 1st week post op and you are drugged up and can't walk or even roll just go off!!!!!

Here's my original review. There should be measurements and what not on there. I have a new body now so I've forgotten all that old stuff (original measurements and weight, etc).

P.s. I didn't even tell the girl my name

P.s. I didn't even tell the girl my name!!!! The driver just said he has to get the boppy pillow to me and next thing you know she's on here saying hey are you "GOVERNMENT NAME" ??? people dont have any discretion and are so ready to make friends that they don't realize PRIVACY comes FIRST! I'm still a little bent out of shape about that. lol

Decided I'm sticking with Salama! HE BEEN DOIN HIS THANG!

I'm so happy that I was patient about my touch ups because I don't know what changed in 2013, but the 2013 Dollies are phenomenal! I still love Duran's work, but I'll stick to what I know since I'm confident that as long as I *communicate* what I want from him, I'll be great. His curves have improved and I am here for it!

I'm going to email Nomie & Ruben ASAP to see about getting in.....soon. Cuz I'm thirsty. Probably more thirsty than the first time.

I was so thirsty to get in and out the first time, that I wasn't communicating properly! I thought I was, but now that I'm a vet I know better! I HAVE TO BE CLEAR about the results I want to see. I'm marking up my wish pictures with a pen (like he did me before the sx) so that Salama clearly sees what results I want. Lucky for me, my wish pics are another Salama Doll that is almost a year post op and she had a similar original shape, so I know he can do this!! I love how her ass fluffed out and all! I swear, once you've gone through it once, you know what to look for beyond a 2 week post operation picture. Those ain't nothin. My waist has shrunk TWO inches since my 2 week post op photo and I eat fast food mostly (not proud, but its the life I live). That proves that lipo swelling can last for up to a year.

Thank you to all the Post Op SalamaDolls who shared pics and their journey. Helped me out so much! I swear!


Before & After

The after pics were taken 11/3/13
Fluffed & Dropped 19 months post op

Pics of me right now

19 months post op with salama

Before & After, 19 Months PO

(see miss shaped inner thighs)
Salama agreed to touch up

Residual fat

The arrow is pointing to some residual fat. My stomach was never completely flat under my belly button after surgery. It's ironically is where fat likes to go to as I gain weight :-( sad face

I emailed Nomie & Ruben today

I asked what they need from me to quote me on what I want done. In 2012 Salama agreed to revisions & I'd only have to pay for anesthesia & hospital, but I'm not sure if he can get me what I want with a simple touch up. I hope so! It's not that huge of a difference. I do want my upper back lipod all over again and I want as much abdomen & waist fat as he can get removed. I might have him put it all in my butt this time. Just depends if he and I can agree on my wishes. Even if I have to pay a little extra I want it done! Stay tuned.

Hemosiderin Staining

I have a hideous scar on my inner left thigh that I haven't been treating because "it fades over time." (-_-) 19 months later and it's still here. As an African American woman, we jump on scars right away because its the only way to stop it from getting dark. Unfortunately by the time I even had a name for the type of scar it is, it already got too dark (-_-). Luckily it has faded to some degree, but since I saw it start around 2 weeks post op and get darker and darker, I believe that with some EDUCATION AND ATTENTION, the staining could have been slowed down or SOMETHING before it got this bad (-_-).

So I did my own research on hemosiderin staining on real self & a doctor said vitamin k oxide will reverse the staining & expedite healing. A whole other doctor recommended DMSO plus a bleaching cream. So I looked into them and was confused as hell.

HOWEVER, I went to good ole eBay and typed in "Hemosiderin Staining" and viola. 2 products with these ingredients popped up. DMSO comes from trees and allows ingredients to get below the external surface of skin. A version of it is in Amerigel Premium Care Lotion, Maximum Strength. So I ordered it for $14. Biopelle Auriderm Post Op gel has the Vitamin K Oxide. I got it for $19.95.

I can't wait until they arrive to see what happens.

Here's a pic of the scar tonight. Ill post another one 1 month after. If this works.....I'm going to be happy but trust that I will call Salama to tell him I know full well he could've figured this out a long time ago. If I did he definitely could have. Black skin & scaring is not THAT complicated. When you act fast on it, the darkness doesn't get a chance to set in. But I'll stop preaching because this stuff may not work lolol.

Got my quote from Duran & Salama (Round 2)

Salama quoted 1500 for revision & 5000 round 2. Duran quoted 3700. I'm leaning toward Duran and it's not about price....I just love her heart shaped booties and already have Salama's shelf. Plus Duran is more artistic. I'll decide today. Smooches Dolls.

Treating my hemosiderin staining

I obtained all the products I mentioned & am terrible with using them religiously so I can't say if they work well. The auriderm is AMAZING for bruises however! I got a bruise from a fall and it never turned purple thanks to auriderm. I will be ordering a lot of it for round 2. :) I went to Salama for Round 2

And due to embarrassment am reviewing it under another account. I got burns. Everything went ok round 1, just needed revisions, then round 2 I get burned. Once I build the courage I will post photos on the round 2 review. These burns are not small, but they are healing. Salama says that in 4-6 weeks the burn wounds should close. So far it's been 18days and only some of the burn wound has closed. By some I'm talking 15%. Which I'm grateful for.

I really regretted not going to Duran once I saw the burn, but another lady had a life threatening experience with Duran & CIPLA the same week of my surgery. I also know 2 other people that experienced life threatening events that week (not with surgery). Maybe that was a bad luck week for the universal energy. I'm just happy I'm alive and have hope my burns will heal.

NOTE: my score is based on round 1 for this review. Please find my round 2 review.

I am ignoring all results related questions

I have a tendency to go off snappy and am trying to avoid that so I'm ignoring results related questions. I don't know what is wrong with the pre-op crowd, but despite me having a whole round 2 review focusing on my burns I'm only getting comments on this review. I guess it's pictures. If my abdomen didn't look embarrassing like a PIZZA I'd post photos here of it and I likely will eventually.

For now don't ask me did he give me the results I want anyone with common sense should know the answer is NO

Hemosiderin Staining

I'm using Amerigel lotion for this. I will use it everytime I change my wound dressings.

Here is a link to the product and it's claim to help fix hemosiderin staining.

I originally came across this product while researching DMSO which allows product to enter the bloodstream thru skin. Somewhere something suggested DMSO plus other agents that may break down the iron.

I'm a bit scared to try DMSO right now as there aren't any clear instructions on how to use it. Plus I read in a few places to use DMSO plus lemon, other sites say plus hydroquonine and others say plus auriderm.

I'm going to commit to using this 2x per day for 30 days since I already have the product at home :) IF it's effective, I will go ahead and order pure DMSO and add a small drop of DMSO to any hemosiderin stained areas to see if it speeds up results.

I had a real round 2, not a revision.

A revision is not a round 2

It's so hard for me to look at my burn

If I could drink I would take a shot of tequila before every shower that I take to wash off the cream. I have to wash off the cream to reapply new cream. 2x per day.

This morning I started scratching the white protein (fibrinous exudate) to try to get it to go away. The white part slows down the healing. The pink areas are healing faster than I thought. But the white slows it down.

Some pink parts stick up thru the white like a pimple. It's very unsightly & creeps me out to see that my skin layers have even burned away.

Lymphatic Drainage Massage

Is it just me or is Salama's office the only place that you can get an aggressive lymphatic massage???? I mean.....per google , YouTube , and the description of it on EVERY massage site.....the massage is emphasized as gentle.

I recommend that EPS create a description of the massage they recommend so that out of state patients can give it to their masseuse.

My new masseuse recommended we wait until my lipo heals to massage it 0_O. She doesn't understand that if it isn't massaged ill be walking like the hunchback of notre dame for a long time. It's harder to massage out the tightness now than after it heals. I know this from some tight areas I had during round 1.

Hyperbaric Oxygen Chamber

Ok! So a lady was just saying that she can't believe salama didn't pay for my creams. I can't either, BUT he did pay for a daily treatment that I had in Florida.

Starting 3 days post op, my friend drove me 1hr to an oxygen chamber where I breathed in 100% oxygen for 90 minutes everyday. The Cosmosure insurance for $160 covers this I think but salama told me not to worry about it either way. If they don't cover it he will. So he does have a heart. Yes I am livid at these burns but don't want to completely throw him under the bus because he appears to be making effort. We text almost every day also.

Anyway I will review my experience in the oxygen chamber but want to say that it REEEAAAALLLLYYYY expedited the healing of my body in general and salama says it made my burn shrink. Because I still had the brown external layer of skin that you would see on any burn, I can't really tell if it made magical results on my burn wound. I can say that I felt a lot less pain every day that I went to the chamber.

You know how in the movies they make patients lay down on a bed and slide it into a tube looking thing? Yes that's what I went through Monday-Friday for 10 days post op. You can't wear weave, lashes, lotion, deodorant, makeup or have nail polish that hasn't dried for 24hrs..... Needless to say I was ugly as hell to myself. Adding to my borderline depressed state of mind.

Santyl & dark marks on my abdomen

Yesterday salama and I were texting and I told him that I read somewhere online that silvadene deactivates the enzymes in the Santyl. The santyl is critical to removing the white protein that's slowing down the healing of the wound. He suggested I use the santyl only in the morning then at night use the silvadene. This morning I put a thick amount of santyl on my wound then covered it with Suran wrap. At night when it was time to clean the wound I noticed more pink. YAY! So now I don't think it's a good idea to mix the creams at all. Tonight I dressed the wound by applying santyl on the white areas and adding silvadene (covered by gauze on the pink areas only so that the santyl was only covered by the Suran wrap) and in the morning we will see what happens.

Other than that I am noticing dark discoloration on my abdomen where I wasn't burned. My whole stomach looks AWEFUL. It is either a 2nd degree burn OR dark discolorations. He says the discoloration is hyper pigmentation, but I swear it's following the exact sensation and stages as the hemosiderin staining in my thigh.

I guess all I can do is try to take treating the staining on my thigh seriously in case I need to do the same to my abdomen.

Salama ordered some hydroquonine for the stomach discoloration because he thinks is hyper pigmentation.

It really sucks that I feel like I'm scarred up like some alley cat hood rat. Like mentally I feel like I'm all scraped up and will be scarred up so what man would be attracted to me. I just wish these doctors understood that for some black women in our mind our value declines with the more scars we have. I might send a copy of dajango to salama so that he can understand why we are so sensitive about scars. I understand that scars are inevitable, but black ppl don't LOVE cocoa butter for nothing. It's that the scars can be a sign of class level just like a car can be a sign of class level. I'm rambling and may get chewed out but someone somewhere understands. I just want salama to take treating the scars more serious. I've had hemosiderin staining for 2yrs and almost 3 months now and he still doesn't have a recipe to cure it.

So far the only comparable burns I've found are 150mmlover

So far the only comparable burns I've found are 150mmlover. Hers are worse based on what Salama said, but I haven't seen any other burns anywhere near mine. HourGlassBBL also has a burn that looks like it was intense. She gives GREAT tips on treatment. Her burns were not as bad as mine, but she had to treat it with Silvadene and dress the wound also. She went to a wound care specialist and it healed well.

Pretty much if the lady was burned and isn't talking about prescribed creams or dressing the wound then her review of her "burn" is probably first degree....unless she is leaving out the details regarding the severity of the wound which is possible because it's hard to come out about them.

I was the last surgery on a Friday

Thought I'd share that :)

If I posted the photos of my burn wound I GUARANTEE women would cancel like crazy

I'm not full of spite so I'm holding off on the photos. It happened before and happened to me so I'm sure it will happen again. That said, I'm just going to post photos after it heals to show the progression as it may be helpful to other ladies. I'm really private so until this heals I'm not comfortable posting pics. This burn is big enough that it may become a tattoo or identifying mark on me. My grandmother agrees with me that I should wait until it heals. That way no one can see the burn photos and know it's me if my abdomen in fact goes back to normal :)

How did I get burned?

Based on all the answers to these questions, burns only come from lipo with chemicals or heated machines.

I really don't know how I've been burned.

Do not lay on your stomach for more than 2hrs without waking up

Hello ladies. If you google "pressure ulcers" you will find a Lot of info on how wounds similar to burn wounds can occur.

Being fresh out of surgery your skin is very vulnerable. Laying on lipo'd areas for too long may be why I have a wound.

Make sure your caregiver wakes you up every 2hrs and has you walk around for 10 min like they instruct in the pre-op meeting. My caregiver round 1 was VERY on top of this. Round 2 I literally had to find the strength to walk to Walgreens for water bottles 8 days post op at 1am because my caregiver didn't do anything without me repeatedly asking for it. Yes she didn't wake me up to walk around not one time. I didn't emphasize it to her because I didn't realize why that's so important.

After the wound was discovered salama did say to stop laying on my stomach. At that point I used a LOT of pillows to lay on so that I was elevated off of the bed and no pressure was on my abdomen.

I do know that 2 days post op I only saw blisters with little discoloration. That was the day salama said don't lay on stomach. So I used a lot of pillows to lay on back with no pressure on butt. Then on day 3 after removing the cream he applied to the blisters the wound had turned dark. AND there was a new burn/wound on my back that was even deeper than my stomach which makes sense because I have HUGE boobs that carry a lot of weight.

In conclusion I can not say that salama burned me not can I say it's a pressure ulcer but I can say that you have to haaaavvvveee to follow all the post care instructions.

I wish I could've just stood up the entire time after surgery. Now I'm even more irritated with my decision on who took care of me.

I am not saying I have a pressure ulcer, just sharing info.

At most I laid on my abdomen for 3hrs the first few days following surgery. Because I kept waking up eager to take pain meds. I remember sneaking to take them because my caregiver was monitoring how often I took my meds. The pain was my alarm clock for sure so I never laid on my abdomen more than a few hours at a time for those first few days. I walked around quite a bit also because I wanted the swelling to go away quickly.

While laying down I also used a lot of pillows. The elevation of the pillows helped me get up and out of the bed without help.

Note I am also very top heavy. Laying on my stomach without pillows is painful to my breasts, surgery or not.

Skin necrosis & liposuction

Hyperbaric oxygen treatment is listed as an option for treating this along with skin grafting and other options. Infection is very common with skin necrosis if the wound is not debrided fast enough, including gangrene.

I HAVE SKIN NECROSIS - not a burn. It looks like a burn. Google images of skin necrosis and you will see that it looks similar to a burn.

I'm currently researching causes of skin necrosis with liposuction and have yet to see "pressure ulcers" anywhere. The stages I witnessed my wound go through are identical to skin necrosis.


I purchased this insurance for $165. I have about a week left in the policy. I do not have health insurance right now.

I am scared that I will end up with an infection and a $10k emergency room medical bill if this wound isn't debrided fast enough. Ladies please pray for my healing. If you are not the religious type, then please just put positive energy into the air for my healing.

I am using santyl for debriding. I want to be surgically debrided as this speeds up healing, but no luck with that so far. I've been using santyl for one week now. So far I haven't seen a significant change in the amount if white disappearing. I am told that in another 5 weeks this wound should close.

The pigmentation in the pink edges of my wound is returning so far. The pink is healing at rapid pace compared to the white.

Going back to Florida

Update: Salama wants me to come back to Florida this week to try to close the wound and debride whatever he can't close.


They have full studio apartments, condos, and you can even rent a room. Look for properties that are reviewed. There are lots of apartments going for 400-600 per week.

COBAN 3M Self Adhesive Tape - to shape waist

I notice that a lot of Durans dolls have this creasing in of their faja almost all the time. I am now using Coban on my wound dressings because the tape hurts my skin and the Suran wrap itches. It's very stretchy and I notice that on one side of my garment I have that indent that I see on Duran dolls where my Coban is. There's no dent on the other side because I have pads to protect my wounds on it. One day I will take a pic but I wonder if this can aid the faja in shaping my waist??

Skin necrosis

Just coming back to say that I don't know what has caused it and per Salama he does not know either. I am doing as much research as possible to identify the cause. All signs are pointing to aggressive lipo, but aggressive lipo can cause either burns or blood vessel damage which then lead to skin necrosis (per my research) so who knows.

I am a round 2 girl so there are chances that since I've had the surgery in the past, it made me riskier. However I waited 26 months to return for more work and my skin was fully recovered as far as I can tell but I'm no expert. I also have a history of smoking but I quit for my surgery.

I would like to know the cause of this complication & understand if it's a combination of things. I walked a lot. Day 2 I was up and walking around. I can't remember about day 1, I will have to ask my caregiver, but I know I was up and eating a LOT! Lol

I don't think I have any seromas.

I have a photo of my abdomen on the surgical bed after the lipo and there are no signs of burns or complication but per the description of skin necrosis I don't expect to see any.

What is debridement & types of debridement

What is debridement?
Debridement involves the removal of dead, devitalized or contaminated tissue and foreign material from a wound, and is an important initial step in wound bed preparation. Non-viable tissue is collectively termed necrotic tissue or slough. Necrotic material may appear as black or brown colored tissue. Where necrotic tissue is yellow and fibrinous it is often termed slough. When the tissue dries out and forms a thick and leathery texture, it is referred to as eschar.

Why does necrotic tissue accumulate in chronic wounds?
'Necrotic burden' is a term used to encompass necrotic material, non-viable tissue, exudate and high levels of bacteria. Necrotic burden tends to continually accumulate in a chronic wound since this type of wound is generally a result of an underlying and uncorrected pathogenic abnormality, such as diabetes or venous insufficiency. Often it is not possible to fully resolve these systemic problems, which makes effective wound bed preparation even more crucial to help facilitate wound closure.

Why is debridement important?
The removal of necrotic tissue by debridement is of great importance for a number of reasons. First, devitalized tissue in the wound bed will reduce the ability of the clinician to adequately assess the depth of the wound or the condition of the surrounding tissue. Concealed dead spaces could harbor bacteria and increase the risk of local infection. Secondly, necrotic tissue may also mask signs of local wound infection. Lastly, the presence of necrotic tissue is a physical barrier to healing and supports significant bacterial growth. Bacterial colonies, which are often present in necrotic tissue, can produce damaging proteases, which break down important constituents of the extracellular matrix and have a negative effect on the formation of granulation tissue and reepithelialization. Therefore, the process of debridement reduces wound contamination as well as removing cell debris thereby reducing tissue destruction.

Types of Debridement
There are four methods of debridement; sharp or surgical, enzymatic, autolytic and mechanical. Once the clinician has made the decision to debride, several factors can influence the choice of debridement method employed (2, 5). These include the size, position and type of wound, moisture levels, pain management, time available for debridement and healthcare setting. Moreover, in treating chronic wounds, it is important to consider the patient's overall condition when choosing the debridement method. In some cases, the use of more than one debridement method may also be appropriate.

Surgical (or Sharp) Debridement
Surgical or sharp debridement is the fastest way to remove debris and necrotic tissue from the wound bed. Surgical debridement is sometimes performed when there is an extensive amount of necrotic tissue in the wound. This is often the case when the depth of the wound cannot be judged or if there is widespread infection requiring bone and infected material to be removed (8). Other than being an efficient method, surgical debridement causes minimal damage to surrounding tissue, and minor bleeding following the procedure can release inflammatory mediators, such as cytokines, that can assist the wound repair process. Surgical debridement does however, have limitations. It cannot be used for patients with bleeding disorders or who are immunocompromised, The procedure may be painful, cause transient bacteremia and damage to nerves and tendons (9).

Enzymatic Debridement
Enzymatic debridement is the most selective method of debridement employing the use of manufactured proteolytic enzymes. When these are applied directly onto the wound surface, they work together with naturally occurring enzymes to degrade necrotic tissue.

Autolytic Debridement
Autolytic debridement is a process, which to some extent, occurs naturally in all wounds. Phagocytic cells (such as macrophages) and proteolytic enzymes in the wound bed, liquefy and separate necrotic tissue and eschar from healthy tissue. Wound dressings, which maintain a moist wound bed, can provide an optimal environment for debridement, as they allow the phagocytic cells to liquefy necrotic tissue thereby promoting granulation. Unsurprisingly, the process of autolytic debridement can result in significant wound fluid, which should be considered when selecting an appropriate dressing. Autolytic debridement is easy to perform and does not damage healthy tissue surrounding the wound. Furthermore, the pain experienced by the patient when using this method is minimal. As autolytic debridement occurs naturally, the process requires limited technical skill.

Mechanical debridement is a non-selective method that physically removes debris from the wound. Examples of mechanical debridement include wound irrigation, whirlpool therapy and wet-to-dry dressings. Wet-to-dry dressings are the simplest form of mechanical debridement (34).
These dressings cause mechanical separation of eschar from the wound bed once the dressing is removed. This can, however, cause the patient significant discomfort and damage newly formed tissue (35). Wound irrigation involves the use of a pressurized stream of water High-pressure irrigation removes bacteria and necrotic debris from wounds but could drive bacteria into soft tissue (4). Whirlpool therapy is another form of powered irrigation which loosens and removes necrotic tissue, debris and wound exudate. This is suitable for use in inflammatory wounds but not for those with fragile granulation tissue (36).

Why is an Extended Phase of Debridement ('Maintenance Debridement') More Appropriate than Single Intervention Therapy?
Until recently, debridement, whether it is done by surgical, enzymatic, autolytic or mechanical means, has been thought of as a single therapeutic step within defined time lines, While a single episode of debridement may be appropriate in acute wounds, with chronic wounds it is generally not possible to fully remove the underlying pathogenic abnormalities, therefore the necrotic burden continues to accumulate. It is likely that this accumulation of necrotic burden could, in itself, cause the failure of wound repair. Therefore, an important part of wound bed preparation is the recognition Of a continual removal of the necrotic burden throughout the lifespan of the wound. In treating chronic wounds, debridement should be viewed as an extended, on-going process, rather than a single intervention. In recognizing this, an extended 'maintenance' phase of debridement has been proposed, which will offer distinct advantages in wound management. Since autolytic and enzymatic methods of debridement are more selective and generally less painful to the patient, these methods are recommended over an extended period.

Source of my latest post

Autolytic Debridement requires lots of moisture

All wounds experience some level of autolytic debridement, which is the natural and highly selective process by which endogenous proteolytic enzymes break down necrotic tissue. These endogenous enzymes are mainly produced by neutrophils and include elastase, collagenase, myeloperoxidase, acid hydrolase, and lysosomal enzymes.[49]

Autolytic debridement may not take place fast enough to encourage rapid wound healing and closure, but the use of occlusive dressings can enhance this natural process, while maintaining a moist wound bed and managing excess exudate.[50] This allows painless, selective debridement and promotes the formation of healthy granulation tissue.[51]

Autolytic debridement can result in the production of significant quantities of exudate. Typical practice for autolytic debridement involves the use of a hydrogel to soften and break down necrotic tissue covered with an absorptive, occlusive dressing to absorb the excess exudate.

With an increase in antibiotic-resistant pathogens, there has been a renaissance in recent times in the use of honey for the treatment of wounds and ulcers.[52] As well as having an antibacterial action, honey provides rapid autolytic debridement and deodorizes wounds, in addition to having anti-inflammatory properties[53] and stimulating immune responses.[54] Though the exact mode of action remains unclear, Tonks, et al.,[55] observed that reactive oxygen intermediate production was significantly decreased (p < 0.001), and TNF-a release was significantly enhanced (p < 0.001) by pasture honey and manuka honey.

Although on practical grounds, autolytic debridement is the easiest method of debriding wounds, it usually takes a prolonged period of time to achieve complete removal of necrotic tissue.


INTRASITE? Gel and Autolytic Debridement
INTRASITE Gel is an excellent example of an advanced wound care product which facilitates autolytic debridement by re-hydrating hard necrotic tissue. This amorphous hydrogel dressing also loosens and absorbs slough and exudate. Notably, during the later stages of wound closure, it provides an optimum moist wound environment (33). This makes INTRASITE Gel ideal for every stage in the wound management process and of particular importance in wound bed preparation.


My experience with santyl for debridement

I alternate between Sulpha Silverdene and Santyl. Whenever I use santyl I cover it with Suran wrap. It drips A LOT so I use an ABD pad over it. I find that The Suran wrap shifts due to the moisture unfortunately, so tonight for the first time I will be using the santyl with Suran wrap secured in place with the Coban by 3M I mentioned above.

I do not experience this drippage with the sulpha Silverdene. When I use it I use gauze covered by Suran wrap to seal in moisture.

The more I learn, the more I see that moisture and protection from bacteria is almost the most important part of healing my wound. It is possible that the white protein I see now is the result of not enough moisture. When my wound was initially debrided by Salama he found red fresh tissue. I don't understand where all of this white protein (fibrinous exudate) came from and I'm researching online to attempt to learn how or why my body is producing it. I HOPE it's not due to lack of moisture as that would indicate that how I'm dressing the wound is not sufficient.

I see hairs growing through some of the white fibrinous exudate on my wound

I see hairs growing through some (must emphasize SOME) of the white fibrinous exudate on my wound. So I'm going to research it. I found this image that lists the layers of skin and thought I'd share here. Hairs grow from the 2nd layer of skin so that's good news to me :-D

Here's a copy paste to go along with the image :)

The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold.

Skin has three layers:

The epidermis, the outermost layer of skin, provides a waterproof barrier and creates our skin tone.
The dermis, beneath the epidermis, contains tough connective tissue, hair follicles, and sweat glands.
The deeper subcutaneous tissue (hypodermis) is made of fat and connective tissue.
The skin’s color is created by special cells called melanocytes, which produce the pigment melanin. Melanocytes are located in the epidermis.


The skin image (forgot to post)

The skin image (forgot to post)
Miami Plastic Surgeon

I would go back. They were a very great staff and the work still looks good 1.5yrs later. :-)

5 out of 5 stars Overall rating
4 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
4 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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