Risk of Contour Irregularities after Liposuction
Of the nearly 1.8 million cosmetic surgical procedures performed in the United States, Liposuction is the second most popular aesthetic surgery with 246,354 procedures executed in 2017. These statistics, issued by the American Society of Plastic Surgeons, represent an increment of more than 5 percent relative from the total of Liposuction procedures performed in 2016 (1). The primary goal of Liposuction is to reduce fat deposits in specific localized areas and achieve the well-proportioned body contours without much down-time. As with any major surgical procedure, Liposuction conveys risks such as bleeding, infection and scar tissue formation, in a very small percentage of cases. However, potential complications can be reduced by choosing a skilled, experienced plastic surgeon to perform the procedure and by carefully adhering to the surgeon's instructions, both before and after the surgery.
In particular, side effects after Liposuction commonly known as contour irregularities or waviness are proven very challenging to correct, but can be positively prevent and/or manage together by doctors and patients. These post-operative irregularities (in the form of dimples, grooves, wrinkles or folds) could be generally due to: excessive superficial or too much liposuction; fibrosis with adhesions; inappropriate compression garment or posture, or caused by redundant skin. Plastic surgeons should forewarn patients with poor skin elasticity about the risk for contour irregularities and suboptimal skin contraction. Likewise, pre-existing cellulite, indentations and scars should be properly documented (2). Although irregularities of the skin are possible following liposuction, this side effect is diminished by the minimally-invasive 4D VASER Liposuction using micro-cannulas and the criss-cross technique of liposuction. It’s worth noting that the size of the liposuction cannula can influence the smoothness of the skin after liposuction. Using micro-cannulas (less than 4 mm in outside diameter) for liposuction can require a little more time than using larger cannulas, but micro-cannulas permit both the removal of more fat and smoother results. VASER Liposuction is also clinically proven (based on randomized clinical studies) to cause 53% skin retraction relative to other standard liposuction methods, which in turn reduces the risk of occasional irregularities of the skin (3).
Liposuction patients can also actively contribute in preventing contour irregularities by following their surgeons’ post-operative protocols to the letter, since correcting surface irregularities in the presence of post-surgical scarring and fibrosis is often very difficult and their effects might be permanent. In this respect, I usually recommend them wearing specialized compression garments around the clock, starting immediately after surgery, during six months, to reduce swelling and help their skin contract smoothly to their new body’s contours. Since ill-fitting garments can lead to contour irregularities, I advise my patients about the correct method of using them, to limit folds and creases in the garments, and regularly check if they are worn properly (4). Additionally, plastic surgeons should advise their patients that, without lymphatic drainage massages, there is a risk that the swelling and inflammation could turn into fibrosis, which is a permanent hardening of the area. At least ten lymphatic drainage massage sessions are required, starting 24 hours after the procedure, to eliminate excess lymph fluid, alleviate swelling and discomfort, and also prevent complications such as seromas (fluid collection) and contour irregularities (indentations, and/or fibrosis). If contour irregularities develop no attempt is usually made to correct them for at least six to twelve months. In my experience, manual lymphatic massages by their own have proven successful, in the majority of cases, in achieving uniform removal of swelling and ensuring smooth contours.
Some indentations may be improved with the “liposhifting” technique. This method is suitable for the correction of irregularities following liposuction. With internal lipomobilization or liposhifting, the fat tissue is cut into micro grafts that are mobilized under the skin without any suction and without removing the fat from the body during the procedure. After the internal lipomobilization a special type of bandage and fixation is needed for the first 48 hours. The results obtained have been very satisfactory (5). Moreover, persistent cases of irregularities due to excessive fibrosis may require a combination of touch-up liposuction along with Autologous Fat Transfer (AFT) to be adequately corrected. The surgeon can suction raised areas around the depression and fill in the depression with autologous fat grafts (from patient’s own body) to achieve the best possible, smooth contours. If the skin is loose then it can be surgically removed by excision. Furthermore, VASER Liposuction may be useful treatment for cellulite and may cause less contour irregularities.