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Archive for the ‘plastic surgery case study’ Category

Case Study – V-Line Jaw Reduction Reversal

Wednesday, February 22nd, 2017

 

Background: One of the most popular jawline surgeries around the world, particularly in Asian people, is jaw reduction. Know more commonly as V-Line jaw reduction surgery, it involves removal of wide or flared jaw angle (amputation) and chin reshaping. (narrow and shortening through am intraoral T-shaped ostectomy) For those patients that have a wide jaw and and a lower facial prominence as a result, it can be an effective lower facial reshaping procedure. It is easy to see why this would be of aesthetic predominantly in Asian patients given their natural facial bone shape.

Because the procedure is performed exclusively through an intraoral approach, it can be very difficult to have even and symmetric bone cut lines. There is also the issue of how the bone heals and the smoothness that may or may not result. For this reason, it is really the norm to expect some bone asymmetries between the two sides of the jaw and even at the chin. Fortunately the overlying soft tissues are thick and can help mask such bony asymmetries/irregularities should they result from the procedure.

But like reduction surgery anywhere on the face and body, losing bone support can also cause adverse soft tissue issues. This is an issue primarily in the jaw angle areas in V-line jaw reduction surgery. It is not rare that I hear from a patient who has had jawline reduction surgery that they do not like the subsequent flattening/weakness of the back of their jaw and that they feel the soft tissues now sag along the jawline.

Jawline Deformity after Jaw Angle AmputationJawline Deformity after Jaw Angle Reduction fronkt viewCase Study: This 45 year-old Caucasian female had V-line jaw reduction surgery three years previously. She did not like the subsequent loss of her jaw angles, lack of jawline definition and how it made her lower face too narrow and more aged in appearance. She wanted more defined jaw angles vertically and a smoother and more linear jawline coming forward. A 3D CT scan shows the loss of jaw angles, higher positioned jaw angles, severely increased mandibular plane angle and inferior border jawline asymmetry.

Custom Jawline Implant foir Jawline Reconstruction after Jawline Reduction side view Dr Barry Eppley IndianapolisCustom Jawline Implanty after Jawline Reduction Surgery design front view Dr Barry Eppley IndianapolisA custom jawline implant was designed with the main purpose of re-establishing the jaw angles in a much lower position but without adding any significant jaw angle width. It also established a more symmetric and smooth jawline coming forward to the chin. A little anterior chin projection was added but creating very minimal chin width. Under general anesthesia and through an exclusive intraoral approach, the custom jawline implant was placed.

Custom Jawline Implant design for Jaw Angle Reconstruction Dr Barry Eppley IndianapolisV-line jaw reduction reversal has to be done using some form of implants. Custom jawline implants are best as the multidimensional jaw augmentation needs are very difficult, if not impossible, to adequately address with any standard jaw angle implant shapes.

Highlights:

1) Unfavorable aesthetic results can occur from jawline reduction (V-line jaw surgery) with loss of jawline definition and tissue support.

2) ‘Reconstruction’ of lost jaw angle and chin from V-line surgery requires a vertical lengthening of the shortened jaw angles and widening of the chin.

3) A custom jawline implant is the best approach to V-line jaw surgery reversal.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Double Chin Correction

Tuesday, February 21st, 2017

 

Background: The shape of the chin has a major effect on facial appearance. Since the chin is a projecting facial structure, it highly influences the shape of the face and how defined the neck can look. The shorter the chin becomes the more convex the facial profile becomes and the neck looks increasingly ‘lost’.

A common aesthetic facial concern is that of the Double Chin. This is really an urban term that is a misnomer. It is not really a double chin per se, it is really a chin deficiency or lack of enough chin projection. When combined with even a small amount of excess neck fat, which occurs right under the chin (submental fat), the profile will show two humps or mounds. They may look like two projecting chins but the lower ‘chin’ ir excessive neck fat.

The treatment of the double chin is a classic diametric surgery. Each ‘chin’ change must be in opposite directions to create the best facial profile change. The upper ‘chin’ must be moved forward and requires some type of bony procedure. (implant vs sliding genioplasty) The lower ‘chin’ requires soft tissue reduction using liposuction fat removal. Together the entire lower face is improved as it becomes more ‘pulled out’ and defined.

Case Study: This 45 year-old female was bothered by the increasing size of her double chin as she aged. She has always had a shorter chin but as she had gotten older the ‘double chin’ appeared.

Under general anesthesia an initial small submental incision was made through which the neck was treated by liposuction removing about 12ccs of fat. The submental incision was extended to 1.5 cms and a 7mm thick curvilinear silicone chin implant was placed in a subperiosteal pocket on the bottom of the anterior chin bone. (the implant had no extended side wings)

Double Chin Correction result side view Dr Barry Eppley IndianapolisDouble Chin Correction result front view Dr Barry Eppley IndianapolisHer eight week postoperative result show elimination of the double chin and a much improved facial profile. Between the chin augmentation and the liposuction, it really takes at least six weeks after surgery to see the full benefits of the double chin correction procedures. Depending upon the degree of horizontal (and even vertical) chin deficiency, the chin deficiency may be better done using a sliding genioplasty for a more 3D chin augmentation effect. It also can have a more positive neck reshaping effect as it pulls the underlying neck muscles (roof of the neck) forward and up.

Highlights:

1) The double chin deformity is a combination of excess fat fullness under the chin and insufficient horizontal chin projection.

2) The combination of submental/neck liposuction and chin augmentation effectively treats the double chin deformity.

3) Whether the chin augmentation is best done by a chin implant or sliding genioplasty depends on the degree of horizontal chin deficiency.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Pediatric Otoplasty

Monday, February 20th, 2017

 

Background: The formation of the ear is an amazingly complex embryonic process. That is evident in just looking at the ear with its spiral array of convexities and concavities of cartilage around the ear canal. It is remarkable that it forms properly and does so twice in most people due to its bilateral presence.

But because of its complexity the ear is one of the most commonly misshapen of all facial features. From minor deformities like earlobe clefts and Stahl’s ear to major malformations like microtia there is a wide array of congenital ear malformations that can occur. One of the most common ear anomalies, and it is questionable whether it should be called an anomaly, is that of the protruding ear. All of the ear is present but its sticks out too far from the side of head due to the lack of an antihelical fold, overgrowth of the concha or some combination of both.

Setback otoplasty, also called ear pinning, is the well recognized surgery for the correction of the excessively protruding ear. It is done in both adults and children. The common question in children is at what age is the proper time to perform the surgery. The underlying premise of this question is when can the surgery be done so that it will not adversely affect growth of the ear cartilage.

Case Study: This 6 year-old male child has very prominent ears due primarily to a lack of antihelical fold development. Where the fold was completely absent the ear stuck out the most. Down near the earlobe some sembence of an antihelical fold was present and the ear stuck out less.

Male Child Otoplasty result front view Dr. Batrry Eppley IndianapolisUnder general anesthesia an otoplasty procedure was performed through an incision on the back of his ears. Minimal skin was removed from the back of the ear and the correction was done principally through multiple horizontal mattress sutures (to create the fold) and some concha-mastoid sutures. (to decrease the auriculo-cephalic angle)

Pediatric Otoplasty result back view Dr Barry Eppley IndianapolisPediatric Otoplasty result side view Dr Barry Eppley IndianapolisHis one month results show a good and reasonable symmetric ear reshaping result. A close-up side view of before and after pictures show that the effect was largely achieved by creating an antihelical fold and a more defined superior crus in the upper helix.

Clinical studies have shown that suture cartilage manipulation of the ear can be done as early as age 2 without any negative growth effects on the ear cartilage. While it can be technically done at such as early age (and I have done so numerous times) there is the important question of postoperative compliance and avoidance of unintentional ear trauma. (which could cause suture disruption and partial ear shape relapse) Between lack of any psychosocial developmental issues in children and performing elective surgery at such a young age, it is far more common to have pediatric otoplasty done closer to age 5 or 6.

Highlights:

1) Congenital ear deformities are amongst the most frequently occurring of all facial deformities of which the protuding ear is the most common one seen.

2) Setback otoplasty (ear pinning) achieves its effect primarily by cartilage bending.

3) The age to perform an otoplasty is largely parent driven in children and be effectively done anytime after age 2.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Dermal Graft for Jaw Angle Asymmetry

Tuesday, February 14th, 2017

 

Background: Asymmetry of the lower third of the face is common. While there can be a soft tissue component to it, more times than not it is caused by asymmetry of the bone. the most common location for jaw asymmetries is in the angle area. The mandibular ramus is the L-shaped portion of the jaw and is prone to differences between the two sides in length and/or width.

Jaw angle asymmetry is best appreciated from the front view. Patients particularly notice it in pictures where the face becomes ‘frozen’ and is most easily seen. But because everyone of us knows our faces so well (and more so today because of smart phones and selfies) patients can see it even when others can’t.

The treatment for a jaw angle symmetry due to a deficiency is an implant. Provided the location is known and the implant is the right shape and size, good correction can be expected. But not everyone likes the concept of an implant so alternative options may be considered.

Case Study: This 32 year-old female had a modest jaw angle asymmetry with a deficiency on her left side. The inferior border along the angle lacked the fullness and jawline that the opposite side had. She preferred to use a more ‘natural’ material rather than an implant.

Dermal Graft for Jaw Angle Asymmetry Correction Dr Barry Eppley IndianapolisLeft Jaw Angle Dermal Graft Implant for Asymmetry Dr Barry Eppley IndianapolisUnder general anesthesia an intraoral approach was used to access the left jaw angle bone. Using allogeneic dermis (Alloderm), a 1.5mm thick section was layered into a thicker implant and sutured together to create a linear graft for the inferior border of the jaw angle. It was inserted and laid along the border. No form of fixation was used.

Jaw Angle Asymmetry Correction result Dr Barry Eppley IndianapolisHer 6 month result showed better jaw angle symmetry and an apparently stable result without resorption.

An allogeneic dermal graft would not ordinarily be a preferred facial bone augmentation material. It is a soft tissue augmentation material that purportedly is integrated into the recipient site and replaced by natural tissue. (scar) In my experience it more often behaves like an implant and becomes a well tolerated tissue filler with some fibrovascular ingrowth. For minor facial bone asymmetries where an implant is not preferred, these dermal products can be an option to consider.

Highlights:

1) Lower facial asymmetry is most commonly caused by a bony asymmetry of the jaw.

2) Jaw angle asymmetries can be treated by a variety of implant materials placed on the bone.

3) For patients wary of synthetic implants on the jawline, an allogeneic dermal graft can be used for smaller jaw asymmetries.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Forehead Reconstructive Implant

Monday, February 13th, 2017

 

Background: Reconstruction of the forehead is very different than aesthetic forehead augmentation. By definition reconstruction is required when a portion of the bony forehead has sustained a full-thickness bone loss. This most commonly occurs due to either trauma or the loss of a craniotomy flap after intracranial tumor surgery.

When rebuilding the forehead that has sustained bone loss, the most common method today is to use a 3D implant. From a 3D CT scan an implant can be designed and fabricated out of various polymeric materials. The precision fit, smoothness of the outer contour and the shortened operative times makes a custom forehead reconstructive implant usually preferred over an autologous bony reconstruction.

Such synthetic forehead reconstructions, however, may be done with good vascularity and thickness of the overlying soft tissues. If the patient has had prior irradiarion or been exposed to multiple reoperative surgeries, the soft tissue quality must be changed rpior to any implant placement. In addition, no portion of the implant should encroach on the frontal sinus cavity space or should have a prior frontal sinus obliteration. In essence forehead bone implants work well when the tissues around them can support them and be resistant to infection.

Fat Injections to Forehead Craniotomy Defect technique Dr Barry Eppley IndianapolisFat Injections to Forehead Craniotomy Defect left oblique view Dr Barry Eppley IndianapolisCase Study: This 55 year-old female had a large central bony defect from multiple intracranial surgeries for recurrent gliomas. She lost her frontal craniotomy bone flap from an infection coming from the frontal sinus/nose several surgeries ago. She ultimately had a vascularized ALT fascial flap placed to cover the dura which was secondarily augmented above it by fat injections due to the thinness of the forehead skin. While much of the injected fat graft was lost by volume, some survived and its effects on the soft tissues further improved the quality of the forehead skin.

Forehead Bony defect model Dr Barry Eppley IndianapolisCustom Forehead Implant Reconstruction intraop Dr Barry Eppley IndianapolisHer large forehead bony defect could be appreciated in a model made of it. A custom forehead reconstructive implant made of PEEK (polyetheretherketone) polymer was finally placed to create a permanent forehead contour restoration. At the time of its placement areas of fat globules could see on top of the ALT fascia over the dura as well as on the underside of the forehead skin. The implant had a perfect fit and was secured with small plates and screws.

3D forehead reconstruction with a computer generated implant sounds high-tech, and it is, but failure will ensue if the soft tissue around it is not of good quality.  The quality of the tissue bed into which the implant will lie can not be improved any form of computer technology. The surgeon must ensure that the tissues can tolerate a synthetic bony implant and all sources of infection are resolved before a custom forehead reconstructive implant is placed.

Highlights:

1) Forehead reconstruction with any form of an implant requires well vascularized and adequately thick overlying soft tissues

2) Restoring forehead tissue thickness can be done using either fat injections or a vascularized free tissue transfer.

3) A custom forehead reconstructive implant made of PEKK material can be placed after the forehead has had its soft tissue quality improved.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Sliding Genioplasty for Chin Implant Replacement

Monday, February 13th, 2017

 

Background: Chin implants in females is a common lower facial reshaping procedure. While they add desired amounts of horizontal projection and improve the facial profile, the extended wing designs of today’s chin implant designs can have adverse effects on they look in the front view. While the extensions on the implants are designed to create a natural transition into the jawline bone without a visible stepoff, they add chin width to do so. While this is rarely an issue in men, it can be more frequent aesthetic problem in women.

Women seeking an improved jawline have a different aesthetic goal than men. They do not necessarily seek an angular jawline with visible corners.  (some women may bit not the majority) Rather they usually desire a V-shape to their jawline with a smooth linear line from front to back. As part of that aesthetic goal the chin must be narrow and may even have a more pointy chin or smaller V-shape appearance. This is in contradiction to the look that many chin implant styles give to the augmented chin.

Case Study: This 35 year-old female had a prior history of having chin augmentation done using a Medpor chin implant of 6mm projection placed through an intraoral approach. She never liked the result as it gave her a wide and boxy chin. This did not fit her small petite face well. While it provided adequate horizontal projection, it made her chin too wide and too vertically long. She also developed some lower lip sag and excess tooth show.

Medpor Chin Implant Removal and Sliding Genioplasty Replacement intraop Dr Barry Eppley IndianapolisChin and Jaw Angle Reshaping result front view Dr Barry Eppley IndianapolisChin and Jaw Angle Reshaping result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia her indwelling Medpor chin implant was removed intraorally. To do so it had to be sectioned into multiple pieces and required the removal of 6 titanium screws. It was replaced by a sliding genioplasty that was brought forward 6mm and vertically shortened 3mms. A mentalis muscle resuspension and vestibuloplasty were performed to help with her lower lip sag. Concurrently, vertical lengthening jaw angle implants were placed through posterior vestibular intraoral incisions. The implants added 7mm of vertical length and 3mms of width.

Any form of chin or jawline augmentation must take into consideration the differences be tween male and female jawline shapes as well as the patient’s aesthetic goals. Even a ‘simple’ chin augmentation must take this into consideration as the operation may be a technical success but an aesthetic failure. (as this case illustrates) The entire jawline from front to back must also be considered in an effort to create an improved jawline that fits the patient’s face.

Highlights:

1) Chin implants in females create horizontal projection but often at the expense of too much chin width.

2) A sliding genioplasty can replace a chin implant by providing horizontal projection but with a more narrow chin width.

3) Jaw angle implants can create vertical lengthening with a sliding genioplasty to give a more defined jawline in females.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Scrotal Reduction

Sunday, February 12th, 2017

 

Background: The normally quiescent scrotum that draws little attention can become a major focus when it dramatically enlarges. There are a variety of causes for scrotal enlargement including injury, genital and pubic mound surgery, inguinal hernias,  testicular torsion, varicoele, orchitis, hydrocoele and epididymitis to name the most common. In almost of of these causes once the source is properly treated and healing has occurred the scrotum will shrink back to normal. Acute scrotal edema almost always completely resolves.

Chronic scrotal edema/enlargement occurs from different sources. One of the common for refractory scrotal enlargement is lymphedema. If partial blockage occurs of the draining lymphatics or veins, the scrotum will remain edematous. There is no compression method to conservatively treat chronic scrotal lymphedema and make the scrotum smaller. Trying such compression may actually worsen the problem and may hinder the already limited blood supply to the scrotum. Further obstructing the venous outflow can increase the swelling. In addition the thin scrotal skin is not very tolerant of compression besides the obvious difficulty. Chronic scrotal enlargement can only be reduced by surgery.

Case Study: This 32 year-old male presented with chronic scrotal enlargement, being roughly 2X to 3X its normal size. He had a history of some form of autoimmune skin infection of the groin, believed to be a form of psoriasis. It eventually become improved through the use Humira and daily low-dose antibiotics. While not 100% cured, it was 98% improved. This skin condition left him with a chronically enlarged scrotum with thickened skin and diffuse subcutaneous tissue thickening. Besides its appearance, it gave him difficulty with wearing clothes and chaffing of the groin and scrotal skin.

testicular dissection in scrotal reduction Dr Barry Eppley IndianapolisScrotal Skin RemovalScrotal Reduction Surgery Dr Barry Eppley IndianapolisUnder general anesthesia and in a frog-legged position, a large elliptical excisional pattern was marked out vertically using the midline raphe as the center. The widest area of excision was 14 cms. The thickened skin and the watery expanded superficial fascial tissue were excised. The testicules and the enveloping tunica vaginalis lining were dissected out and preserved. Closure was done by covering the testicles with the remaining scrotal skin with a midline approximation.

A chronically enlarged scrotum can be effectively reduced by wide excision of the redundant tissues. The scar line should be placed along the naturally occurring midline raphe where a good scar outcome would be expected.

Highlights:

1) Permanent scrotal enlargement can occur from chronic skin infections that results in enlarged and abnormal skin

2) Scrotal reduction involves an elliptical excision of skin and fascia centered along the vertical midline raphe.

3) Scrotal reduction preserves the testicles and their surrounding sac.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Implants and Stretch Marks

Sunday, February 12th, 2017

 

Background:  The finding of stretch marks on the breasts is common and reflects loss of skin elasticity from pregnancy and/or weight gain/loss. They always occur in a radiating pattern around the areola like rays of the sun. Careful inspection of the stretch marks will reveal that they are thinner than the surrounding skin and have less pigment. In many ways, they represent skin that has partially torn and is now a line of scar.

It is rare that breast implants ever cause stretch marks. It can happen, and it is an occurrence I have read about, but no a postperative breast augmentation finding that I have ever seen. Conversely, the other question is whether placing breast implants will make existing stretch marks look worse. Since so many women have them it is an understandable concern of will happen to them afterwards when the breasts become larger.

Case Study: This 32 year-old female came in for breast implants. She had lost most of her breast volume after multiple pregnancies. Despite the involution her nipples had good position above her inframammary folds. But she did have many wide and deep stretch marks radiating outward from her areola in a 360 degree pattern.

Breast Implants and Stretch Marks result front view Dr Barry Eppley IndianapolisUnder general anesthesia and through inframammary incisions , 325cc smooth round silicone breast implants were placed in a dual plane position. Her stretched out breast mound skin had no problem accommodating these modest size breast implants.

Breast Implants and Stretch marks result oblique view Dr Barry Eppley IndianapolisBreast Implants and Stretch Marks result side view Dr Barry Eppley IndianapolisHer breast appearance just a few weeks after surgery shows stretch marks that actually appear worse. Often times the immediate stretch of the tissues from the implants makes the scar hyperemic and the small capillaries in them dilate. This subsides over first couple months as the swelling goes down and the skin relaxes.

Highlights:

1) Having stretch marks on the breasts does not preclude one from having breast implants.

2) Breast augmentation surgery may temporarily make severe stretch marks look worse due to temporary redness.

3) Breast augmentation surgery, on average, does not appear to make stretch marks look better or worse in the long run.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Weight Loss Breast Augmentation

Saturday, February 11th, 2017

 

Background:  Significant weight loss, albeit through diet and exercise or bariatric surgery, will have a dramatic effect on all body areas. As the fat is burned off the support for the skin is lost. This causes an overall body sag that creates a well known collection of body changes that are most reflected centrally in the trunk.

For women one of the most affected areas is that of the breasts. The loss of breast volume allows the overlying skin to sag and the nipples to head south. What degree of breast sag that ensues depends on how large the breasts were initially and whether they had any significant sag before the weight loss. Smaller breasts develop less sag while larger breasts can have a dramatic sag with a large skin sleeve that ends up having them lay against the upper abdomen.

Breast implants are almost always needed for ‘reconstruction’ of the weight loss breast. Whether they can be effective by themselves without the need for a breast lift depends on how much skin sag exists.

Weight Loss Breast Augmentation Female before surgery Dr Barry Eppley IndianapolisCase Study: This 22 year-old female underwent a 60lb weight loss on her own without the need for bariatric surgery. The breasts must have been initially small ad the skin sag was slight and the nipples still remained fairly centralized on the reduced mound size.

Weight Loss Breast Augmentation result front view Dr Barry Eppley IndianapolisWeight Loss Breast Augmentation result right oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, a transaxillary approach was used to place 375cc saline breast implants that were filled bilaterally to 450ccs in the partial submuscular position. This filled out her breasts fully. Like many transaxillary breat augmentation approaches, the initial result will have slightly too much upper pole fullness which will settle over time.

Weight Loss Breast Augmentation result side view Dr Barry Eppley IndianapolisWith the nipples above the inframammary fold, breast implants is all that is needed in the large weight loss female. Unfortunately for many weight loss women the breast condition is not so favorable that implants alone will suffice.

Highlights:

1) Significant weight loss affects the breasts through loss of breast tissue and often creating a breast mound sag.

2) Breast implants can produce a dramatic change in breast size and shape in breasts that have lost a lot of volume. (weight loss breast augmentation)

3) Breast implants alone will work in the weight loss patient IF the position of the the nipple is at or just below the inframammary crease.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Chronic Abdominal Seroma after Tummy Tuck

Saturday, February 11th, 2017

 

Background:  A tummy tuck is a remarkably effective procedure that achieves its effect through wide excision of loose abdominal skin and fat and underlying muscle tightening. The raising of the upper abdominal skin flap to cover the removed lower abdominal tissue creates a large surface area of wounded tissue. This results in an expected serous fluid leak from these injured wound edges after surgery. This has been the historic reason that drains are placed during tummy tuck surgery and maintained for variable periods of time in the early healing period.

While there has been a recent trend towards the concept of the drainless tummy tuck, which strives to slow down or eliminate abdominal seromas through the use of quilting sutures, the risk of a subsequent fluid collection is not zero. Drained and drainless tummy tucks both have abdominal seroma risks.

The typical and usually very effective treatment for a seroma is needle aspirations and time. Once the internal tissues heal more the fluid leak usually ceases. In some cases a drain may be placed if the needle aspiration volumes are persistently high. But in very rare cases fluid colletion persist for a very long time or seemingly redevelop in an abdominal area with a prior history of a fluid collection.

Chronic Abdominal SeromaCase Study: This 50 year-old female had a history of having a tummy tuck nearly two years previously with the prolonged use of a drain. (8 weeks after surgery) Thereafter, she had a persistent area of firmness between the belly button and the lower abdominal scar line but it remained flat for a long time. Then six months ago (1 1/2 years after the surgery) the area mysteriously began to enlarge. She underwent radiofrequency treatments by her initial surgeon but it did not help and the area kept getting bigger.

Mini Tummy Tuck Sero0ma Surgery design Dr Barry Eppley IndianapolisChronic Abdominal Seroma Surgery Dr Barry Eppley IndianapolisUnder general anesthesia, a skin excision pattern was marked out for removal of excess skin that have been created from the expanding abdominal mass. The original tummy tuck scar was opened and dissection was carried down until a dark mass was encountered. This was an obvious encapsulated mass which expressed a large amount of dark fluid when it was entered. The cavity opened revealing a very thick encapsulated  lining on the abdominal fascia and into the overlying subcutaneous fat. The entire capsule  was removed, quilting sutures used and a small drain placed. The excess skin was removed, in the form of a mini-tummy tuck, and the outer abdomen thus re-tightened.

A delayed chronic seroma after a tummy tuck is very rare. This is only the second one that I have ever seen. They both have been associated with an early persistent fluid collection that either required prolonged use of a drain or the need for frequent needle aspirations. A firm abdominal mass that persisted thereafter for a long time as a bulge would represent an original undrained seroma. But this case represents an area that was flat (albeit firm) and then started to grow long after surgery. The exact mechanism for this phenomeon is not clear but its treatment would be the same for a chronic seroma that persisted much earlier after surgery.

Highlights:

1) The most common ‘complication’ after tummy tuck surgery is  seroma or fluid collection.

2) Most abdominal seromas are solved through healing time, needle aspirations and, ocasionally, the use of drain.

3) A chronic seroma is a very rare late tummy tuck complication that appears months to years later as a firm abdominal bulge that must be treated by open excision.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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