The single most common aesthetic complication in liposuction surgery is irregularities or contour depressions. These aesthetic issues are not rare and are often present in very minor manifestations that are acceptable to most patients. They are most common on non-flat contour areas such as the thighs due to the use of a straight cannula around a curved surface. Artistic skill and experience lessens the risk of these contour issues but, even in the best hands, the risk of asymmetry and irregularities are possible.
There are two fundamental approaches to treating liposuction defects, further use of liposuction and liposhifting, fat grafting, or some combination of these two techniques. Liposuction is useful when the irregularity is caused by inadequate fat removal and a high area needs to be reduced to match the surroung area. Fat grafting is used in the opposite circumstance when too much fat has been removed and the area needs to be built up. Quite frankly, better results are obtained when a lipo-treated area needs to be reduced and this is easier and more predictable. When adding injected fat grafts, the results are much more unpredicable as the amount of fat that may survive is not predictable.
A modification of these corrective techniques is an amalgamation of both, known as liposhifting. In this method, the fat is sifted from the surrounding tissues into a hollow or indented area without actually removing it from the body. While this technique is theoretically appealing, it does cause a lot of trauma to the treated area and some residual hardness of the overlying skin has been seen due to the amount of undermining.
While it is always better to avoid these complications, an admixture of these corrective liposuction techniques consistently provides improvement, albeit not perfection.
Dr Barry Eppley
Indianapolis, Indiana