Liposuction is a very popular and successful method of removing unwanted fat. While it removes fat, the real underlying intent of liposuction is body contouring. Reducing or removing bulges and undesired body protrusions is almost always a fat problem with only the abdomen and arms often have an excess skin problem as well. Since body contouring is the real goal of liposuction, the smoothness or evenness of the skin that makes up the outer aspect of the body contours is equally important.
If you read message boards, patient commentaries and various plastic surgery sites, it becomes clear that the most common concern after liposuction are ‘lumps and bumps’. Skin irregularities, unevenness and asymmetry are not rare liposuction problems and concerns. Whether it is in the first few weeks after surgery or months later, how the skin looks and feels over treated areas raises lots of questions. Some of these concerns will only be temporary while others will go on to be a persistent aesthetic distraction.
The process of liposuction is, by its very nature, somewhat imprecise and not always predictable. It is basically a blind procedure in which the amount of fat and, equally importantly, the evenness of its removal is done by the look and feel of the treated area. This leaves a lot of judgment to the treating physician and the influence of skill and experience is huge in getting optimal results. There is also the effect of how fat that is left behind, and you always have to leave some to prevent skin contractures and indentations, survives from the trauma of the surgery. Uneveness of the skin can occur, even if an even layer is left underneath the skin, if some fat dies or resorbs in the after surgery healing period.
The lumps and bumps from liposuction should be viewed and understood as three types or phases, early middle and late. Early skin irregularities after liposuction is the norm right after the procedure. This is due to swelling, bruising, collections of fluid (blood, liquid fat, tumescent fluid), and lack of skin healing and contraction. Some patients will have a lot of these irregularities while others will have far fewer. It is somewhat dependent on the anatomic location and the quality of the skin over the treated area. These early lumps and bumps will be evident during the first month after surgery and this phase can be considered over when there is no longer any bruising or grossly evident swelling. Numbness of the skin is still prevalent over much of the treated area.
The middle or intermediate phase of liposuction contouring effects ranges from between one and three months after surgery. Blood and fluid collections under the skin are largely gone by this time and most of the major amounts of swelling are gone. Some irregularities that were initially seen have either gone away or have greatly diminished. The skin begins to feel softer and less firm. Some of the skin numbness has gone away and normal feeling is beginning to return. A lot of healing is occurring underneath the skin and this is a very active phase of collagen formation and the reuniting of disrupted tissues.
The last phase of liposuction skin reshaping occurs between three and six months after surgery. By this point the skin is soft again as the final remnants have swelling have resolved. The treated areas are no longer uncomfortable to deep pressure and squeezing. Completely normal skin feeling has returned. The skin has contracted down to show the evenness of the subcutaneous fat removal. Any additional fat that was not removed but would go on to resorption has done so by this point in time.
Understanding these phases of skin reshaping and the time course of irregularities after liposuction should help patients with their expectations and concerns. What may seem like a skin problem early on my gone on to resolve itself as part of the natural process of healing. If skin irregularities and asymmetries persist beyond six months after surgery, these are not likely to resolve on their own as the healing process is complete. This is when revision of these liposuction results would not be premature.
Dr. Barry Eppley
Indianapolis, Indiana