Recurrent Seroma after Fat Injections

Q: Dr. Eppley, I have had a liposuction surgery three years ago for my lateral thigh. After that I had a fat injection (six month ago) because of the indentation that occurred from the liposuction. After secondary fat injection, the seroma formed. However I had it drained it seven times but it keeps coming back. Last week my plastic surgeon placed a drainage tube, cleaned and freshened my iwound and I wore compression garments. But unfortunately the seroma does not stop . Please help me.

A: While I don’t know the size of your thigh defect, your history suggests an encapsulated seroma cavity. What this means is that there has been a layer of scar (capsule) that has formed around the fluid collection (similar to a bursa) This no matter how many times it is drained, or even a drainage tube placed, the fluid keeps returning.

The treatment for a encapsulated fluid collection is to remove the entire lining through a surgical procedure.(capsulectomy) as it is the lining that continues to produce the fluid. I don’t know what was done with the ‘cleaned and freshened’ part of your treatment and whether that involved the complete removal of this lining.

Once the lining is removed the decision then is whether a drain is placed to remove the immediate fluid that will occur or whether a en bloc fat graft should be placed. That would depend on thesis of the cavity.

The other option for treating encapsulated seromas is to inject sclerosing solutions. These exert their effect by internally ‘cauterizing’ the seroma lining to stop the fluid collection. My concern is your case with that approach is that it may cause reactive hyperpigmentation.

I would need to see a picture of the thigh area to give a better qualified answer.

Dr. Barry Eppley

Indianapolis, Indiana