Q: Dr. Eppley, I am interested in liposuction of one thigh. I had an injury that created a large hematoma on my upper thigh and I would like it removed. (It is stable). The hematoma occurred when I fell off of one of my horses and he jumped on my leg a few times (also happened to the other leg, but not as extensively). It tore my quad and created the “dent” that you can see as shadowing in the picture. The hematoma is behind that. It has settled into the size that it is now. My grandfather (retired surgeon), stated that he was most familiar with cases where they would evacuate the hematoma after it was non-expanding. He may have outdated information, as he is 84! If you have any other ideas for treatment, I would be very interested. I also attached a picture a few days after the injury occurred.
A: Liposuction may or may not be what you are looking for. Large expanding hematomas may need to be surgically drained if they create a large pocket, but that is not what you had. You had generalized bruising through the thigh musculature which must be allowed to resolve on its own…which yours now has. Liposuction is never a treatment for a hematoma regardless of the type.
The dent that is now in your leg is the result of the initial hematoma due to subcutaneous fat atrophy. Between the initial trauma to the tissues and the breakdown products of blood, some fat loss has occurred and this is why you have the dent. (tissue loss) This is extremely common occurrence from large hematomas.
Fat management is the key to improvement in your thigh contour but there are two different approaches depending upon what you want to achieve. If you want the surrounding contour to be even at the level of the dent, then the surrounding thigh areas need to have liposuction down to it. If you want the dent to be built out back to the level of the rest of the thigh (as it was before) then fat injection grafting is needed.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting fat injections to my face as I have lost some volume in the cheek area as I have aged. As I read about fat injections it seems like there is some controversy as to how well they work or how long they last. I have read several doctors who claim if the procedure is done right the results are excellent with good long-term survival. How do I know if my doctor will do the fat injections the right way?
A: It doesn’t really matter what anyone claims about fat injections. They are unpredictable in terms of survival no matter how it is done and anyone that would use the statement…’if done right’…is either misinformed or full of themselves. If there was a good and reliable way to do them that assured predictable long-term results, then so many people wouldn’t be talking about the different methods of how to do it. If one way really worked everyone would be doing it and that would be the end of the discussion. There are some basic principles of fat harvest, concentration and injection that are currently used, but no one doctor can claim any proprietary method of how best to do fat injections. Much of the science of it remains unknown at present. In addition, anyone that talks about long-term fat injection results is either speculating or commenting on their own personal observations as there have never been any long-term clinical studies that have shown in a quantitative objective manner how stable the results are.
That being said, I think fat injections is a very useful technique and the only good solution for some aesthetic augmentation issues. But the patient has to know that the result is unpredictable and can not be assured or guaranteed how well it will work. Fat injections are great as they are a natural tissue but the result is a gamble.
Dr. Barry Eppley