Q: Dr. Eppley, I had smartlipo three years ago to try and reduce some small areas of fat on my stomach. I was thin to start with and was just trying to do a little sculpting and refinement of a few stubborn areas to enhance what I had already achieved by working out. This has left me with a lot of rippling over my stomach area that has never gone away and it is very disturbing and embarrassing. My doctor suggested Thermage treatments which didn’t end up do anything. Now he recommends fat injections to try and smooth the areas out. What do you think? I have attached some pictures of my stomach area for you to review.
A: Thank you for being brave and sending your photos. I can see your concerns and your post-liposuction abdominal problem is both uncommon and difficult to treat. Given your thin body frame and age, I am not surprised that skin tightening (Thermage) did not work. While it did no harm, you have now proven that the overlying skin is not the problem. It is the differential thickness of the remaining fat layer that is the problem. Therefore, any potential treatment must focus on the fat layer.
At this point you have three treatment options, fill in the depressed areas with fat injections, try and take down the high areas with lipodissolve injections, or undergo a revisional liposuction procedure with emphasis on total skin release and suctioning on the numerous high areas.
I am not enthusiastic about fat injection treatment because you have little fat to harvest elsewhere to generate the graft material, the large number of depressed areas to treat and the unreliability of injected fat survival.
Spot lipodissolve injections is a better option than fat injections in my opinion. But there are a lot of high spots and it would take a series of very specific injections and time to see some improvement. And it would take a dedicated injector to be very specific with the injection areas.
Probably the best approach, although the least desireable from your standpoint, would be a re-do liposuction procedure using skin release and high spot reduction. I think you simply have too many irregular areas and the problem is really one spread out throughout your entire abdomen, not just one regional area.
Dr. Barry Eppley