In the arena of high definition body contouring it is critical to link treatment of fat excess with evaluation of skin redundancy. Removal of fat excess needs be performed while being cognizant of not creating skin redundancy. As a trainer of surgeons for high definition body liposuction, I routinely observe poor postoperative outcomes by my trainees that involve creation of skin irregularities. Skin irregularities occur when too much fat is removed for the degree of skin redundancy. It is intuitive that removing unwanted fat is only going to result in more skin redundancy. As such, it is critical to identify and plan on coping with skin redundancy when it is present preoperatively. When redundant skin not addressed, it will result in skin contour irregularities that will compromise your over all result. The reason for this is that redundant skin does not how to settle evenly. Despite our efforts to help the skin to lay back down evenly by using compression garments and customized foam inlays, the skin ends up wrinkling down in uneven and operated looking ways. In addition, to the uneven laying down of the skin, redundant skin will firm up and look “woody” in appearance in the early postoperative period. This undesirable firming of the skin results during the pro-inflammatory phase of surgery that extends from one week to one month after surgery involves the body’s influx of fibroblasts into the surgical field and their deposition of collagen molecules, i.e. scar tissue.
Several maneuvers are utilized to counter the pro-inflammatory phase. The first, is that patients are placed on steroids, called Medrol dose pack, for five days immediately following surgery to block the pro-inflammatory phase that is responsible for attracting fibroblasts. In addition, patients are placed on Accolate medication that counters formation of scar tissue and was initially advocated to counter capsular contracture that occurs in breast implant augmentation cases. More aggressive measures are taken postoperatively starting as early as two weeks following surgery with the use of radiofrequency administered to break down collagen deposition that results in scar tissue buildup. Topical radiofrequency is applied at ½ strength at two weeks and then ¾ dose at three weeks, and finally full dose at 4 weeks. Avoiding skin irregularities following high definition body contouring Finally,
In summary, avoiding skin irregularities following high definition body contouring requires a multi-modality effort. The most effective technique to counter the unwanted operated look is your surgical design that addresses skin redundancy either with scar-less, minimally invasive Renuvion skin tightening tool or a more aggressive excision of skin, mini tucking procedure, that is done simultaneously with liposuction. The second measure utilizes taking anti-inflammatory measures to counter the pro-inflammatory phase of healing using Medrol dose pack and Accolate. The final effort requires use of postoperative modalities that will help break down any undue collagen laid down that will create scar tissue. When all of the measures are taken, then successful contouring can be achieved without the effects of an operated look.
Please see this 46 year old female who demonstrated fibrotic operated look at two months but which resolved at the six month mark.