Expert: Alan M. Engler, MD, FACS - 2/6/2008

Question
Having performed searches on my problem following smartlipo, I came across this website offering your advice which seems very astute in this area.

I have had 2 smartlipo procedures on my lower abdomen. The first was without suction - it did not work yet formed a large hard mound beneath my belly button abour 6 inches accross.

A year later the surgeon performed the procedure for a second time, this time with suction, and he said that the lazer broke through the hard mound and felt like cardboard as it broke it down. This time the fat as well as whatever the hard mound was was sucked out and I was happy.

However, just 3 or 4 days later I noticed this large lump forming, almost exactly as before. It started off quite soft but got harder over a couple of days.

Now, 2 weeks after my second procedure it feels very hard, with some swelling above it, but almost exactly the same as the mound which formed after the first procedure making me strongly doubt the lump can break down naturally as it would not before.

From reading your advice, I am wondering whether this is a pseudobursa?

My surgeon believes it might be stubborn fat which has once again accumulated and could be broken down with massaging, however, this did not work the first time.

I would greatly appreciate your advice as to what this is. It protrudes a great deal and makes my physique look worse than before having the procedure!

Many thanks.

Dan.

Answer
Hi Dan,

There's more about plastic surgery at my site, www.bodysculpture.com.

I'm sorry for the problem you're having.  I don't know that I can offer a definite solution, but here are a few thoughts.  Also, I do not have extensive experience with smartlipo - but plenty with lipo in general.

It is understandably wishful to think that everything that makes up a bulge - whether before or after surgery - is fat, and that it can all be removed.  In fact, fullness in areas such as these is obviously a combination of fat, skin, connective tissue, blood vessels, etc.  The thicker the skin and its connective tissue components (more typically in men and with darker skin, though that is not an absolute) the harder it is to get "everything" out with lipo.

So the first question is what you looked like before.  If you had a large bulge there and it was inadequately removed, then I would think that more aggressive procedures - such as lipo using a cutting cannula (or one that is more aggressive than the common blunt cannula with the hole on the side) might actually "cut" out some of this excess tissue.  It can, in theory, also be "melted" with smartlipo or ultrasonic, but that appears not to have been successful.

If, however, it has formed after each procedure but was not there before, then it sounds like a fluid accumulation that was inadequately drained.  Fluid is often absorbed by the body, in which case it's not a problem.  But I have become a fan of making sure that that fluid has a way out whenever possible - and that means leaving in a drain for a few days.  Even that is not 100% as you may need to reinsert it if the fluid reaccumulates.

A pseudobursa would typically take much longer than two weeks to form, so I don't think that's an issue.  Yet.

I would try to aspirate the mass (put in a needle and see if any fluid comes out).  If it does, I would try to reinsert a drain somewhere.  If not, then I think you have to consider a more aggressive lipo procedure (not yet - wait at least 3 months and preferably longer to see if it goes down), whether traditional, or laser, or ultrasonic (there are, of course risks with all of these).  In extreme cases, you might need to have it opened up and actually cut out surgically, though that risks leaving a scar that defeats the purpose of having a cosmetic procedure to a certain extent.

Again, I'm sorry for the problem you're having but I hope this helps,

Dr. E
www.bodysculpture.com