AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2700 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Education/Credentials Dr. Engler graduated from Yale University (undergraduate) and the College of Physicians and Surgeons of Columbia University (medical school). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York.
Question Hi Dr. Engler, I am 52 years old and had a mini tummy tuck in July of 2008 with vaser assisted lipo of the upper and lower abs., flanks and muscle repair. I have never smoked, was 5'6" and 130 lbs. before the surgery.I exercise, eat well etc. My surgeon is young (40ish) very well trained and well respected. He is board certified in plastic and reconstructive surgery and does a lot of reconstructive work. My surgery went well and I healed well except for an odd crease that ran vertically from my belly button to my sternum. He thought it would go away on its own but it didn't so at 6 months he revised the area. He went through my belly button and a hole he made about 3" higher and using tumescent fluid he loosened the skin with a canula so the skin could re-drape without the crease. At 2 days out I was very badly bruised (I always do but no bleeding disorder) and in 2 areas the skin peeled off in my upper abs and subsequently became necrotic. It is healing well now and ultimately he will cut out the scar tissue and I will have a small linear scar. He can't figure out why this happened and neither can I. Essentially I had a small bit of lipo there but with no fat sucked out, just the skin loosening. I can't find anyone that has had this happen on any of the message boards with lipo. The rest of the area is fine. I have a friend who is a nurse and she is convinced the doctor did something wrong but I don't think so. I think it is just one of those weird things that happens. My father was an M.D. so I am aware that things don't always go perfectly even when everything is done correctly. All I can find that would cause this would be using the canula too close to the surface but I really don't think he did that. I was wondering if you had any ideas as to why this happened. I had a compression garment on after the procedure but I know that is typical. I did have 5 hyperbaric oxygen treatments starting on day 3 in the hopes of saving the area. I wish it didn't happen but it is not something that is keeping me awake at night. I would leave the area alone after it heals but the doctor thinks it will pucker and not look as good as a small linear scar. Any thoughts on why this happened?
Answer from Dr. Alan Engler
www.bodysculpture.com
Dear Sandy,
Obviously, I'm sorry for the problems you're having.
I certainly can't say anything definitively without examining you and knowing more about the specifics of this case, and I would not want my opinion to be considered a standard of care, absolute expertise, or to be used for anything other than informational purposes.
With that understanding, though, the issue may start with the Vaser procedure. Vaser is a form of ultrasonic technology and it emits energy that "melts" fat. The energy is emitted somewhat beyond the dimensions of the probe itself. It sounds like the crease formed because the dermis of the skin adhered to the underlying muscle; ie, slightly more fat than was ideal was removed from that spot (along that line). I can't say how or why that happened; it can occur with any form of lipo and, depending on what you looked like before, may not have taken much to get there. It could also simply have occurred because of individual variations in healing. Whatever the reason, the crease was the result of irregular or incomplete or excessive fat removal, coupled with less-than-ideal redraping of the skin.
The next step may have exacerbated the situation slightly if, in doing the tumescent lipo, the skin was further devascularized (ie, the blood supply was compromised further). That, too, can occur with ultrasonic lipo or with traditional lipo, as was the case here. Once that happened, in an attempt to get the skin to redrape, the necrosis was set in motion.
I don't think that the garment had anything to do with it.
I realize that this may not be crystal-clear but I don't think it's necessarily that simple or straight-forward to figure out; nevertheless, I hope this has helped a bit.
