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 I am 4 months post op tummy tuck. I suffered a seroma and necrosis and the wound finally closed after 14 weeks. I still have intense pain in the abdominal area around the naval and above the scar itself. I am swollen and have uneven bulges on each side of the navel. I have seen the PS at least 10 times since the surgery and have received assurances that this will all settle down with time. Can you please tell me (1) what could be causing the pain (2) what are the uneven bulges around the navel area (3) willall the swelling go down in time (4) at what point in time would I be able to undergo scar revision on the area of the wound above the pubis. Thank you
Answer from Dr. Alan Engler
www.bodysculpture.com
Hi Ann,
I'm sorry for the problems you've been having.
It is obviously not possible for me to comment specifically about your case without being able to examine you, but here are a few thoughts and generalities.
The pain is most likely due to a number of factors, including the pulling and tightness that results from tissues contracting, which is how they heal after necrosis. There is a certain amount of elasticity to tissues, but the contraction process and resultant scar tissue include many small nerve endings, and so the result - tissue healed via contraction - is often tender. This eventually settles down, though thickened scar tissue, if it remains, may remain sensitive.
The bulges are from the uneven way the tissue survived (even within a region some parts survived better than others), persistent swelling, and folds that develop as tissues heal by contraction. How much each component contributes is hard to determine, but it's usually some combination of the above.
Much of the swelling will, in fact, go down over time (up to a year or more) but it may not be completely flat and even.
You need to wait at least six months from the time it healed (closed) before considering anything, and probably more like a year. The tissues are just too swollen and sensitive right now, and you want to give them a chance to (a) heal and (b) soften and stretch, so that they can be manipulated more easily during a secondary procedure. Incidentally, since a lot of the tissue elasticity has been used up in closing on its own, it's not necessarily such a simple and straight-forward procedure to do a "scar revision." It's really more like a re-advancement of abdominal and surrounding tissue, and you'll need to discuss this in depth before you have the surgery so that you can know what to expect. It may have to be done in stages, there may be some additional scars, etc.
You will, therefore, need to understand as much as you can about how you've healed. It may be a good idea to go see a few plastic surgeons just to get some different ideas on what can be done; you can find some at surgery.org and plasticsurgery.org (look for International Corresponding Members, since these are American societies).
