Correcting Contour Irregularities

The photographs are one 56-year-old woman after a procedure of correcting contour irregularities. They show that result. They do not label whether the fault was the fat layer or the skin. The standing exam is what separates those two causes before any further cannula passes are planned.

A different irregularity comes from the deep fat. When a novice cannot remove the deep layer uniformly, the result is waves. One band of deep fat is gone and the next band is still there, so the surface rises and falls. Waves and divots can sit on the same torso. They are both inappropriate fat removal. They are not the same pass, and they are not fixed by treating only the skin.

Removing fat also compounds whatever skin redundancy was already there. A loose shell over a smaller volume wrinkles more, not less. Seeing that redundancy before surgery is what keeps a later irregularity from being built in. Further liposuction, once the skin is already redundant, only makes that redundancy worse. Liposuction of residual fat is still required where fat was left behind. It is the wrong tool where the skin is the excess.

Correcting contour irregularities means both jobs. Identify and accommodate the skin redundancy, and remove residual fat that is still in excess. When the earlier fat removal was inappropriate, ultrasound-assisted liposuction is what evens the fat consistency. That ultrasound-assisted method is VASER. It is used to smooth the uneven deep or superficial fat, not to dig the same divot deeper.

Fat grafting into a dent is not the correction named here. The uneven fat is evened with the ultrasound-assisted cannula. A depression that is simply missing fat is a different finding from a wave of fat that was never taken evenly. Filling a wave with graft would stack volume on a layer that still needs to be smoothed. The revision of the fat layer is the smoothing pass.

Skin is the second job, and it is graded. Minimal to moderate redundancy is treated with helium plasma and radiofrequency together. Moderate to severe redundancy is removed with excisional surgery. Helium plasma does not cut out a large excess of skin. Excision does not replace the plasma step when the excess is small. More liposuction does not do either job.

The outcome looked for is a smooth skin shell, without the artifacts that make a result look operated, and with the shadows that belong on an unoperated surface. A divot casts a shadow that a natural contour does not. A wave does the same along its ridge. Taking those artifacts out is the point of correcting contour irregularities. Leaving them and tightening only the deepest fat leaves the operated look in place.

High-definition liposuction is the setting for that work because it already plans fat and skin together. A consult for a botched result starts with which layer failed. Superficial divots, deep waves, and redundant skin can all be present. Each one gets its own maneuver. The fee for a single area of liposuction is not the fee for a revision that evens fat and also treats the skin. That exam is done standing, at the liposuction locations, so a groove of missing superficial fat is not mistaken for loose skin.

Mayo Clinic describes liposuction as fat removal, which matches the limit used here. Suction removes fat. It does not excise a redundant shell, and it does not tighten minimal redundancy the way helium plasma and radiofrequency are used to. When the preoperative exam already shows redundant skin, the plan includes that skin treatment before any more fat is taken. Skipping it is how the next irregularity is made.

Skin sits on top of both of those findings and can hide which one is which. A redundant shell wrinkles over a smooth fat layer and also wrinkles over a waved one. Pinching the skin while the patient is standing shows whether the wrinkle is extra skin or a fat step underneath. If the wrinkle flattens when the skin is pulled, and the fat underneath is even, the finding is redundancy. If the wrinkle stays as a groove when the skin is pulled tight, the finding is the fat layer. Helium plasma and radiofrequency are for the first of those. VASER is for the second. Excision is for redundancy that is moderate to severe, the amount that plasma is not asked to shrink away.

Fibrosis can make a surface feel firm after liposuction, and it is named here only so it is not treated as a divot. A firm scarred patch is not a pocket of superficial fat the cannula missed, and it is not a wave of deep fat. Evening passes do not soften that firmness into a smooth shell. The weekly botched results that are divots and waves are the ones this plan addresses. A firm patch is recognized on exam and is not suctioned as if it were leftover fat.

The 56-year-old photographs show one woman after the procedure. They do not mark each divot, each wave, or the skin grade. They are not a map of how much fat was evened or whether excision was required. The smooth shell they show is the goal: no operated artifact, and shadows that follow the body rather than a groove. Liposuction that is limited to residual fat, plus the skin treatment the grade calls for, is how that shell is built. Adding graft into a wave is not part of that build. A garment can hold the surface while swelling settles. It does not fill a divot, and it does not remove a redundant shell. The maneuver is chosen on the standing exam, from the layer that actually failed, before another cannula is passed. Two layers can fail at once, and then both maneuvers are planned, not one substituted for the other. The shell is judged smooth only when the fat step and the extra skin are both gone.